Overview of ESBL-producing Enterobacteriaceae from a Nordic perspective

Area of Science:

• Microbiology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Extended spectrum β-lactamases (ESBL) are rapidly increasing worldwide, with CTX-M type E. coli being the most common.
• ESBL-producing E. coli infections, often originating from gut microbiota, include urinary tract infections and severe systemic infections.
• The increasing prevalence of ESBL-producing Enterobacteriaceae (EPE) poses a significant challenge to public health due to potential community dissemination.

Purpose of the Study:

• To provide an overview of the global problem of ESBL-producing Enterobacteriaceae from a Nordic perspective.
• To highlight the need for further research into the drivers of ESBL dissemination, including bacterial clones and plasmids.
• To emphasize the importance of understanding EPE persistence in carriers and the impact of risk factors on spread.

Main Methods:

• This is a review article, synthesizing existing research and epidemiological data.
• The review focuses on strain types, plasmids, and mobile genetic elements contributing to ESBL dissemination.
• It examines factors influencing the persistence of EPE in carriers and the role of antibiotic treatment.

Main Results:

• CTX-M type ESBL-producing E. coli are the most prevalent clinical isolates.
• E. coli's role as a gut colonizer makes ESBL dissemination particularly concerning.
• The exact drivers of EPE spread (clones vs. plasmids) require further investigation.

Conclusions:

• Combating the rise of EPE necessitates a deeper understanding of their epidemiology and transmission dynamics.
• Further research is essential to address the persistence of EPE in carriers and the influence of risk factors.
• A Nordic perspective is offered on this critical global health issue.