Infection control
Philip Woodrow in Nursing Acutely Ill Adults, 2015
Antibiotic resistance rapidly followed introduction of antibiotics: meticillin was marketed in 1960, and six months later resistance was reported (Grundmann, 2006). However, recent exponential increase in microbial resistance (‘superbugs’) (Larson et al., 2010) raises spectres of antibiotic-resistance epidemics (Cars et al., 2008), prompting promotion of antibiotic stewardship – avoiding unnecessary usage. Emergence of extended spectrum beta-lactamase (ESBL) enables organisms to develop cross-resistance to many antibiotics, making them even more difficult to eliminate. Carbapenems are the ‘last resort’ antibiotic (WHO, 2014), so carbapenem-resistant Enterobactericeae (CRE, previously called New Delhi Metallo Beta-Lactamase – NDM-1) pose a major threat, which is increasing (CDC, 2013; WHO, 2014).
Identification of clinical specimens isolated from neonates
Elida Zairina, Junaidi Khotib, Chrismawan Ardianto, Syed Azhar Syed Sulaiman, Charles D. Sands, Timothy E. Welty in Unity in Diversity and the Standardisation of Clinical Pharmacy Services, 2017
NICU patients represent a unique human host model, as the development of resident microflora starts on admission to the epidemiology. Transferable resistant mechanisms, such as ESBL production, pose a challenge to controlling of multi-resistant organisms. ESBL colonization is related to antibiotic use. Once colonized, infants exposed to invasive device may become infected. 12% (2003) and 14% (2004) of total isolates were Klebsiella pneumoniae.57.5% (2003) and 29.4% (2004) of them were ESBL-producing K. pneumoniae.4% were E. coli, only isolated (2003), and 15.4% of them were ESBL-producing organisms.
Problematic Beta-Lactamases: An Update
Robert C. Owens, Lautenbach Ebbing in Antimicrobial Resistance, 2007
Figure 1 shows how the ESBL mutations open the active site, leading to greater rates of cephalosporin hydrolysis, causing antibiotic resistance. An interesting property, or phenotype, of these ESBLs was noted: despite their ability to hydrolyze our most potent antibiotics of the time, they were inhibited even more effectively than their progenitors by drugs like clavulanic acid and tazobactam. These inhibitor drugs had been developed specifically to target the wild-type TEM and SHV Class A type enzymes, and were designed to be given together with extended spectrum penicillins like amoxicillin, ampicillin, and piperacillin. This inhibitor-sensitive phenotype is being used in the clinical microbiology laboratory to detect ESBL production in Enterobacteraciae [reviewed in (12)].
Synergistic antibacterial and anti-biofilm activity of nisin like bacteriocin with curcumin and cinnamaldehyde against ESBL and MBL producing clinical strains
Published in Biofouling, 2020
Garima Sharma, Shweta Dang, Aruna K, Manjula Kalia, Reema Gabrani
Extended spectrum β-lactamases (ESBLs) producing organisms, are prevalent in hospitals and in the community and these bacteria are resistant to a multitude of antibiotics and are therefore of medical and scientific concern (Dhillon and Clark 2012). E. coli and Klebsiella pneumoniae are ESBL-producing organisms that can be isolated globally (Shaikh et al. 2015). The metallo-beta-lactamases (MBLs) render Gram-negative bacteria resistant to most β lactams and these have spread across numerous bacterial species with increasing diversity (Cornaglia et al. 2007; Zhang et al. 2020). Infections by ESBL and MBL bacteria are, at times, very resilient to antibiotics. Biofilm producing ESBL and MBL strains are significantly more resistant to a wide range of antibiotics compared to non-biofilm forming strains (Neupane et al. 2016). There is thus an urgent need to explore alternative therapies to address the current problem. The current focus of the World Health Organisation (WHO) is to identify the magnitude of antibacterial resistance and develop a global action plan for its mitigation.
High frequency and molecular characterization of ESBL-producing Enterobacteriaceae isolated from wound infections in North Lebanon
Published in Expert Review of Anti-infective Therapy, 2023
Afnan M. Hamwi, Elie Salem-Sokhn
According to studies, resistance to third-generation cephalosporins (3GCs) was accompanied by resistance to other antimicrobial classes and was borne on plasmids [5,59,60]. In this study, resistance to drugs which are not hydrolyzed by ESBLs was more frequently found in ESBL producers than in non-ESBL producers, as it was in a study conducted in France [57]. The resistance of ESBL-PE isolates to other antibiotic classes is concerning, because it may limit the choice of appropriate empirical treatment for infections caused by these bacteria [61]. Our results showed that most ESBL producers were resistant to other tested antimicrobials. High resistance was found to amoxicillin/clavulanate (96%), ciprofloxacin (82%), gentamicin (50%), and tetracyclines (44%). This is in agreement with other many studies [52,56,62,63]. This result confirmed that these isolates are multidrug-resistant ESBL-PE, where the ESBL resistance genes were found co-migrating with other antimicrobial classes, posing an additional challenge for the successful therapy of other infectious diseases in which these bacteria might be involved. However, several drugs remain effective in overcoming ESBL infections. Our findings showed that imipenem, ertapenem, and amikacin had the ability to cure a large range of ESBL-PE isolates. This is consistent with many studies carried out in Lebanon [56,64] and other countries [57,65,66]. To avoid the development of carbapenem-resistant Enterobacteriaceae, these drugs should be carefully used for empirical therapies [57].
In vitro and in silico β-lactamase inhibitory properties and phytochemical profile of Ocimum basilicum cultivated in central delta of Egypt
Published in Pharmaceutical Biology, 2022
Nagwa A. Shoeib, Lamiaa A. Al-Madboly, Amany E. Ragab
Phenotypic detection of ESBL activity among test E. coli pathogens showed only two positive isolates. Double disc synergy results usually observed as synergism between amoxicillin/clavulanic acid and the test antibiotic (Figure 2(a)). It showed typical keyhole pattern due to merged inhibition zones denoting a positive ESBL producing isolates. For confirmation, combination disc test was used. Data showed increased zone diameter (≥5 mm) around the discs of cefotaxime or ceftazidime after addition of clavulanic acid compared to their zone diameters when tested alone confirming positive ESBL as presented in Figure 2(b). Genotypic detection of blaCTX-M gene revealed the presence of an amplified band at 500 bp in two test isolates as noticed in Figure 2(c).
Related Knowledge Centers
- Antibiotic
- Bacteria
- Carbapenem
- Cephalosporin
- Cephamycin
- Enzyme
- Ertapenem
- Multiple Drug Resistance
- Beta-Lactam Antibiotics
- Beta-Lactam