Journal Article

CTX-M: changing the face of ESBLs in the UK

D. M. Livermore and P. M. Hawkey

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 56, issue 3, pages 451-454
Published in print September 2005 | ISSN: 0305-7453
Published online July 2005 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dki239
CTX-M: changing the face of ESBLs in the UK

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The UK has experienced a sudden rise in extended-spectrum β-lactamase (ESBL) rates, largely due to the appearance and spread of Escherichia coli producing CTX-M-15 type β-lactamase. The British Society for Antimicrobial Chemotherapy organized two update meetings during 2004 to report and discuss the recognition, clinical diagnosis, treatment and control of bacteria producing these β-lactamases. This paper reports the data and reviews made by contributors to the conferences. The historical distribution and emergence of ESBLs was reviewed along with the emergence of plasmid-mediated CTX-M ESBLs following their mobilization from the chromosome of Kluyvera spp. The first significant outbreak of CTX-M producers in the UK occurred in 2001 and involved Klebsiella pneumoniae with CTX-M-26 at one site, but by 2003, cloned and diverse E. coli with CTX-M-15 were widespread, with Shropshire one of the most affected regions. The specific experience in Shropshire was reported on and a comprehensive review made of the level of awareness of the need for ESBL detection in laboratories in England and Wales, together with a description of the variety of methods that may be applied, with recommendations for optimal methodology. The increased mortality associated with inappropriate treatment of infections caused by ESBL-producing strains was highlighted, together with discussion on potential control of cross-infection. The meeting concluded that the CTX-M genes have now become widespread in not only E. coli but other Enterobacteriaceae in the UK and this will represent a substantial threat to both the treatment of infections caused by these bacteria in the community and within hospitals.

Keywords: extended-spectrum β-lactamases; ESBLs; BSAC

Journal Article.  3642 words. 

Subjects: Medical Oncology ; Critical Care

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