beta lactam resistance


Summary: Nonsusceptibility of bacteria to the action of the beta-lactam antibiotics. Mechanisms responsible for beta-lactam resistance may be degradation of antibiotics by BETA-LACTAMASES, failure of antibiotics to penetrate, or low-affinity binding of antibiotics to targets.

Top Publications

  1. Mugnier P, Poirel L, Pitout M, Nordmann P. Carbapenem-resistant and OXA-23-producing Acinetobacter baumannii isolates in the United Arab Emirates. Clin Microbiol Infect. 2008;14:879-82 pubmed publisher
    ..The single non-clonally related isolate harboured the bla(OXA-23) gene on a 70-kb transferable plasmid. This study reports on the dissemination of OXA-23-producing A. baumannii isolates in the Middle East...
  2. Moya B, Juan C, Alberti S, Perez J, Oliver A. Benefit of having multiple ampD genes for acquiring beta-lactam resistance without losing fitness and virulence in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2008;52:3694-700 pubmed publisher
    ..aeruginosa. Therefore, as a consequence of the presence of additional ampD genes, partial ampC derepression mediated by ampD inactivation confers a biologically efficient resistance mechanism on P. aeruginosa. ..
  3. Bellissimo Rodrigues F. Antimicrobial drug use and antibiotic-resistant bacteria. Emerg Infect Dis. 2008;14:187; author reply,187-8 pubmed publisher
  4. Schmidtke A, Hanson N. Role of ampD homologs in overproduction of AmpC in clinical isolates of Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2008;52:3922-7 pubmed publisher
    ..Overall, the findings of the present study indicate that there is still an unknown factor(s) that contributes to ampC regulation in P. aeruginosa. ..
  5. Zarrilli R, Vitale D, Di Popolo A, Bagattini M, Daoud Z, Khan A, et al. A plasmid-borne blaOXA-58 gene confers imipenem resistance to Acinetobacter baumannii isolates from a Lebanese hospital. Antimicrob Agents Chemother. 2008;52:4115-20 pubmed publisher
    ..The production of the carbapenem-hydrolyzing oxacillinase OXA-58 was apparently the only mechanism for carbapenem resistance in A. baumannii isolates causing the outbreak at the Lebanese Hospital. ..
  6. Coque T, Novais A, Carattoli A, Poirel L, Pitout J, Peixe L, et al. Dissemination of clonally related Escherichia coli strains expressing extended-spectrum beta-lactamase CTX-M-15. Emerg Infect Dis. 2008;14:195-200 pubmed publisher
    ..Most plasmids contained blaOXA-1, aac(6')-Ib-cr, and blaTEM-1. Worldwide dissemination of CTX-M-15 seems to be determined by clonal complexes ST131 and ST405 and multidrug-resistant IncFII plasmids. ..
  7. Zapun A, Contreras Martel C, Vernet T. Penicillin-binding proteins and beta-lactam resistance. FEMS Microbiol Rev. 2008;32:361-85 pubmed publisher
  8. Poirel L, Figueiredo S, Cattoir V, Carattoli A, Nordmann P. Acinetobacter radioresistens as a silent source of carbapenem resistance for Acinetobacter spp. Antimicrob Agents Chemother. 2008;52:1252-6 pubmed publisher
    ..Therefore, A. radioresistens, a commensal bacterial species which is identified on the skin of hospitalized and healthy patients (a property shared with A. baumannii), was identified as the source of the bla OXA-23 gene. ..
  9. Gonullu N, Aktas Z, Kayacan C, Salcioglu M, Carattoli A, Yong D, et al. Dissemination of CTX-M-15 beta-lactamase genes carried on Inc FI and FII plasmids among clinical isolates of Escherichia coli in a university hospital in Istanbul, Turkey. J Clin Microbiol. 2008;46:1110-2 pubmed publisher
    ..Plasmid typing of transconjugates carrying bla(CTX-M-15) showed that most isolates belonged to the Inc/rep FII group but that one isolate also belonged to the FI group. ..

More Information


  1. Park Y, Choi J, Jung S, Park K, Lee H, Jung D, et al. Two distinct clones of carbapenem-resistant Acinetobacter baumannii isolates from Korean hospitals. Diagn Microbiol Infect Dis. 2009;64:389-95 pubmed publisher
    ..The distribution of these main carbapenem-resistant A. baumannii clones did not relate to locality, indicating that they are widespread in Korean hospitals. In addition, we found new types of PER beta-lactamases, PER-6. ..
  2. Walsh T. Clinically significant carbapenemases: an update. Curr Opin Infect Dis. 2008;21:367-71 pubmed publisher
    ..aeruginosa. Carbapenem resistance continues to increase both in number and into new species/strain types, but our therapeutic options remain woefully inadequate - a dilemma that will not improve in the foreseeable future. ..
  3. Stoeva T, Higgins P, Bojkova K, Seifert H. Clonal spread of carbapenem-resistant OXA-23-positive Acinetobacter baumannii in a Bulgarian university hospital. Clin Microbiol Infect. 2008;14:723-7 pubmed publisher
    ..The isolates belonged to two different clonal groups, indicating a sustained hospital outbreak. This study demonstrates both the epidemic potential of carbapenem-resistant A. baumannii and its longevity in the hospital environment. ..
  4. Muzaheed -, Doi Y, Adams Haduch J, Endimiani A, Sidjabat H, Gaddad S, et al. High prevalence of CTX-M-15-producing Klebsiella pneumoniae among inpatients and outpatients with urinary tract infection in Southern India. J Antimicrob Chemother. 2008;61:1393-4 pubmed publisher
  5. Moland E, Hanson N, Black J, Hossain A, Song W, Thomson K. Prevalence of newer beta-lactamases in gram-negative clinical isolates collected in the United States from 2001 to 2002. J Clin Microbiol. 2006;44:3318-24 pubmed
    ..In conclusion, organisms producing ESBLs and transferable AmpC beta-lactamases were widespread. Clinical laboratories must be able to detect important beta-lactamases to ensure optimal patient care and infection control. ..
  6. Yan J, Hsueh P, Lu J, Chang F, Ko W, Wu J. Characterization of acquired beta-lactamases and their genetic support in multidrug-resistant Pseudomonas aeruginosa isolates in Taiwan: the prevalence of unusual integrons. J Antimicrob Chemother. 2006;58:530-6 pubmed
    ..aeruginosa isolates in Taiwan. The spread of bla(VIM-2)-related genes by horizontal transfer might have occurred. ..
  7. Stapleton P, Shah S, Ehlert K, Hara Y, Taylor P. The beta-lactam-resistance modifier (-)-epicatechin gallate alters the architecture of the cell wall of Staphylococcus aureus. Microbiology. 2007;153:2093-103 pubmed
    ..Thus, ECg-mediated alterations to the physical nature of the bilayer will elicit structural changes to WTA that result in modulation of the cell-surface properties necessary to maintain the beta-lactam-resistant phenotype. ..
  8. Luzzaro F, Mezzatesta M, Mugnaioli C, Perilli M, Stefani S, Amicosante G, et al. Trends in production of extended-spectrum beta-lactamases among enterobacteria of medical interest: report of the second Italian nationwide survey. J Clin Microbiol. 2006;44:1659-64 pubmed
    ..The appearance of ESBL-positive enterobacteria in the community makes it mandatory that family physicians learn how to treat these pathogens. ..
  9. Lavollay M, Mamlouk K, Frank T, Akpabie A, Burghoffer B, Ben Redjeb S, et al. Clonal dissemination of a CTX-M-15 beta-lactamase-producing Escherichia coli strain in the Paris area, Tunis, and Bangui. Antimicrob Agents Chemother. 2006;50:2433-8 pubmed
    ..coli clone with a strong propensity for dissemination. ..
  10. Naas T, Bogaerts P, Bauraing C, Degheldre Y, Glupczynski Y, Nordmann P. Emergence of PER and VEB extended-spectrum beta-lactamases in Acinetobacter baumannii in Belgium. J Antimicrob Chemother. 2006;58:178-82 pubmed
    ..Both genes were chromosomally encoded. This work illustrates the inter-country spread of VEB-1-producing A. baumannii isolates as well as the emergence of PER-1-producing A. baumannii strains in Belgium. ..
  11. Oteo J, Navarro C, Cercenado E, Delgado Iribarren A, Wilhelmi I, Orden B, et al. Spread of Escherichia coli strains with high-level cefotaxime and ceftazidime resistance between the community, long-term care facilities, and hospital institutions. J Clin Microbiol. 2006;44:2359-66 pubmed
    ..Epidemic or occasional isolates of cefotaxime- and ceftazidime-resistant E. coli can spread between distinct health facilities including hospitals, community health centers, and long-term care centers. ..
  12. Carattoli A, Miriagou V, Bertini A, Loli A, Colinon C, Villa L, et al. Replicon typing of plasmids encoding resistance to newer beta-lactams. Emerg Infect Dis. 2006;12:1145-8 pubmed
  13. Novais A, Canton R, Valverde A, Machado E, Galan J, Peixe L, et al. Dissemination and persistence of blaCTX-M-9 are linked to class 1 integrons containing CR1 associated with defective transposon derivatives from Tn402 located in early antibiotic resistance plasmids of IncHI2, IncP1-alpha, and IncFI groups. Antimicrob Agents Chemother. 2006;50:2741-50 pubmed
    ..The presence of bla(CTX-M-9) on broad-host-range IncP-1alpha plasmids might contribute to its dissemination to hosts that were not members of the family Enterobacteriaceae. ..
  14. Poirel L, Nordmann P. Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology. Clin Microbiol Infect. 2006;12:826-36 pubmed
    ..baumannii may also result from porin or penicillin-binding protein modifications. Several porins, including the 33-kDa CarO protein, that constitute a pore channel for influx of carbapenems, might be involved in carbapenem resistance. ..
  15. Harris A, McGregor J, Johnson J, Strauss S, Moore A, Standiford H, et al. Risk factors for colonization with extended-spectrum beta-lactamase-producing bacteria and intensive care unit admission. Emerg Infect Dis. 2007;13:1144-9 pubmed
    ..15; 95% CI 1.04-1.27). Coexisting conditions and previous antimicrobial drug exposure are thus predictive of colonization, and a large percentage of these patients have subsequent positive clinical cultures for ESBL-producing bacteria. ..
  16. Naas T, Coignard B, Carbonne A, Blanckaert K, Bajolet O, Bernet C, et al. VEB-1 Extended-spectrum beta-lactamase-producing Acinetobacter baumannii, France. Emerg Infect Dis. 2006;12:1214-22 pubmed
    ..The national alert enabled early control of new clusters, demonstrating the usefulness of early warning about antimicrobial drug resist. ..
  17. Dzierzanowska D, Kamińska W, Semczuk K, Borowiec D, Matysiak M, Szumała Kakol A, et al. Carriage of genes for various extended-spectrum beta-lactamases: a novel resistance strategy of Klebsiella pneumoniae in Poland. Int J Antimicrob Agents. 2010;35:392-5 pubmed publisher
    ..pneumoniae isolates by pulsed-field gel electrophoresis (PFGE) revealed a relatively high genetic diversity between isolates producing the same combination of enzymes. Clonally related strains were uncommon. ..
  18. Ehlers M, Veldsman C, Makgotlho E, Dove M, Hoosen A, Kock M. Detection of blaSHV, blaTEM and blaCTX-M antibiotic resistance genes in randomly selected bacterial pathogens from the Steve Biko Academic Hospital. FEMS Immunol Med Microbiol. 2009;56:191-6 pubmed publisher
    ..8% in Denmark for similar pathogens. These research findings indicated that it is crucial to routinely monitor the prevalence of these resistance genes. ..
  19. Ahmad S, Al Juaid N, Alenzi F, Mattar E, Bakheet O. Prevalence, antibiotic susceptibility pattern and production of extended-spectrum beta-lactamases amongst clinical isolates of Klebsiella pneumoniae at Armed Forces Hospital in Saudi Arabia. J Coll Physicians Surg Pak. 2009;19:264-5 pubmed publisher
    ..pneumoniae and a high rate of multidrug resistance. Continued infection control measures and prudent use of antimicrobial agents are essential in reducing the spread of multi-resistant ESBL-producing K. pneumoniae. ..
  20. Robledo I, Aquino E, Santé M, Santana J, Otero D, León C, et al. Detection of KPC in Acinetobacter spp. in Puerto Rico. Antimicrob Agents Chemother. 2010;54:1354-7 pubmed publisher
    ..DNA sequencing of the bla(KPC) gene identified KPC-2, -3, and -4 and a novel variant, KPC-10. This is the first report of a KPC-type beta-lactamase identified in Acinetobacter species. ..
  21. Fankhauser C, Zingg W, Francois P, Dharan S, Schrenzel J, Pittet D, et al. Surveillance of extended-spectrum-beta-lactamase-producing Enterobacteriaceae in a Swiss Tertiary Care Hospital. Swiss Med Wkly. 2009;139:747-51 pubmed publisher
    ..Documented nosocomial ESBL-E transmission was low. ..
  22. Zhao S, Blickenstaff K, Glenn A, Ayers S, Friedman S, Abbott J, et al. beta-Lactam resistance in salmonella strains isolated from retail meats in the United States by the National Antimicrobial Resistance Monitoring System between 2002 and 2006. Appl Environ Microbiol. 2009;75:7624-30 pubmed publisher
  23. Marcano D, Pasteran F, Rapoport M, Faccone D, Ugarte C, Salgado N, et al. First isolation of a VIM-producing Klebsiella pneumoniae from a seven-year-old child in Venezuela. J Infect Dev Ctries. 2008;2:241-4 pubmed
  24. Zong Z, Partridge S, Thomas L, Iredell J. Dominance of blaCTX-M within an Australian extended-spectrum beta-lactamase gene pool. Antimicrob Agents Chemother. 2008;52:4198-202 pubmed publisher
    ..ESBL genes were present in diverse community isolates and in a variety of associated conjugative plasmids. ..
  25. Tam V, Ledesma K, Schilling A, Lim T, Yuan Z, Ghose R, et al. In vivo dynamics of carbapenem-resistant Pseudomonas aeruginosa selection after suboptimal dosing. Diagn Microbiol Infect Dis. 2009;64:427-33 pubmed publisher
    ..Our data suggested that suboptimal meropenem exposures might facilitate in vivo selection of resistance in a heterogeneous P. aeruginosa population. ..
  26. Juan Nicolau C, Oliver A. [Carbapenemases in Pseudomonas spp]. Enferm Infecc Microbiol Clin. 2010;28 Suppl 1:19-28 pubmed publisher
  27. Giraud Morin C, Fosse T. [Recent evolution and characterization of extended-spectrum beta-lactamase producing enterobacteria in the CHU of Nice (2005-2007)]. Pathol Biol (Paris). 2008;56:417-23 pubmed publisher
    ..Caracterization of E-ESBL+ is essential to better understand their mode of dissemination, monitor the emergence of new enzymes and adapt the efforts against BMR cross transmission. ..
  28. Samuelsen O, Buarø L, Giske C, Simonsen G, Aasnaes B, Sundsfjord A. Evaluation of phenotypic tests for the detection of metallo-beta-lactamase-producing Pseudomonas aeruginosa in a low prevalence country. J Antimicrob Chemother. 2008;61:827-30 pubmed publisher
    ..Including ceftazidime resistance to the MBL-screening criteria would significantly improve the performance of the MBL Etest and IPM-EDTA disc test. ..
  29. Saner F, Canbay A, Gerken G, Broelsch C. [Collateral damage of cephalosporins and quinolones and possibilities for control]. Med Klin (Munich). 2009;104:114-8 pubmed publisher
    ..To avoid the occurrence of multidrug-resistant microorganisms, a strict indication and time-limited use (e.g., 1 week) of antibiotics are required, as already established in the guidelines for infection. ..
  30. Zhao W, Hu Z. Beta-lactamases identified in clinical isolates of Pseudomonas aeruginosa. Crit Rev Microbiol. 2010;36:245-58 pubmed publisher
    ..This review summarizes the beta-lactamases identified in clinical isolates of P. aeruginosa, with a particular focus on AmpC-type beta-lactamases, extended-spectrum beta-lactamases, and carbapenemases. ..
  31. Roh K, Kim S, Kim C, Yum J, Kim M, Yong D, et al. New cfiA variant and novel insertion sequence elements in carbapenem-resistant Bacteroides fragilis isolates from Korea. Diagn Microbiol Infect Dis. 2010;66:343-8 pubmed publisher
    ..The transposase, terminal inverted repeat sequence, and target site duplication sequence of the 2 novel IS elements were unique. This study reconfirmed the correlation between ISs and carbapenem resistance in B. fragilis. ..
  32. Rodríguez Baño J, Picón E, Gijón P, Hernández J, Ruiz M, Peña C, et al. Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis. Clin Infect Dis. 2010;50:40-8 pubmed publisher
    ..ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors. ..
  33. Akpaka P, Swanston W, Ihemere H, Correa A, Torres J, Tafur J, et al. Emergence of KPC-producing Pseudomonas aeruginosa in Trinidad and Tobago. J Clin Microbiol. 2009;47:2670-1 pubmed publisher
    ..We now report KPC-2-producing P. aeruginosa in Trinidad and Tobago. Surveillance for similar strains is warranted, considering their wide geographic spread and known association with mobile genetic elements. ..
  34. Poeta P, Radhouani H, Goncalves A, Figueiredo N, Carvalho C, Rodrigues J, et al. Genetic characterization of antibiotic resistance in enteropathogenic Escherichia coli carrying extended-spectrum beta-lactamases recovered from diarrhoeic rabbits. Zoonoses Public Health. 2010;57:162-70 pubmed publisher
    ..The detection of genes involved in the resistance to antibiotics of different families in a relatively high proportion of faecal E. coli isolates of rabbits is of great interest and could be considered a serious public health problem. ..
  35. Gusatti C, Ferreira A, Fuentefria D, Corção G. [Resistance to beta-lactams among Acinetobacter spp isolated from hospital sewage in southern Brazil]. Rev Soc Bras Med Trop. 2009;42:183-7 pubmed
    ..The profile obtained revealed the presence of multidrug-resistant strains and showed that resistance mechanisms such as the production of extended-spectrum beta-lactamases and efflux pumps may be present in these strains. ..
  36. Pérez I A, García C P, Poggi M H, Braun J S, Castillo V C, Roman J, et al. [Presence of metallo beta-lactamases in imipenem-resistant Pseudomonas aeruginosa]. Rev Med Chil. 2008;136:423-32 pubmed publisher
    ..There was no concordance between phenotypic and genotypic MBL detecting methods. All the strains were also multiresistant. The presence of MBL was detected in 19% of imipenem resistant Psae strains. ..
  37. Rodríguez M, Ruiz del Castillo B, Rodríguez Mirones C, Romo M, Monteagudo I, Martinez Martinez L. [Molecular characterization of Pseudomonas aeruginosa isolates in Cantabria, Spain, producing VIM-2 metallo-beta-lactamase]. Enferm Infecc Microbiol Clin. 2010;28:99-103 pubmed publisher
    ..In the clinical isolates studied, the presence of MbetaL VIM-2 sufficed to explain their resistance to carbapenems. ..
  38. Petrella S, Ziental Gelus N, Mayer C, Renard M, Jarlier V, Sougakoff W. Genetic and structural insights into the dissemination potential of the extremely broad-spectrum class A beta-lactamase KPC-2 identified in an Escherichia coli strain and an Enterobacter cloacae strain isolated from the same patient in France. Antimicrob Agents Chemother. 2008;52:3725-36 pubmed publisher
  39. Ben Ami R, Rodríguez Baño J, Arslan H, Pitout J, Quentin C, Calbo E, et al. A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing enterobacteriaceae in nonhospitalized patients. Clin Infect Dis. 2009;49:682-90 pubmed publisher
    ..Novel approaches are required to adequately address issues such as empirical treatment for severe community-acquired infection and infection control. ..
  40. Mayoral G, Ferreyra M, Eden A, Gueudet P, Miquel C, Lecaillon E. [Evolution of third-generation cephalosporin resistance in Enterobacteriaceae from 2000 to 2008 in a Perpignan hospital]. Pathol Biol (Paris). 2010;58:7-10 pubmed publisher
    ..The mesures to contain the spread of MRE strains remained inefficient because of outpatients circulation, multiresistant E. coli being community species. ..
  41. Raja S, Murali M, Devaraj S. Differential expression of ompC and ompF in multidrug-resistant Shigella dysenteriae and Shigella flexneri by aqueous extract of Aegle marmelos, altering its susceptibility toward beta-lactam antibiotics. Diagn Microbiol Infect Dis. 2008;61:321-8 pubmed publisher
    ..In conclusion, AEAM influences susceptibility of beta-lactam-resistant Shigella toward beta-lactam antibiotics by altering porin channels. Hence, AEAM along with beta-lactam can be used for treatment of multidrug-resistant Shigella...
  42. Borjesson S, Dienues O, Jarnheimer P, Olsen B, Matussek A, Lindgren P. Quantification of genes encoding resistance to aminoglycosides, beta-lactams and tetracyclines in wastewater environments by real-time PCR. Int J Environ Health Res. 2009;19:219-30 pubmed publisher
    ..The developed LUX real-time PCR assays were shown to be fast and reproducible tools for detection and quantification of the four genes encoding antibiotic resistance in wastewater. ..
  43. Kader A, Kamath K. Faecal carriage of extended-spectrum beta-lactamase-producing bacteria in the community. East Mediterr Health J. 2009;15:1365-70 pubmed
    ..3%) healthy persons and 29 (13.7%) outpatients. We conclude that the community could be a reservoir of these ESBL-producing bacteria and enzymes. ..
  44. Ahmed A, Shimamoto T. Emergence of a cefepime- and cefpirome-resistant Citrobacter freundii clinical isolate harbouring a novel chromosomally encoded AmpC beta-lactamase, CMY-37. Int J Antimicrob Agents. 2008;32:256-61 pubmed publisher
    ..Phylogenetic analysis suggested that CMY-37 is the origin of many plasmid-mediated AmpC beta-lactamases. This study highlights the emergence of cefepime and cefpirome resistance in C. freundii owing to a new type of AmpC beta-lactamase. ..
  45. Urban C, Bradford P, Tuckman M, Segal Maurer S, Wehbeh W, Grenner L, et al. Carbapenem-resistant Escherichia coli harboring Klebsiella pneumoniae carbapenemase beta-lactamases associated with long-term care facilities. Clin Infect Dis. 2008;46:e127-30 pubmed publisher
    ..The identification of these enzymes in patients staying in long-term care facilities should be of great concern to all components of health care systems. ..
  46. Shu J, Chia J, Kuo A, Su L, Wu T. A 7-year surveillance for ESBL-producing Escherichia coli and Klebsiella pneumoniae at a university hospital in Taiwan: the increase of CTX-M-15 in the ICU. Epidemiol Infect. 2010;138:253-63 pubmed publisher
    ..pneumoniae. ..
  47. Hirsch E, Tam V. Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrug-resistant infection. J Antimicrob Chemother. 2010;65:1119-25 pubmed publisher
    ..Studies examining combination therapy and well-controlled clinical trials are needed to ascertain the optimal treatment of infections caused by KPC bacteria...
  48. Mokaddas E, Abdulla A, Shati S, Rotimi V. The technical aspects and clinical significance of detecting extended-spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary-care hospital in Kuwait. J Chemother. 2008;20:445-51 pubmed
  49. Rizvi M, Fatima N, Rashid M, Shukla I, Malik A, Usman A, et al. Extended spectrum AmpC and metallo-beta-lactamases in Serratia and Citrobacter spp. in a disc approximation assay. J Infect Dev Ctries. 2009;3:177-86 pubmed
    ..CPS may be advised due to the triple advantage of detection of all three types of beta-lactamases. ..
  50. Iregbu K, Anwaal U. Extended spectrum Beta-Lactamase-producing Klebsiella pneumoniae septicaemia outbreak in the Neonatal Intensive Care Unit of a tertiary hospital in Nigeria. Afr J Med Med Sci. 2007;36:225-8 pubmed
    ..pneumnoniae brought into the hospital by a neonate delivered and admitted from an external health institution. Sink and the incubator were also contaminated by the same strain. ..
  51. Réglier Poupet H, Naas T, Carrër A, Cady A, Adam J, Fortineau N, et al. Performance of chromID ESBL, a chromogenic medium for detection of Enterobacteriaceae producing extended-spectrum beta-lactamases. J Med Microbiol. 2008;57:310-5 pubmed publisher
    ..Its chromogenic properties and its selectivity are particularly useful in specimens containing resident associated flora. ..
  52. Tamayo J, Orden B, Cacho J, Cuadros J, Gomez Garces J, Alos J. Activity of ertapenem and other antimicrobials against ESBL-producing enterobacteria isolated from urine in patients from Madrid. Rev Esp Quimioter. 2007;20:334-8 pubmed
  53. Dettenkofer M, Utzolino S, Luft D, Lemmen S. [Effectiveness and risks of isolation precautions in patients with MRSA and other multidrug-resistant bacteria]. Zentralbl Chir. 2010;135:124-8 pubmed publisher
    ..Additional precautions, including single-room isolation, should be implemented critically if indicated...