title: CTX-M: changing the face of ESBLs in Europe.
abstract: 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 beta-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.
authors.affiliation: Antibiotic Resistance Monitoring and Reference Laboratory, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK. david.livermore@hpa.org.uk
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
authors.forename: Rafael
authors.initials: R
authors.lastname: Canton
authors.forename: Marek
authors.initials: M
authors.lastname: Gniadkowski
authors.forename: Patrice
authors.initials: P
authors.lastname: Nordmann
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
authors.forename: Guillaume
authors.initials: G
authors.lastname: Arlet
authors.forename: Juan
authors.initials: J
authors.lastname: Ayala
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Coque
authors.forename: Izabela
authors.initials: I
authors.lastname: Kern-Zdanowicz
authors.forename: Francesco
authors.initials: F
authors.lastname: Luzzaro
authors.forename: Laurent
authors.initials: L
authors.lastname: Poirel
authors.forename: Neil
authors.initials: N
authors.lastname: Woodford
mesh_terms: D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D004754:Enterobacter / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology; D004926:Escherichia coli / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007709:Klebsiella / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology; D009154:Mutation; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001618:beta-Lactamases