JAC Advance Access originally published online on May 25, 2005
Journal of Antimicrobial Chemotherapy 2005 56(1):52-59; doi:10.1093/jac/dki166
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Emergence of Enterobacteriaceae producing extended-spectrum ß-lactamases (ESBLs) in the community
1 Division of Microbiology, Calgary Laboratory Services, #9, 3535 Research Rd NW, Calgary, Alberta, Canada T2L 2K8; 2 Departments of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; 3 Departments of Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; 4 Service de Bactériologie-Virologie, Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine Paris-Sud, University Paris XI, 94275 Le K.-Bicêtre, France; 5 Department of Medicine, University of Calgary, Calgary, Alberta, Canada; 6 Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
* Corresponding author. Tel: +1-403-770-3309; Fax: +1-403-770-3347; E-mail: johann.pitout{at}cls.ab.ca
Enterobacteriaceae, especially Klebsiella spp. producing extended-spectrum ß-lactamases (ESBLs) such as SHV and TEM types, have been established since the 1980s as a major cause of hospital-acquired infections. Appropriate infection control practices have largely prevented the dissemination of these bacteria within many hospitals, although outbreaks have been reported. However, during the late 1990s and 2000s, Enterobacteriaceae (mostly Escherichia coli) producing novel ESBLs, the CTX-M enzymes, have been identified predominantly from the community as a cause of urinary tract infections. Resistance to other classes of antibiotics, especially the fluoroquinolones, is often associated with ESBL-producing organisms. Many clinical laboratories are still not aware of the importance of screening for ESBL-producing Enterobacteriaceae originating from the community. A heightened awareness of these organisms by clinicians and enhanced testing by laboratories, including molecular surveillance studies, is required to reduce treatment failures, to limit their introduction into hospitals and to prevent the spread of these emerging pathogens within the community.
Keywords: antibiotic-resistant organisms , ESBL-producing Enterobacteriaceae , community-onset infection
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