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      Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern.

      The Lancet Infectious Diseases

      biosynthesis, beta-Lactamases, microbiology, epidemiology, drug therapy, diagnosis, Urinary Tract Infections, Reagent Kits, Diagnostic, Polymerase Chain Reaction, Humans, Global Health, Enterobacteriaceae Infections, enzymology, drug effects, Enterobacteriaceae, Drug Resistance, Multiple, Bacterial, analysis, DNA, Bacterial, Communicable Diseases, Emerging, Communicable Disease Control, therapeutic use, pharmacology, Anti-Bacterial Agents

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          The medical community relies on clinical expertise and published guidelines to assist physicians with choices in empirical therapy for system-based infectious syndromes, such as community-acquired pneumonia and urinary-tract infections (UTIs). From the late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. Recent reports have also described ESBL-producing E coli as a cause of bloodstream infections associated with these community-onset UTIs. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Thus, more rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.

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