Brolund Alma
Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden ; Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden.
Infect Ecol Epidemiol. 2014 Oct 1;4. doi: 10.3402/iee.v4.24555. eCollection 2014.
Extended spectrum β-lactamases (ESBL) are increasing rapidly worldwide. E. coli producing CTX-M type ESBLs are the most common clinically encountered. The majority of E. coli ESBL infections are represented by urinary tract infections, but they can also cause severe infections, for example, in the blood stream and central nervous system. Since E. coli is a common colonizer of the normal gut microbiota, increasing prevalence of ESBL-producing strains is particularly worrisome. Once disseminated in the community, containment of this resistance type will be challenging. The driver of ESBL-producing Enterobacteriaceae (EPE) is debated. Some suggest that the ESBL genes were introduced to particularly successful bacterial clones. Others imply that very successful plasmids drive the rapid dissemination. More research and epidemiological studies of strain types, plasmids and mobile genetic elements are needed for these questions to be answered. In order to combat, or at least slow down, the worrisome trend of increasing numbers of EPE more knowledge is also needed on persistence of EPE in carriers as well as better understanding of how antibiotic treatment and other risk factors affect persistence and further dissemination. This review aims at giving an overview of this global problem from a Nordic perspective.
超广谱β-内酰胺酶（ESBL）在全球范围内迅速增加。产CTX-M型ESBL的大肠杆菌是临床上最常见的。大多数大肠杆菌ESBL感染表现为尿路感染，但它们也可引起严重感染，例如血流感染和中枢神经系统感染。由于大肠杆菌是正常肠道微生物群的常见定植菌，产ESBL菌株的患病率增加尤其令人担忧。一旦在社区中传播，控制这种耐药类型将具有挑战性。产ESBL肠杆菌科细菌（EPE）的驱动因素存在争议。一些人认为ESBL基因被引入到特别成功的细菌克隆中。另一些人则暗示非常成功的质粒推动了其快速传播。需要更多关于菌株类型、质粒和移动遗传元件的研究及流行病学研究来回答这些问题。为了对抗，或至少减缓EPE数量增加这一令人担忧的趋势，还需要更多关于EPE在携带者中持续存在的知识，以及更好地理解抗生素治疗和其他风险因素如何影响其持续存在和进一步传播。本综述旨在从北欧视角对这一全球问题进行概述。
