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Overview of the epidemiological profile and laboratory detection of extended-spectrum beta-lactamases Pfaller MA; Segreti JClin Infect Dis 2006[Apr]; 42 Suppl 4 (ä): S153-63Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated bacterial enzymes that confer resistance to a broad range of beta-lactams. They are descended by genetic mutation from native beta-lactamases found in gram-negative bacteria, especially infectious strains of Escherichia coli and Klebsiella species. Genetic sequence modifications have broadened the substrate specificity of the enzymes to include third-generation cephalosporins, such as ceftazidime. Because ESBL-producing strains are resistant to a wide variety of commonly used antimicrobials, their proliferation poses a serious global health concern that has complicated treatment strategies for a growing number of hospitalized patients. Another resistance mechanism, also common to Enterobacteriaceae, results from the overproduction of chromosomal or plasmid-derived AmpC beta-lactamases. These organisms share an antimicrobial resistance pattern similar to that of ESBL-producing organisms, with the prominent exception that, unlike most ESBLs, AmpC enzymes are not inhibited by clavulanate and similar beta-lactamase inhibitors. Recent technological improvements in testing and in the development of uniform standards for both ESBL detection and confirmatory testing promise to make accurate identification of ESBL-producing organisms more accessible to clinical laboratories.|*beta-Lactam Resistance/genetics[MESH]|Enterobacteriaceae Infections/drug therapy/epidemiology/*microbiology[MESH]|Enterobacteriaceae/*drug effects/*enzymology/genetics[MESH]|Escherichia coli Infections/classification/epidemiology/microbiology[MESH]|Escherichia coli/drug effects/enzymology/genetics[MESH]|Humans[MESH]|Klebsiella Infections/classification/epidemiology/microbiology[MESH]|Klebsiella/drug effects/enzymology/genetics[MESH]|Microbial Sensitivity Tests/methods/*standards[MESH]|Risk Factors[MESH]|beta-Lactamases/classification/genetics/*isolation & purification[MESH] |
