Epidemiology of β-Lactamase-Producing Pathogens

Abstract

SUMMARY β-Lactam antibiotics have been widely used as therapeutic agents for the past 70 years, resulting in emergence of an abundance of β-lactam-inactivating β-lactamases. Although penicillinases in Staphylococcus aureus challenged the initial uses of penicillin, β-lactamases are most important in Gram-negative bacteria, particularly in enteric and nonfermentative pathogens, where collectively they confer resistance to all β-lactam-containing antibiotics. Critical β-lactamases are those enzymes whose genes are encoded on mobile elements that are transferable among species. Major β-lactamase families include plasmid-mediated extended-spectrum β-lactamases (ESBLs), AmpC cephalosporinases, and carbapenemases now appearing globally, with geographic preferences for specific variants. CTX-M enzymes include the most common ESBLs that are prevalent in all areas of the world. In contrast, KPC serine carbapenemases are present more frequently in the Americas, the Mediterranean countries, and China, whereas NDM metallo-β-lactamases are more prevalent in the Indian subcontinent and Eastern Europe. As selective pressure from β-lactam use continues, multiple β-lactamases per organism are increasingly common, including pathogens carrying three different carbapenemase genes. These organisms may be spread throughout health care facilities as well as in the community, warranting close attention to increased infection control measures and stewardship of the β-lactam-containing drugs in an effort to control selection of even more deleterious pathogens.

Characteristics and Epidemiology of Extended-Spectrum β-Lactamase-Producing Multidrug-Resistant Klebsiella pneumoniae From Red Kangaroo, China

“…This is a rapidly evolving class of β-lactamases, usually from bla TEM–1 , bla TEM–2 , or bla SHV–1 genes, which can hydrolyze third-generation cephalosporins and aztreonam and can be inhibited by clavulanic acid ( Paterson and Bonomo, 2005 ). Although new members of the ESBLs family are often found, the earlier bla CTX–M–14 and bla CTX–M–15 enzymes are prevalent in the world at large ( Bush and Fisher, 2011 ; Bush and Bradford, 2020 ), while bla CTX–M–3 enzymes are prevalent mainly in Europe ( Canton et al, 2008 ). Resistance to extended-spectrum cephalosporins such as ceftazidime, cefotaxime, and cefepime were often observed when ESBLs appeared in Klebsiella sp.…”

Clinical Relevance of Antibiotic Susceptibility Profiles for Screening Gram-negative Microorganisms Resistant to Beta-Lactam Antibiotics

“…The remaining isolates belonged to E. coli and K. pneumonia species. They do not constitutively express these types of enzyme because they lack the regulating genes, and their expression is produced by the acquisition of plasmids from the chromosomal β-lactamases of E. cloacae (ACT-1 and MIR-1), C. freundii (CMY), Hafnia alvei (ACC-1), and M. morganii (DHA-1) [ 25 ]. The observation of CMY-2 and DHA-1 in E. coli isolates and DHA-1 in K. pneumoniae isolates is very frequent [ 26 ].…”

Extended Spectrum β-Lactamase (ESBL) Producing Escherichia coli in Pigs and Pork Meat in the European Union

“…CTX-M β-lactamases hydrolyze cefotaxime and ceftriaxone better than ceftazidime. However, the spectrum of hydrolysis varies by the enzyme, and there are CTX enzymes (CTX-M-15, CTXM-16 and CTX-M19) that exhibit enhanced catalytic efficiencies against ceftazidime [ 11 , 56 ].…”