Navigating treatment approaches for presumed ESBL-producing infections

ESBL-producing Enterobacterales (ESBL-E) remain a significant global threat. In several regions of the world, ESBLs are produced by over half of Escherichia coli or Klebsiella pneumoniae infections, contributing to significant morbidity and mortality. Though it is accepted that carbapenems are effective for the treatment of invasive ESBL-E infections, controversy remains as to whether carbapenem alternatives can be considered in select cases. Indiscriminate carbapenem use for the treatment of ESBL-E infections will likely further the international antimicrobial resistance crisis, underscoring the importance of investigating the role of non-carbapenem options. In this issue of JAC-Antimicrobial Resistance, we present a PRO/CON debate exploring whether carbapenems are necessary for all infections caused by ceftriaxone-resistant Enterobacterales.