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Overview of the Epidemiological Profileand Laboratory Detection of Extended-Spectrum β-Lactamases

机译：广谱β-内酰胺酶的流行病学概况和实验室检测概述

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Extended-spectrum β-lactamases (ESBLs) are plasmid-mediated bacterial enzymes that confer resistance to a broad range of β-lactams. They are descended by genetic mutation from native β-lactamases found in gram-negative bacteria, especially infectious strains of Escherichia coli and Klebsiella species. Genetic sequence modifications have broadened the substrate specificity of the enzymes to include third-generation cephalosporins, such as ceftazidime. Because ESBL-producing strains are resistant to a wide variety of commonly used antimicrobials, their proliferation poses a serious global health concern that has complicated treatment strategies for a growing number of hospitalized patients. Another resistance mechanism, also common to Enterobacteriaceae, results from the overproduction of chromosomal or plasmid-derived AmpC β-lactamases. These organisms share an antimicrobial resistance pattern similar to that of ESBL-producing organisms, with the prominent exception that, unlike most ESBLs, AmpC enzymes are not inhibited by clavulanate and similar β-lactamase inhibitors. Recent technological improvements in testing and in the development of uniform standards for both ESBL detection and confirmatory testing promise to make accurate identification of ESBL-producing organisms more accessible to clinical laboratories.
机译：广谱β-内酰胺酶（ESBLs）是质粒介导的细菌酶，可对多种β-内酰胺产生耐药性。它们是由革兰氏阴性细菌特别是大肠埃希菌和克雷伯菌属的传染性菌株中发现的天然β-内酰胺酶的基因突变引起的。遗传序列修饰扩大了酶的底物特异性，使其包括第三代头孢菌素，例如头孢他啶。由于产生ESBL的菌株对多种常用的抗菌剂具有抗性，因此它们的增殖引起了严重的全球健康问题，对于越来越多的住院患者而言，其治疗策略复杂。肠杆菌科也常见的另一种抗药性机制是由染色体或质粒衍生的AmpCβ-内酰胺酶的过量生产引起的。这些生物具有与产生ESBL的生物相似的抗药性模式，但最显着的例外是，不同于大多数ESBL，AmpC酶不受棒酸和类似的β-内酰胺酶抑制剂的抑制。在测试方面以及在为ESBL检测和确认性测试制定统一标准方面的最新技术改进有望使临床实验室更容易获得对ESBL产生生物的准确鉴定。

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  • 来源
    《Clinical Infectious Diseases》 |2006年第4期|S153-S163|共11页
  • 作者

    Michael A. Pfaller; and John Segreti;

  • 作者单位

    Department of Pathology Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa City;

    Department of Medicine Rush Medical College of Rush University Chicago Illinois;

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