Journal List > Urogenit Tract Infect > v.10(2) > 1084187

Choi, Yoo, and Lee: Changing Epidemiology of Extended Spectrum Beta-Lactamases Pathogen of Urinary Tract

Abstract

This review covers the recent findings on extended spectrum beta-lactamases (ESBL) pathogens, focusing on the epidemiology of infection due to this pathogen. Use of ESBL is growing rapidly and widely. CTX-M-15 producing ESBL Escherichia coli is the most commonly encountered in clinical practice. In general, ESBL infections are represented by urinary tract infections, but they can also cause fatal infections involving the vascular system and central nervous system. Because E. coli is a common colonizer of normal intestine, increasing prevalence of ESBL-producing pathogens is particularly troublesome. In a situation where ESBLs are disseminated in the community, the ideal control of this multidrug-resistant pathogen will be challenging. Precise data on the prevalence and risk factors of ESBL-producing microorganism are still undetermined. More epidemiological studies are needed for the question to be answered. In order to maximize efficiency of treatment, information on the trend of increasing numbers of ESBLs is also needed on persistence of ESBLs in carriers as well as better understanding of how antibiotic treatment and other risk factors affect their persistence and further dissemination. The global emergence of multidrug-resistant ESBL pathogen has recently led to critical treatment problems. Early detection, adequate antibiotic therapy, and effective prevention are necessary for achievement of a safe community.

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Table 1.
The prevalence rates of ESBL worldwide
Location First author, year ESBL (+)/total clinical samples in strains Total number (%) of ESBL (+) pathogen
Australia [26] Hawser, 2009 A (1/13), B (0/3), C (0/0) 1 (6.3)
Benin [27] Ahoyo, 2007 A (31/143) 31 (21.7)
Central African Republic [28] Bercion, 2009 A (29/357), B (17/57), F (3/3), G (1/1) 50 (12.0)
China [29] Hawkey, 2008 A (158/287), B (25/91), C (1/4) 184 (48.2)
Egypt [30,31] Fam, 2011 A (55/291), B (23/165) 78 (17.1)
  Saied, 2011 A (9/23), B (130/162) 139 (75.1)
Hong Kong [29] Hawkey, 2008 A (8/45), B (0/0), C (0/0) 8 (17.8)
India [32] Varaiya, 2008 A (264/334), B (77/111), C (15/15) 356 (77.4)
Kenya [33] Kohli, 2010 A (10/69), B (5/38) 15 (14.0)
Morocco [34,35] Barguigua, 2013 B (34/453) 34 (7.5)
  Barguigua, 2011 A (10/767), B (2/36) 12 (1.5)
New Zealand [26] Hawser, 2009 A (3/94), B (1/14), C (1/5) 5 (4.4)
Nigeria [36,37] Aibinu, 2012 A (14/109) 14 (12.8)
  Ogbolu, 2011 A (7/28), B (8/63), D (3/11), F (2/2), G (2/3), H (1/1) 23 (21.3)
Philippines [26] Hawser, 2009 A (9/53), B (8/20), C (0/2) 17 (22.7)
Senegal [38] Sire, 2007 A (38/1,010) 38 (3.8)
Singapore [26] Hawser, 2009 A (17/51), B (12/32), C (0/1) 29 (34.5)
South Africa [39-43] Keddy, 2012 E (4/263) 4 (1.5)
  Bamford, 2012 A (29,066/358,843) 29,066 (8.1)
  Brink, 2012 A (43/566), B (59/171), D (8/71) 110 (13.6)
  Habte, 2009 A (84/482), B (30/239), D (8/85) 122 (15.1)
  Brink, 2007 A (1,420/28,412), B (1,954/7,514), F (484/4,031) 3,858 (9.7)
South Korea [44] Ko, 2008 A (10/44), B (12/37), C (1/4) 23 (27.1)
Taiwan [45] Chambers, 2005 A (33/260), B (30/164), C (2/14) 65 (14.8)
Tanzania [46] Blomberg, 2005 A (9/36), B (9/52), C (1/37) 19 (15.2)
Thailand [29] Hawkey, 2008 A (33/65), B (15/33), C (0/2) 48 (48.0)
Tunisia [47] Ben Haj Khalifa, 2012 B (40/198) 40 (20.2)
Vietnam [48] Jones, 2006 A (42/122), B (9/23), C (2/4) 53 (35.6)

ESBL: extended spectrum beta-lactamases, A: Escherichia coli, B: Klebsiella pneumoniae, C: Klebsiella oxytoca, D: Proteus mirabilis, E: Shigella, F: Enterobacter spp., G: Morganella morganii, H: Serratia odorifera.

Table 2.
Outbreaks of infection due to ESBL-producing Enterobacteriaceae
High risk patient     Intensive care units
History of transplantation
Long-term care facilities
Risk factor                         Severity of disease
Length of hospital/intensive care units stay
Arterial/central venous catheter
Infusion of total parenteral nutrition
Mechanical ventilator
Feeding tube
Urethral catheter
Age
Hemodialysis
Bedsore
Altered nutrition
Premature baby
Previous antibiotics treatment; fluoroquinolones, broad-spectrum cephalosporins, aztreonam, aminoglycosides, metronidazole
Reservoir   Hospital workers hand
Medical devices; thermometers, ultrasound gel,
oxygen probes, liquid soap

ESBL: extended spectrum beta-lactamases.

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