Please note: This is for information only.

Refer to local guidelines for treatment recommendations

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• Recent local, national and international surveillance has identified a worrying increase in multiple resistance to antibiotics in Gram-negative bacilli; particularly gentamicin, quinolone and cephalosporin resistant E. coli. This is of concern as E coli is the most common cause of community and hospital acquired Gram-negative sepsis.
• Local surveillance has identified the following risk factors for multi- resistant E coli sepsis:  

Recurrent urinary or biliary tract sepsis particularly where multi-resistant isolates have been previously identified from clinical specimens. Recent treatment with a quinolone antibiotic eg ciprofloxacin.

• To enable effective management of these patients, it is therefore important that appropriate specimens (including blood cultures) are taken and their previous microbiology reviewed.
• Where a multiresistant isolate has been identified previously eg gentamicin resistant coliform in urine, first line therapy must be discussed with a microbiologist, as usual first line guidance may not be appropriate.
• Strict infection control procedures must be followed with patients infected with a multiresistant Gram-negative bacteria.

Main clinical infections:

• Abdominal , Biliary and Urinary Tract Infections.
• Hospital-acquired pneumonia particularly ventilator-associated.

Usually sensitive to:

• Amikacin
• Nitrofurantoin (except proteus sp.)
• Carbapenems (imipenem, meropenem)

Varying sensitivity to:

• Piptazobactam (tazocin)
• Co-amoxiclav

Usually resistant to:

• Amoxicillin
• All cephalosporins (cefradine, cefuroxime, ceftazidime, ceftriaxone, cefotaxime)
• Quinolones (ciprofloxacin, levofloxacin)
• Gentamicin, tobramycin,