Emergence of Metallo- β-Lactamases and Carbapenem resistance
We read with interest the recent article by Murki, et al. on impact of cephalosporins restriction on incidence of extended spectrum b-lactamases (ESBLs) producing gram negative bacteria. Antibiotics restriction and their cycling are no doubt proven strategies to limit emergence of resistant microbial flora, provided they are employed judiciously. However, while attempting this policy in intensive care units (ICUs), one needs to be careful regarding the inadvertent overuse of carbapenem groups of antibiotics, the most potent weapon in our armamentarium to fight ESBL producing gram-negative organisms. Although ESBLs producing bugs have now become a major threat to the utility of cephalosporins, particularly to the broad spectrum third and fourth generation members of this group, the recent resurgence of another group of beta-lactamases, the metallo-b-lactamases (MBLs) in enterobacteriacae have far more serious threat to the antimicrobial world. (Correspondence)