JAC Advance Access originally published online on July 8, 2005
Journal of Antimicrobial Chemotherapy 2005 56(3):451-454; doi:10.1093/jac/dki239
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Meeting report |
CTX-M: changing the face of ESBLs in the UK
1 Antibiotic Resistance Monitoring and Reference Laboratory, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT, UK; 2 Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK; 3 Health Protection Agency West Midlands Public Health Laboratory, Birmingham Heartlands and Solihull NHS Trust, Bordesley Green East, Birmingham B9 5SS, UK
* Corresponding author. Tel: +44-121-424-1240; Fax +44-121-772-6229; E-mail: p.m.hawkey{at}bham.ac.uk or peter.hawkey{at}heartsol.wmids.nhs.uk
The UK has experienced a sudden rise in extended-spectrum ß-lactamase (ESBL) rates, largely due to the appearance and spread of Escherichia coli producing CTX-M-15 type ß-lactamase. The British Society for Antimicrobial Chemotherapy organized two update meetings during 2004 to report and discuss the recognition, clinical diagnosis, treatment and control of bacteria producing these ß-lactamases. This paper reports the data and reviews made by contributors to the conferences. The historical distribution and emergence of ESBLs was reviewed along with the emergence of plasmid-mediated CTX-M ESBLs following their mobilization from the chromosome of Kluyvera spp. The first significant outbreak of CTX-M producers in the UK occurred in 2001 and involved Klebsiella pneumoniae with CTX-M-26 at one site, but by 2003, cloned and diverse E. coli with CTX-M-15 were widespread, with Shropshire one of the most affected regions. The specific experience in Shropshire was reported on and a comprehensive review made of the level of awareness of the need for ESBL detection in laboratories in England and Wales, together with a description of the variety of methods that may be applied, with recommendations for optimal methodology. The increased mortality associated with inappropriate treatment of infections caused by ESBL-producing strains was highlighted, together with discussion on potential control of cross-infection. The meeting concluded that the CTX-M genes have now become widespread in not only E. coli but other Enterobacteriaceae in the UK and this will represent a substantial threat to both the treatment of infections caused by these bacteria in the community and within hospitals.
Keywords: extended-spectrum ß-lactamases , ESBLs , BSAC
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