From the Guidelines
ESBL (Extended-Spectrum Beta-Lactamase) refers to enzymes produced by certain bacteria that can break down and inactivate many commonly used antibiotics, particularly beta-lactam antibiotics like penicillins and cephalosporins. These enzymes are produced by gram-negative bacteria, most commonly Escherichia coli and Klebsiella species, making infections caused by these organisms difficult to treat with standard antibiotics. ESBL-producing bacteria are resistant to most penicillins, cephalosporins (except cephamycins like cefoxitin), and aztreonam. When treating ESBL infections, carbapenems (such as meropenem, imipenem, or ertapenem) are typically the antibiotics of choice, usually given intravenously for serious infections. In some cases, other options like piperacillin-tazobactam, ceftazidime-avibactam, or fosfomycin may be considered based on susceptibility testing 1. ESBL-producing bacteria are considered multidrug-resistant organisms and are associated with increased mortality, longer hospital stays, and higher healthcare costs. The spread of these resistant bacteria is a growing public health concern, highlighting the importance of appropriate antibiotic use, infection control measures, and proper hand hygiene in healthcare settings. Key points to consider in the management of ESBL-producing bacteria include:
- The use of rapid testing strategies to identify specific resistance mechanisms and guide antibiotic therapy 1
- The importance of antibiotic stewardship to prevent the spread of resistance
- The need for infection control measures to prevent the transmission of ESBL-producing bacteria in healthcare settings. It is crucial to note that the management of ESBL-producing bacteria requires a comprehensive approach that includes appropriate antibiotic use, infection control measures, and proper hand hygiene in healthcare settings. In terms of treatment, carbapenems are typically the antibiotics of choice for serious ESBL infections. However, the choice of antibiotic should be guided by susceptibility testing and the specific resistance mechanism involved 1. Overall, the management of ESBL-producing bacteria requires a careful and nuanced approach that takes into account the latest evidence and guidelines.
From the FDA Drug Label
As with other extended-spectrum beta-lactam antibacterial drugs, resistance can develop during therapy, leading to clinical failure in some cases. The term ESBL stands for Extended-Spectrum Beta-Lactamase, which refers to a type of enzyme produced by certain bacteria that makes them resistant to beta-lactam antibiotics, including extended-spectrum cephalosporins like ceftazidime 2.
From the Research
Definition of ESBL
- ESBL stands for Extended-Spectrum Beta-Lactamase, which refers to a group of enzymes that hydrolyze antibiotics, including those containing new cephalosporins 3, 4, 5, 6, 7.
- These enzymes are found in a significant percentage of Escherichia coli and Klebsiella pneumoniae strains, and are often plasmid-encoded, allowing for easy transfer between bacteria 4, 5, 7.
Characteristics of ESBLs
- ESBLs are capable of hydrolyzing third-generation cephalosporins and aztreonam, but are inhibited by clavulanic acid 4, 5, 6.
- They are derived from genes for TEM-1, TEM-2, or SHV-1 by mutations that alter the amino acid configuration around the active site of these beta-lactamases 4, 6.
- ESBL-producing organisms often exhibit co-resistance to many other classes of antibiotics, resulting in limited therapeutic options 3, 4, 5, 7.
Clinical Significance of ESBLs
- The presence of ESBLs carries tremendous clinical significance, as they can lead to treatment failures and increased morbidity and mortality 4, 5, 7.
- Carbapenems are often the treatment of choice for serious infections due to ESBL-producing organisms, but carbapenem-resistant isolates have been reported 4, 5, 7.
- Efficient infection-control practices and intervention strategies, such as antibiotic rotation, are necessary to reduce the selection and spread of these resistant pathogens 5.