Redefining extended-spectrum beta-lactamases: balancing science and clinical need

Area of Science:

• Microbiology
• Biochemistry
• Clinical Medicine

Background:

• Current beta-lactamase classification systems are overly complex and inaccessible to many healthcare stakeholders.
• The term extended-spectrum beta-lactamases (ESBLs) is currently narrowly defined, excluding other clinically significant enzymes.
• A need exists for a more comprehensible nomenclature to facilitate clinical understanding and management of beta-lactamase-producing organisms.

Purpose of the Study:

• To propose a simplified and clinically relevant classification scheme for acquired beta-lactamases.
• To expand the definition of ESBLs to encompass a broader range of clinically important enzymes, including carbapenemases.
• To enhance engagement of diverse healthcare professionals in combating the spread of acquired beta-lactamases.

Main Methods:

• Review and analysis of existing beta-lactamase classification systems.
• Development of a revised nomenclature based on functional and clinical relevance.
• Categorization of beta-lactamases into proposed new groups: ESBLA, ESBLM, and ESBLCARBA.

Main Results:

• Introduction of a simplified classification system for beta-lactamases.
• Classical class A ESBLs are designated ESBLA.
• Plasmid-mediated AmpC and OXA-ESBLs are classified as miscellaneous ESBLs (ESBLM), and carbapenemases as ESBLCARBA.

Conclusions:

• The proposed classification simplifies beta-lactamase nomenclature, making it more accessible to clinicians and other healthcare professionals.
• This revised scheme broadens the definition of ESBLs to include enzymes with activity against extended-spectrum cephalosporins and carbapenems.
• The simplified classification is expected to foster greater engagement in preventing the spread of acquired beta-lactamases.