JAC Advance Access published online on December 6, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl483
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1 Antibiotic Resistance Monitoring and Reference Laboratory, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK
* To whom correspondence should be addressed. 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
Review
CTX-M: changing the face of ESBLs in Europe
David M. Livermore 1 *, Rafael Canton 2, Marek Gniadkowski 3, Patrice Nordmann 4, Gian Maria Rossolini 5, Guillaume Arlet 6, Juan Ayala 7, Teresa M. Coque 2, Izabela Kern-Zdanowicz 8, Francesco Luzzaro 9, Laurent Poirel 4, and Neil Woodford 1
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
David M. Livermore, E-mail: david.livermore{at}hpa.org.uk
Abstract 
-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.-lactamases; antibiotic resistance; -lactamases; CTX-M -lactamases.
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M. Golebiewski, I. Kern-Zdanowicz, M. Zienkiewicz, M. Adamczyk, J. Zylinska, A. Baraniak, M. Gniadkowski, J. Bardowski, and P. Ceglowski Complete Nucleotide Sequence of the pCTX-M3 Plasmid and Its Involvement in Spread of the Extended-Spectrum {beta}-Lactamase Gene blaCTX-M-3 Antimicrob. Agents Chemother., November 1, 2007; 51(11): 3789 - 3795. [Abstract] [Full Text] [PDF]
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J. S. Lewis II, M. Herrera, B. Wickes, J. E. Patterson, and J. H. Jorgensen First Report of the Emergence of CTX-M-Type Extended-Spectrum {beta}-Lactamases (ESBLs) as the Predominant ESBL Isolated in a U.S. Health Care System Antimicrob. Agents Chemother., November 1, 2007; 51(11): 4015 - 4021. [Abstract] [Full Text] [PDF]
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J. Empel, K. Filczak, A. Mrowka, W. Hryniewicz, D. M. Livermore, and M. Gniadkowski Outbreak of Pseudomonas aeruginosa Infections with PER-1 Extended-Spectrum {beta}-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex J. Clin. Microbiol., September 1, 2007; 45(9): 2829 - 2834. [Abstract] [Full Text] [PDF]
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D. Livermore The zeitgeist of resistance J. Antimicrob. Chemother., August 1, 2007; 60(suppl_1): i59 - i61. [Abstract] [Full Text] [PDF]
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P. L. Ho, W. W. N. Poon, S. L. Loke, M. S. T. Leung, K. H. Chow, R. C. W. Wong, K. S. Yip, E. L. Lai, K. W. T. Tsang, and on behalf of the COMBAT study group Community emergence of CTX-M type extended-spectrum {beta}-lactamases among urinary Escherichia coli from women J. Antimicrob. Chemother., July 1, 2007; 60(1): 140 - 144. [Abstract] [Full Text] [PDF]
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A. San Millan, J. A. Escudero, A. Catalan, S. Nieto, F. Farelo, M. Gibert, M. A. Moreno, L. Dominguez, and B. Gonzalez-Zorn {beta}-Lactam Resistance in Haemophilus parasuis Is Mediated by Plasmid pB1000 Bearing blaROB-1 Antimicrob. Agents Chemother., June 1, 2007; 51(6): 2260 - 2264. [Abstract] [Full Text] [PDF]
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S. Mushtaq, R. Hope, M. Warner, and D. M. Livermore Activity of faropenem against cephalosporin-resistant Enterobacteriaceae J. Antimicrob. Chemother., May 1, 2007; 59(5): 1025 - 1030. [Abstract] [Full Text] [PDF]
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