CTX-M: changing the face of ESBLs in the UK.
The UK has experienced a sudden rise in extended-spectrum beta-lactamase (ESBL) rates, largely due to the appearance and spread of Escherichia coli producing CTX-M-15 type beta-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 beta-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.
Livermore
D M
DM
Antibiotic Resistance Monitoring and Reference Laboratory, Centre for Infections, Health Protection Agency, London NW9 5HT, UK.
Hawkey
P M
PM
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D002511:Cephalosporins / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004926:Escherichia coli / Q000302:isolation & purification / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000235:genetics / Q000472:pathogenicity; D006113:United Kingdom / Q000453:epidemiology; D018440:beta-Lactam Resistance / Q000502:physiology*; D001618:beta-Lactamases / Q000187:drug effects / Q000235:genetics / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases