Fecal Colonization With Extended-spectrum Beta-lactamase–ProducingEnterobacteriaceaeand Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis

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Abstract

Gut colonization is a risk factor for infections with extended-spectrum beta-lactamase (ESBL)-producing organisms. We aimed to determine the ESBL class A reservoir among healthy individuals.

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

Johann Pitout, Kevin B Laupland (2008)

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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Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data.

Thomas Van Boeckel, Sumanth Gandra, Ashvin Ashok … (2014)

Antibiotic drug consumption is a major driver of antibiotic resistance. Variations in antibiotic resistance across countries are attributable, in part, to different volumes and patterns for antibiotic consumption. We aimed to assess variations in consumption to assist monitoring of the rise of resistance and development of rational-use policies and to provide a baseline for future assessment. With use of sales data for retail and hospital pharmacies from the IMS Health MIDAS database, we reviewed trends for consumption of standard units of antibiotics between 2000 and 2010 for 71 countries. We used compound annual growth rates to assess temporal differences in consumption for each country and Fourier series and regression methods to assess seasonal differences in consumption in 63 of the countries. Between 2000 and 2010, consumption of antibiotic drugs increased by 36% (from 54 083 964 813 standard units to 73 620 748 816 standard units). Brazil, Russia, India, China, and South Africa accounted for 76% of this increase. In most countries, antibiotic consumption varied significantly with season. There was increased consumption of carbapenems (45%) and polymixins (13%), two last-resort classes of antibiotic drugs. The rise of antibiotic consumption and the increase in use of last-resort antibiotic drugs raises serious concerns for public health. Appropriate use of antibiotics in developing countries should be encouraged. However, to prevent a striking rise in resistance in low-income and middle-income countries with large populations and to preserve antibiotic efficacy worldwide, programmes that promote rational use through coordinated efforts by the international community should be a priority. US Department of Homeland Security, Bill & Melinda Gates Foundation, US National Institutes of Health, Princeton Grand Challenges Program. Copyright © 2014 Elsevier Ltd. All rights reserved.

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CTX-M Enzymes: Origin and Diffusion

Rafael Cantón, José-María González-Alba, Juan Carlos Galán … (2012)

CTX-M β-lactamases are considered a paradigm in the evolution of a resistance mechanism. Incorporation of different chromosomal bla CTX-M related genes from different species of Kluyvera has derived in different CTX-M clusters. In silico analyses have shown that this event has occurred at least nine times; in CTX-M-1 cluster (3), CTX-M-2 and CTX-M-9 clusters (2 each), and CTX-M-8 and CTX-M-25 clusters (1 each). This has been mainly produced by the participation of genetic mobilization units such as insertion sequences (ISEcp1 or ISCR1) and the later incorporation in hierarchical structures associated with multifaceted genetic structures including complex class 1 integrons and transposons. The capture of these bla CTX-M genes from the environment by highly mobilizable structures could have been a random event. Moreover, after incorporation within these structures, β-lactam selective force such as that exerted by cefotaxime and ceftazidime has fueled mutational events underscoring diversification of different clusters. Nevertheless, more variants of CTX-M enzymes, including those not inhibited by β-lactamase inhibitors such as clavulanic acid (IR-CTX-M variants), only obtained under in in vitro experiments, are still waiting to emerge in the clinical setting. Penetration and the later global spread of CTX-M producing organisms have been produced with the participation of the so-called “epidemic resistance plasmids” often carried in multi-drug resistant and virulent high-risk clones. All these facts but also the incorporation and co-selection of emerging resistance determinants within CTX-M producing bacteria, such as those encoding carbapenemases, depict the currently complex pandemic scenario of multi-drug resistant isolates.

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Journal

Title: Clinical Infectious Diseases

Abbreviated Title: Clin Infect Dis.

Publisher: Oxford University Press (OUP)

ISSN (Print): 1058-4838

ISSN (Electronic): 1537-6591

Publication date Created: July 15 2016

Publication date Created: August 01 2016

Publication date (Print): August 01 2016

Publication date (Electronic): May 03 2016

Volume: 63

Issue: 3

Pages: 310-318

Article

DOI: 10.1093/cid/ciw283

PubMed ID: 27143671

SO-VID: 9b1c5a5b-ae81-41b1-935a-0ee2b7271424

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Fecal Colonization With Extended-spectrum Beta-lactamase–ProducingEnterobacteriaceaeand Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis

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Most cited references 39

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

Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data.

CTX-M Enzymes: Origin and Diffusion

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