ESBL (Extended-Spectrum Beta-Lactamase)-producing enterobacteriaceae is highly associated with healthcare associated infection (HAI). The prevalence of gram-negative bacteria resistant to broad spectrum β-lactam antibiotics  is rapidly increasing over the last 10 years. Although carbapenem therapy is considered as a selective alternative to treat ESBL-producing enterobacteriaceae, the use of carbapenems has been associated with the emergence of Carbapenem-resistant enterobacteriaceae (CRE). Since the wide use of carbapenems increases the incidence of CRE and there is a lack of alternative treatment options when carbapenem treatment is failed, appropriate use of carbapenems is necessary. Recent studies suggest that other antibiotics (BL/BLIs, aminoglycoside, the fourth generation of cefalosporines, quinolones etc.) can be used as an alternative to carbapenems. Thus, the needs of studies on the efficacy of alternative antibiotics are continuously emerged. 

This study systematically reviewed the recently published evidence to evaluate the clinical effectiveness of carbapenems and other alternative antibiotics in treating bacteremia and urinary tract infection caused by ESBL-producing Enterobacteriaceae and analyzed the comparative clinical outcomes of those therapies using multi-center data in Korea.