Recent developments in {beta} lactamases and extended spectrum {beta} lactamases

doi:10.1136/bmj.327.7425.1209

BMJ 2003;327:1209-1213 (22 November), doi:10.1136/bmj.327.7425.1209

Clinical review

Recent developments in ${beta}$ lactamases and extended spectrum ${beta}$ lactamases

Joumana N Samaha-Kfoury, specialist in infectious diseases¹, George F Araj, director of clinical microbiology¹

¹ Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, PO Box 113-6044, Beirut, Lebanon

Correspondence to: G F Araj garaj@aub.edu.lb

Resistance to ${beta}$ lactam antibiotics is an increasing problem worldwide.This review describes the classification and mechanism of actionof ${beta}$ lactamases and the options available for detecting, treating,and controlling extended spectrum ${beta}$ lactamases

The first 150 words of the full text of this article appear below.

Introduction

${beta}$ lactam antimicrobial agents are the most common treatment forbacterial infections (table 1).¹ Rates of bacterial resistanceto antimicrobial agents are increasing worldwide, includingin Lebanon.² Production of ${beta}$ lactamases is the most common mechanismof bacterial resistance (table 2).^1
3 These enzymes are numerous,and they mutate continuously in response to the heavy pressureof antibiotic use, leading to the development of extended spectrum ${beta}$ lactamases (ESBLs).⁴ Examples are the mutated TEM and SHV genes,mainly found in strains of Escherichia coli and Klebsiella pneumoniaerespectively. Infections with ESBL producing bacterial strainsare encountered singly or in outbreaks, especially in criticalcare units in hospitals, resulting in increasing costs of treatmentand prolonged hospital stays. We aim to present a simplifiedreview of this highly complex subject, in the hope that it willguide the practising physician in appropriate decisions relatingto the use of ${beta}$ lactams in patient . . . [Full text of this article]

Sources and selection criteria

Groups and mechanisms of action of ${beta}$ lactams

${beta}$ lactamases

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Classification of ${beta}$ lactamases

Extended spectrum ${beta}$ lactamases

Methods of detecting ESBLs

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Treatment of ESBLs

Control measures

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