title: Addressing the challenge of extended-spectrum beta-lactamases.
abstract: During the last decade, community-acquired extended-spectrum beta-lactamase (ESBL)-producing bacteria, and in particular Escherichia coli producing ESBLs of the CTX-M-type, have spread worldwide. These organisms are most often isolated from the urinary tract, but have also been isolated from bacteria in the blood. Cephalosporin- and fluoroquinolone-containing treatments are the two most common risk factors identified in patients with ESBL producers. In addition, associated resistance to other classes of antimicrobial agents are often observed in CTX-M producers, limiting the availability of therapeutic options. Carbapenems should be considered as the drug of choice for treating serious systemic infections caused by ESBL-producing bacteria, but preventing the spread of and appropriately managing these infections remains difficult.
authors.affiliation: Université René Descartes, Hygiène Hospitalière, Centre d'Infectiologie Necker-Pasteur, CHU Necker Enfants-Malades, Paris, France.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
authors.forename: Gilles
authors.initials: G
authors.lastname: Potel
authors.forename: Patrick
authors.initials: P
authors.lastname: Plesiat
authors.forename: Patrice
authors.initials: P
authors.lastname: Nordmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000145:classification / Q000235:genetics / Q000378:metabolism; D047090:beta-Lactams / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D024841:Fluoroquinolones; D047090:beta-Lactams; D001618:beta-Lactamases