The blood culture from a patient of febrile neutropenia has grown Pseudomonas aeruginosa, It was found to be a producer of extended-spectrum beta-lactamase enzyme. The best choice of antimicrobial therapy should be -

Ans. is 'd' i.e., Imipenem + Amikacin Extended spectrum b lactamases are now responsible for majority of multidrug resistance in Gram negative bacteria.Outbreaks due to strains possessing ESBL have been associated with extensive institutional use of 3rd generation cephalosporins.Extended spectrum b lactamases are resistant to :Third generation cephalosporinsAztreonamAminoglycosidesTetracyclinesTrimethoprim - sulphamethoxazoleFluoroquinolonesDrug effective against expended spectrum b lactamase inhibitors.* CarbapenemAlso knowCarbapenems of ESBL resistance occurs via transferrable plasmids.