Epidemiology of extended-spectrum β-lactamases in Enterobacterales in Taiwan for over two decades

Abstract

The emergence of antimicrobial resistance among microorganisms is a serious public health concern, and extended-spectrum β-lactamases (ESBL)-producing Enterobacterales is one of the major concerns among antibiotic-resistant bacteria. Although the prevalence of ESBL in Enterobacterales has been increasing with time, the prevalence of ESBL could differ according to the species, hospital allocation, sources of infections, nosocomial or community acquisitions, and geographic regions. Therefore, we conducted a comprehensive review of the epidemiology of ESBL-producing Enterobacterales in Taiwan. Overall, the rates of ESBL producers are higher in northern regions than in other parts of Taiwan. In addition, the genotypes of ESBL vary according to different Enterobacterales. SHV-type ESBLs (SHV-5 and SHV-12) were the major types of Enterobacter cloacae complex, but Serratia marcescens, Proteus mirabilis, Escherichia coli, and Klebsiella pneumoniae were more likely to possess CTX-M-type ESBLs (CTX-M-3 and CTX-M-14). Moreover, a clonal sequence type of O25b-ST131 has been emerging among urinary or bloodstream E. coli isolates in the community in Taiwan, and this clone was potentially associated with virulence, ESBL (CTX-M-15) production, ciprofloxacin resistance, and mortality. Finally, the evolution of the genetic traits of the ESBL-producing Enterobacterales isolates helps us confirm the interhospital and intrahospital clonal dissemination in several regions of Taiwan. In conclusion, continuous surveillance in the investigation of ESBL production among Enterobacterales is needed to establish its long-term epidemiology.

The Impact of COVID-19 Pandemic on ESBL-Producing Enterobacterales Infections: A Scoping Review

“…For example, a higher frequency of Eco-ESBL has been reported in Southeast Asia, Africa, and Central America compared with Europa [ 5 , 24 ]. Similarly, the rates of ESBL-PE are higher in northern regions than in other parts of Taiwan [ 25 ], and a study from the USA (overall prevalence of 11%) showed that while ESBL-PE prevalence was 5% in Michigan, in Washington, DC, it was 26% [ 26 ]. In terms of patient populations, infections caused by ESBL-PE are most commonly seen in hospitalized patients, particularly those with underlying medical conditions, those with immunocompromised status, and those who have been exposed to invasive medical procedures or devices, such as those in intensive care units.…”

Antibiotic Resistance Induced by Extended-Spectrum Beta-Lactamases and Covid-19

“…Furthermore, a clonal sequence type of O25b-ST131 has emerged among urine or bloodstream E. coli isolates in the Taiwanese community, and this clone has been linked to toxicity, ESBL (CTX-M-15) expression, ciprofloxacin resistance, and fatality. [6] Reports from the early 2000s revealed that CTX-M-producing strains were spreading throughout Europe, Latin America, and the Asia-Pacific region. TEM-and SHV-type enzymes were once the most common ESBLs globally.…”