Extended-Spectrum β-Lactamases (ESBL): Challenges and Opportunities

Area of Science:

• Microbiology
• Infectious Diseases
• Public Health

Background:

• Antimicrobial resistance (AMR), especially from extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E), is a critical global health issue.
• ESBL-E infections often lead to empirical antibiotic therapy failure, increasing morbidity and mortality.
• The CTX-M genotype, prevalent in E. coli and K. pneumoniae, is a major ESBL type, spread by mobile genetic elements.

Purpose of the Study:

• To review the background, risk factors, transmission, and therapy of ESBL.
• To focus on the current situation and future threats of ESBL-E in South Asia and beyond.
• To highlight the need for rapid diagnostics, alternative treatments, and the One Health approach.

Main Methods:

• Literature review on ESBL-E, focusing on South Asia.
• Analysis of existing data on ESBL prevalence, resistance mechanisms, and treatment outcomes.
• Synthesis of information on risk factors, transmission dynamics, and therapeutic challenges.

Main Results:

• ESBL-E poses a significant threat due to treatment failures and rising resistance.
• Carbapenem resistance is emerging, necessitating carbapenem-sparing strategies.
• Irrational antibiotic use in South Asia exacerbates the ESBL-induced AMR problem, with superbugs resistant to last-resort antibiotics reported.

Conclusions:

• Rapid diagnostic tools and efficient alternative treatments are crucial for combating ESBL-E.
• Implementing the One Health approach with systematic surveillance is strongly recommended.
• Urgent action is required to address the escalating crisis of antimicrobial resistance in the South Asian region and globally.