Epidemiology and Management of Emerging Drug-Resistant Gram-Negative Bacteria: Extended-Spectrum β-Lactamases and Beyond

Urol Clin North Am. 2015 Nov;42(4):493-505. doi: 10.1016/j.ucl.2015.05.005. Epub 2015 Jul 15.


Worldwide prevalence of antimicrobial resistance is rapidly increasing, primarily a result of antibiotic misuse in the medical community. Resistant infections involving the urinary tract are typically caused by gram-negative bacteria. When treating these infections, clinicians have few effective antimicrobials to choose from and many are associated with significant adverse effects. There are now situations when clinicians are tasked with managing infections from pan-resistant organisms; thus, it is of paramount importance that spread of resistance be controlled. This review discusses common gram-negative resistance classes, highlighting the mechanisms of resistance, risk factors, type of infections, treatment, and outcomes associated with each class.

Keywords: Antibiotic resistance; Carbapenem-resistant Acinetobacter baumannii; Carbapenem-resistant enterobacteriaceae; Extended-spectrum β-lactamases; Multidrug-resistant Pseudomonas aeruginosa; New Delhi metallo–β-lactamase.

Publication types

  • Review

MeSH terms

  • Acinetobacter baumannii / enzymology
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Proteins / biosynthesis*
  • Carbapenems / therapeutic use*
  • Drug Resistance, Multiple, Bacterial
  • Gram-Negative Bacteria / enzymology*
  • Gram-Negative Bacterial Infections / drug therapy*
  • Gram-Negative Bacterial Infections / epidemiology
  • Gram-Negative Bacterial Infections / microbiology*
  • Humans
  • Klebsiella pneumoniae / enzymology
  • Pseudomonas aeruginosa / enzymology
  • Risk Factors
  • beta-Lactam Resistance*
  • beta-Lactamases / biosynthesis*


  • Anti-Bacterial Agents
  • Bacterial Proteins
  • Carbapenems
  • beta-Lactamases
  • carbapenemase