Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern.
The medical community relies on clinical expertise and published guidelines to assist physicians with choices in empirical therapy for system-based infectious syndromes, such as community-acquired pneumonia and urinary-tract infections (UTIs). From the late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. Recent reports have also described ESBL-producing E coli as a cause of bloodstream infections associated with these community-onset UTIs. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Thus, more rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.
Pitout
Johann D D
JD
Division of Microbiology, Calgary Laboratory Services, Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada. johann.pitout@cls.ab.ca
Laupland
Kevin B
KB
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D003140:Communicable Disease Control; D021821:Communicable Diseases, Emerging; D004269:DNA, Bacterial / Q000032:analysis; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D014943:Global Health; D006801:Humans; D016133:Polymerase Chain Reaction; D011933:Reagent Kits, Diagnostic; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D011933:Reagent Kits, Diagnostic; D001618:beta-Lactamases