Rise in the prevalence of resistance to extended-spectrum cephalosporins in the USA, nursing homes and antibiotic prescribing in outpatient and inpatient settings

J Antimicrob Chemother. 2021 Oct 11;76(11):2745-2747. doi: 10.1093/jac/dkab251.


The prevalence of resistance to extended-spectrum (ES) cephalosporins for multiple types of infections treated in US hospitals and the incidence of hospitalization with ESBL-producing Enterobacteriaceae (many of which are detected in nursing home residents) have grown markedly in recent years. Here, I review these developments, as well as evidence for their adverse consequences, including the increase in the overall burden of bacterial infections due to proliferation of ESBL-producing/ES cephalosporin-resistant bacteria, the contribution of ESBL-producing/ES cephalosporin-resistant bacteria to the increase in the burden of mortality associated with bacterial infections and the contribution of the proliferation of ESBL-producing bacteria to the prevalence of carbapenem resistance. I argue that in order to mitigate the escalation of these phenomena, a reduction in outpatient prescribing of cephalosporins, especially to older adults, mitigation of transmission of ESBL-producing organisms in nursing homes and a reduction in inpatient prescribing of ES cephalosporins (which has seen a major increase in recent years) are needed.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Cephalosporins* / therapeutic use
  • Enterobacteriaceae Infections* / drug therapy
  • Enterobacteriaceae Infections* / epidemiology
  • Humans
  • Inpatients
  • Nursing Homes
  • Outpatients
  • Prevalence
  • beta-Lactamases


  • Anti-Bacterial Agents
  • Cephalosporins
  • beta-Lactamases