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Systematic Endobronchial Ultrasound - The Six Landmarks Approach
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The continuing challenge of ESBLs.

Federico Perez1, Andrea Endimiani, Kristine M Hujer

  • 1Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.

Current Opinion in Pharmacology
|September 19, 2007
PubMed
Summary

Extended-spectrum beta-lactamases (ESBLs) in Escherichia coli and Klebsiella pneumoniae, particularly CTX-M and KPC types, pose significant treatment challenges. Ongoing research addresses detection methods and carbapenem resistance concerns.

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Area of Science:

  • Microbiology
  • Biochemistry
  • Infectious Diseases

Background:

  • Extended-spectrum beta-lactamases (ESBLs) from Escherichia coli and Klebsiella pneumoniae have been clinically significant for over two decades.
  • Initially, TEM and SHV beta-lactamases were most common, but CTX-M enzymes are now globally prevalent in clinical isolates.
  • K. pneumoniae carbapenemases (KPC) represent a major challenge, conferring resistance to carbapenems and extended-spectrum cephalosporins.

Purpose of the Study:

  • To review the evolution and current landscape of ESBL-producing bacteria.
  • To highlight the increasing prevalence and clinical impact of CTX-M and KPC enzymes.
  • To discuss challenges in ESBL detection and the implications for carbapenem therapy.

Main Methods:

  • Review of existing literature on beta-lactamase evolution and characterization.
  • Analysis of structural data related to ESBL active site modifications.
  • Discussion of clinical implications and emerging resistance trends.

Main Results:

  • CTX-M enzymes have surpassed TEM and SHV as the most prevalent ESBLs globally.
  • KPC enzymes present a significant threat, conferring resistance to carbapenems.
  • Structural studies reveal active site alterations enabling extended hydrolytic activity.

Conclusions:

  • ESBL-producing bacteria, especially those with CTX-M and KPC, remain a critical clinical concern.
  • Optimal detection methods for ESBLs require further investigation.
  • The efficacy of carbapenems is threatened by the rise of carbapenemase-producing organisms.