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Abstract
The medical community relies on clinical expertise and published guidelines to assist
physicians with choices in empirical therapy for system-based infectious syndromes,
such as community-acquired pneumonia and urinary-tract infections (UTIs). From the
late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that
produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have
emerged within the community setting as an important cause of UTIs. Recent reports
have also described ESBL-producing E coli as a cause of bloodstream infections associated
with these community-onset UTIs. The carbapenems are widely regarded as the drugs
of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae,
although comparative clinical trials are scarce. Thus, more rapid diagnostic testing
of ESBL-producing bacteria and the possible modification of guidelines for community-onset
bacteraemia associated with UTIs are required.