Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern

Lancet Infect Dis. 2008 Mar;8(3):159-66. doi: 10.1016/S1473-3099(08)70041-0.

Abstract

The medical community relies on clinical expertise and published guidelines to assist physicians with choices in empirical therapy for system-based infectious syndromes, such as community-acquired pneumonia and urinary-tract infections (UTIs). From the late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. Recent reports have also described ESBL-producing E coli as a cause of bloodstream infections associated with these community-onset UTIs. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Thus, more rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Communicable Disease Control
  • Communicable Diseases, Emerging
  • DNA, Bacterial / analysis
  • Drug Resistance, Multiple, Bacterial*
  • Enterobacteriaceae / drug effects*
  • Enterobacteriaceae / enzymology
  • Enterobacteriaceae Infections / diagnosis
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / epidemiology
  • Enterobacteriaceae Infections / microbiology*
  • Global Health
  • Humans
  • Polymerase Chain Reaction
  • Reagent Kits, Diagnostic
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / microbiology*
  • beta-Lactamases / biosynthesis

Substances

  • Anti-Bacterial Agents
  • DNA, Bacterial
  • Reagent Kits, Diagnostic
  • beta-Lactamases