What is the first-line treatment for infections caused by Extended-Spectrum Beta-Lactamases (ESBLs)?

Carbapenems are considered the first-line treatment for infections caused by Extended-Spectrum Beta-Lactamases (ESBLs) due to their broad spectrum of activity and resistance to hydrolysis by ESBL-producing organisms. ESBLs are enzymes produced by certain bacteria that confer resistance to many penicillins and cephalosporins, rendering these antibiotic classes ineffective against such infections. Carbapenems, which include agents like meropenem and imipenem, are stable against these enzymes and therefore are often the preferred choice when treating serious infections caused by ESBL-producing Enterobacteriaceae.

In this context, the other options may not provide the necessary coverage. Cephalosporins are typically ineffective against ESBL-producing bacteria, as these bacteria specifically target and inactivate them. Piperacillin-tazobactam may have some efficacy against certain strains but is not reliably effective against all ESBLs, making it a less preferred choice. Vancomycin, while a powerful antibiotic for treating Gram-positive infections, is not effective against Gram-negative organisms producing ESBLs. Thus, carbapenems stand out as the most reliable option in this scenario.