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Related Experiment Videos

Extended-spectrum plasmid-mediated beta-lactamases

D Sirot1

  • 1Laboratoire de Bactériologie, Faculté de Médecine, Clermont Ferrand, France.

The Journal of Antimicrobial Chemotherapy
|July 1, 1995
PubMed
Summary

Extended-spectrum beta-lactamases (ESBLs) confer resistance to many cephalosporins. Carbapenems like meropenem are the most effective treatments against ESBL-producing bacteria, including Klebsiella pneumoniae.

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Impairment of respiratory burst in polymorphonuclear leukocytes by extended-spectrum beta-lactamase-producing strains of Klebsiella pneumoniae.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology·2003

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Extended-spectrum beta-lactamases (ESBLs) are enzymes that confer resistance to broad-spectrum cephalosporins and monobactams.
  • ESBLs are commonly derived from TEM or SHV (class A) enzymes, but newer class C enzymes also exist, conferring resistance to all cephalosporins, including cephamycins.
  • Klebsiella pneumoniae is a primary species where ESBLs are reported, often leading to nosocomial outbreaks.

Purpose of the Study:

  • To review the characteristics of ESBLs and their impact on antibiotic resistance.
  • To evaluate the efficacy of various beta-lactam antibiotics against ESBL-producing bacteria.
  • To guide the selection of appropriate antimicrobial agents for treating infections caused by ESBL-producing organisms.

Main Methods:

  • Review of existing literature on ESBLs, their genetic origins, and mechanisms of resistance.
  • Analysis of antimicrobial susceptibility data for different beta-lactam classes against ESBL-producing strains.
  • Comparison of the in vitro activity of various antibiotics, including cephalosporins, cephamycins, and carbapenems.

Main Results:

  • ESBLs confer resistance to cefotaxime, ceftazidime, and aztreonam, but not typically to cephamycins or carbapenems.
  • Newer plasmid-mediated ESBLs (class C) can confer resistance to all cephalosporins, including cephamycins.
  • Carbapenems (imipenem, meropenem) demonstrate high stability against TEM and SHV-derived beta-lactamases and are the most effective agents, with meropenem showing superior activity.

Conclusions:

  • The emergence of ESBLs necessitates careful antibiotic selection to combat resistance.
  • While some beta-lactam/beta-lactamase inhibitor combinations may be useful, carbapenems remain the most reliable treatment option for ESBL-producing infections.
  • Clinicians must consider potential co-existing resistance mechanisms and the specific ESBL type when choosing therapy.

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