Mycological analysis for skin, hair & nail

If no severity signs (septic shock or “new” sepsis) then no carbapenem, even if there is a risk factor for ESBL.

If risk factor (cf below) and severity (sepsis, septic shock) consider:

• add amikacin to empiric antibiotherapy (or gentamycine if not available)
• prescription of imipenem or meropenem only in most serious cases and/or ESBL documentation within the last 3 months, until bacteriological documentation.

OTHER RISK FACTORS

• Recent use of amoxicillin/clavulanate, second- or third-generation cephalosporins (C2G, C3G), or fluoroquinolones within the last 3 months.
• Healthcare-associated infection.
• Colonization or infection with ESBL-producing Enterobacterales within the last 3 months.
• Travel within the past 3 months to high-risk regions (e.g., India, Southeast Asia, the Middle East, North Africa, Mediterranean basin).