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March 24/31, 1999

Control of Outbreaks Due to Organism Producing Extended-Spectrum β-Lactamases—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(12):1080-1081. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-12-jbk0324

In Reply: We wish to emphasize that in our study imipenem was not selected as a single agent to replace late-generation cephalosporins. As indicated in the "Methods" section, empirical imipenem use remained restricted to prior infectious disease approval except during the first 72 hours in intensive care units. A wide variety of alternative parenteral agents was allowed and encouraged throughout the hospital with routine "antibiotic streamlining" according to culture results. Piperacillin-tazobactam was introduced in 1996 without restriction. However, approximately one third of our ESBL-producing Klebsiella isolates are resistant to this agent, possibly due to multiple or high-level β-lactamase production.