CTX-M: changing the face of ESBLs in the UK
CTX-M: changing the face of ESBLs in the UK
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DOI：
10.1093/jac/dki239
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发表时间：
2005-09-01
影响因子：
5.2
通讯作者：
Hawkey, PM
中科院分区：
文献类型：
--
作者：
Livermore, DM;Hawkey, PM
英国的超广谱 β-内酰胺酶 (ESBL) 率突然上升，这主要是由于产生 CTX-M-15 型 β-内酰胺酶的大肠杆菌的出现和传播。英国抗菌化疗协会在 2004 年组织了两次更新会议，报告并讨论了产生这些 β-内酰胺酶的细菌的识别、临床诊断、治疗和控制。本文报告了会议贡献者所做的数据和评论。回顾了 ESBL 的历史分布和出现，以及从克鲁维拉属染色体动员后质粒介导的 CTX-M ESBL 的出现。英国第一次重大 CTX-M 生产者爆发发生在 2001 年，在一个地点涉及带有 CTX-M-26 的肺炎克雷伯菌，但到 2003 年，带有 CTX-M-15 的克隆和多样化大肠杆菌广泛传播，什罗普郡是受影响最严重的地区之一。报道了什罗普郡的具体经验，并对英格兰和威尔士实验室对 ESBL 检测必要性的认识程度进行了全面审查，同时描述了可能采用的各种方法，并提出了最佳方法的建议。强调了与产 ESBL 菌株引起的感染治疗不当相关的死亡率增加，并讨论了交叉感染的潜在控制。会议得出的结论是，CTX-M 基因现在不仅在大肠杆菌中广泛存在，而且在英国的其他肠杆菌科细菌中也广泛存在，这将对社区和医院内由这些细菌引起的感染的治疗构成重大威胁。
The UK has experienced a sudden rise in extended-spectrum beta-lactamase (ESBL) rates, largely due to the appearance and spread of Escherichia coli producing CTX-M-15 type beta-lactamase. The British Society for Antimicrobial Chemotherapy organized two update meetings during 2004 to report and discuss the recognition, clinical diagnosis, treatment and control of bacteria producing these beta-lactamases. This paper reports the data and reviews made by contributors to the conferences. The historical distribution and emergence of ESBLs was reviewed along with the emergence of plasmid-mediated CTX-M ESBLs following their mobilization from the chromosome of Kluyvera spp. The first significant outbreak of CTX-M producers in the UK occurred in 2001 and involved Klebsiella pneumoniae with CTX-M-26 at one site, but by 2003, cloned and diverse E. coli with CTX-M-15 were widespread, with Shropshire one of the most affected regions. The specific experience in Shropshire was reported on and a comprehensive review made of the level of awareness of the need for ESBL detection in laboratories in England and Wales, together with a description of the variety of methods that may be applied, with recommendations for optimal methodology. The increased mortality associated with inappropriate treatment of infections caused by ESBL-producing strains was highlighted, together with discussion on potential control of cross-infection. The meeting concluded that the CTX-M genes have now become widespread in not only E. coli but other Enterobacteriaceae in the UK and this will represent a substantial threat to both the treatment of infections caused by these bacteria in the community and within hospitals.