ESBLs: A Clear and Present Danger?

Abstract

Extended spectrum β-lactamases (ESBLs) are enzymes produced by a variety of Gram negative bacteria which confer an increased resistance to commonly used antibiotics. They are a worrying global public health issue as infections caused by such enzyme-producing organisms are associated with a higher morbidity and mortality and greater fiscal burden. Coupled with increasing prevalence rates worldwide and an ever diminishing supply in the antibiotic armamentarium, these enzymes represent a clear and present danger to public health. This article aims to give an overview of the current situation regarding ESBLs, with a focus on the epidemiology and management of such infections.

Revisión sistemática de la resistencia antimicrobiana en enterobacterias en aislamientos intrahospitalarios en Colombia

“…Con base en los estudios identificados, en los últimos años (2009 a 2011) la frecuencia de BLEE podría situarse entre 10,1 y 11,8 % en E. coli y entre 14,6 y 32,6 % en K. pneumoniae. A nivel mundial, los datos del estudio TEST (Tigecycline Evaluation and Surveillance Trial) (56)(57)(58)(59), los del proyecto Sentry (60) y los del estudio SMART (Study for Monitoring Antimicrobial Resistance Trends) muestran cómo en la última década las tasas más altas se observan en Asia, seguidas por las de América Latina y, por último, las de los países desarrollados (61)(62)(63). Al comparar la situación de Colombia con los datos reportados, en el caso de K. pneumoniae productora de BLEE el país estaría al nivel de América Latina, con las tasas de resistencia más altas.…”

Frequency and Sensitivity of Extended Spectrum Beta-Lactamase Positive Organisms in a Secondary and Tertiary Level Hospital Network in Dhaka

“…In other studies, it was found that tigecycline had excellent in vitro sensitivity but data reflecting clinical outcome is lacking. 20,23,25 It was also reported that there was increased mortality rate in tigecycline-treated patients than in patients treated by other antibiotics. 20 FDA warned health professionals and their medical care organizations about the increased risk of death when intravenous tigecycline is used.…”

“…2,7 ESBL organisms have continued to increase in varieties (more than 400 variants detected) 8 and prevalence and are now a global health concern. 4,9,10 The ESBL organisms have implications for clinicians and patients because these are associated with treatment failure, increased morbidity and mortality, poor outcomes, increased length of stay (LOS) in hospital and health care costs. 9 So, it is important to treat it properly as soon as it is diagnosed.…”

“…Hospital and different hospitals/centres located at different sites of Dhaka city has been shown in 20 However, prevalence of ESBL positive organisms is increasing throughout the world. 4 Predominating organism in our study was E. coli (82.8%, n=472) and the rest (17.2%) was Klebsiella spp.…”

“…Cefepime is considered as a therapeutic option by some authors, but clinical data show high failure rate. 20 Some patients with ESBL positive organisms were treated successfully with cephalosporins where organisms appeared sensitive in disc diffusion methods and had very low MIC. 1,16,17,21,22 However, MIC is not done routinely in our department except in cases of multidrug resistance when higher than MIC level of antibiotic is targeted.…”