Coque T M, Baquero F, Canton R
Microbiology Department, University hospital Ramon y Cajal, CIBER Epidemiology and Public Health, Madrid, Spain.
Euro Surveill. 2008 Nov 20;13(47):19044.
Extended-spectrum beta-lactamases (ESBLs) have been increasingly reported in Europe since their first description in 1983. During the 1990s, they were described mainly as members of the TEM- and SHV-beta-lactamase families in Klebsiella pneumoniae causing nosocomial outbreaks. Nowadays, they are mostly found in Escherichia coli that cause community-acquired infections and with increasing frequency contain CTX-M enzymes. Dissemination of specific clones or clonal groups and epidemic plasmids in community and nosocomial settings has been the main reason for the increase in most of the widespread ESBLs belonging to the TEM (TEM-24, TEM-4, TEM-52), SHV (SHV-5, SHV-12) and CTX-M (CTX-M-9, CTX-M-3, CTX-M-14 or CTX-M-15) families in Europe. Co-selection with other resistances, especially to fluoroquinolones, aminoglycosides and sulfonamides, seems to have contributed to the problem. The emergence of epidemic clones harbouring several beta-lactamases simultaneously (ESBLs, metallo-beta-lactamases or cephamycinases) and of new mechanisms of resistance to fluoroquinolones and aminoglycosides warrants future surveillance studies.
自1983年首次被描述以来，超广谱β-内酰胺酶（ESBLs）在欧洲的报道日益增多。在20世纪90年代，它们主要被描述为肺炎克雷伯菌中TEM-和SHV-β-内酰胺酶家族的成员，可引起医院感染暴发。如今，它们大多存在于引起社区获得性感染的大肠杆菌中，且含有CTX-M酶的频率不断增加。特定克隆或克隆群以及流行质粒在社区和医院环境中的传播，是欧洲大多数广泛传播的属于TEM（TEM-24、TEM-4、TEM-52）、SHV（SHV-5、SHV-12）和CTX-M（CTX-M-9、CTX-M-3、CTX-M-14或CTX-M-15）家族的ESBLs增加的主要原因。与其他耐药性，尤其是对氟喹诺酮类、氨基糖苷类和磺胺类药物的共同选择，似乎也加剧了这一问题。同时携带多种β-内酰胺酶（ESBLs、金属β-内酰胺酶或头孢菌素酶）的流行克隆以及对氟喹诺酮类和氨基糖苷类药物新的耐药机制的出现，值得未来开展监测研究。
