JAC Advance Access originally published online on October 28, 2008
Journal of Antimicrobial Chemotherapy 2009 63(1):1-4; doi:10.1093/jac/dkn444
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Redefining extended-spectrum β-lactamases: balancing science and clinical need
1 Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden 2 Department of Microbiology and Infection Control, University Hospital of Northern Norway, Norway 3 Section for Microbiology and Virology, Department of Medical Biology, University of Tromsø, Tromsø, Norway 4 Department of Clinical Microbiology, Central Hospital, Växjö, Sweden 5 Antibiotic Resistance Monitoring and Reference Laboratory, Centre for Infections, Health Protection Agency, London, UK 6 Service de Bactériologie-Virologie, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Sud, France 7 University of Queensland Centre for Clinical Research and Royal Brisbane and Women's Hospital, Brisbane, Australia 8 Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain 9 School of Medicine, Cardiff University, Cardiff, Wales, UK
* Corresponding author. Tel: +46-8-517-73574; Fax: +46-8-30-8099; E-mail: christian.giske{at}karolinska.se
The current β-lactamase classifications have reached a high level of complexity, making them less accessible to clinicians, infection control professionals, hospital management and politicians. From the clinical perspective, a revised comprehensible nomenclature scheme is therefore needed. The term extended-spectrum β-lactamases (ESBLs) has reached a broader audience over time, but is currently restricted to functional class 2be/molecular class A, clavulanic acid inhibited enzymes with activity against extended-spectrum cephalosporins. The proposed new classification expands the definition of ESBL to other clinically important acquired β-lactamases with activity against extended-spectrum cephalosporins and/or carbapenems. The classical class A ESBLs have been designated ESBLA in this classification, whereas plasmid-mediated AmpC and OXA-ESBLs are classed as miscellaneous ESBLs (ESBLM). Lastly, the carbapenemases have been designated ESBLCARBA, ESBLs with hydrolytic activity against carbapenems. We believe that this simplified classification may encourage new groups of healthcare professionals to engage in the effort to prevent the spread of acquired β-lactamases.
Keywords: classification , ESBLs , metallo-β-lactamases , OXA , KPC
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