JAC Advance Access originally published online on December 6, 2006
Journal of Antimicrobial Chemotherapy 2007 59(2):165-174; doi:10.1093/jac/dkl483
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Review |
CTX-M: changing the face of ESBLs in Europe
1 Antibiotic Resistance Monitoring and Reference Laboratory, Centre for Infections, Health Protection Agency 61 Colindale Avenue, London NW9 5EQ, UK
2 Servicio de Microbiologia, Hospital Universitario Ramon y Cajal 28034, Madrid, Spain
3 Department of Molecular Microbiology, National Institute of Public Health Che
mska 30/34, 00-725 Warsaw, Poland
4 Service de Bacteriologie—Virologie Hopital de Bicetre, South-Paris Medical School France
5 Department of Molecular Biology, Section of Microbiology, University of Siena 53100 Siena, Italy
6 Service de Bacteriologie—Hopital Tenon (AP-HP), University Pierre et Marie Curie Paris, France
7 Centro de Biología Molecular ‘Severo Ochoa’, Consejo Superior de Investigaciones Científicas, Campus de la Universidad Autónoma de Madrid Cantoblanco, 28049 Madrid, Spain
8 Department of Microbial Biochemistry, Institute of Biochemistry and Biophysics, Polish Academy of Sciences Pawi
skiego 5a, 02-106 Warsaw, Poland
9 Laboratory of Medical Microbiology, Ospedale di Circolo and University of Insubria 21100 Varese, Italy
*Corresponding author. Tel: +44-208-327-7223; Fax: +44-208-327-6264; E-mail: david.livermore{at}hpa.org.uk
Since around 2000—earlier in Poland and Spain and later in France and the UK—dramatic shifts have occurred in the prevalence and types of extended-spectrum ß-lactamases (ESBLs) in Europe. Before this watershed, most producers were nosocomial isolates, often Klebsiella spp. or Enterobacter spp. from specialist care units, and had mutant TEM or SHV ESBLs. Subsequently, CTX-M ESBLs have become dominant, with much greater penetration into Escherichia coli, and with many infections in ‘complicated community’ patients, usually with underlying disease, recent antibiotic usage, or healthcare contact. The degree of clonality among producers varies with the country, as does the enzyme type produced, with group 9 (CTX-M-9 and -14) enzymes dominant in Spain and group 1 enzymes (particularly CTX-M-3 and -15) dominant elsewhere. Irrespective of the particular enzyme, most producers are multiresistant. These changing patterns present major therapeutic and infection control challenges, with the public health intervention points unclear.
Keywords: extended-spectrum ß-lactamases , antibiotic resistance , ß-lactamases , CTX-M ß-lactamases
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