Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
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Genes encoding extended-spectrum beta-lactamases (ESBLs) have been reported in a variety of Gram-negative species, mostly in Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii. They are mostly either TEM or SHV derivatives, CTX-M-like enzymes--now emerging worldwide--or, less frequently, VEB, GES, and PER ESBLs. The mechanisms responsible for their acquisition are very diverse, and mostly are related to insertion sequences (ISs), transposons, class 1 integrons, and also sul1-type integrons containing the ISCR1 element. This diversity of genetic vehicles at the origin of these mobilisation/acquisition processes enhances the spread of ESBLs.
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Among the many different structurally distinct classes of beta-lactams, the carbapenem class is regarded as that which is most potent and which has the widest spectrum of antimicrobial activity. Rapidly bactericidal, and demonstrating time-dependent killing, carbapenemes have a spectrum of antimicrobial activity that includes Gram-positive and Gram-negative aerobic and anaerobic pathogens. ⋯ Imipenem, meropenem and ertapenem are licensed in the European Community and panipenem and biapenem are also available in Japan and South Korea. Other carbapenemes are under development.