CTX-M: Changing the face of ESBLs in Europe

David M Livermore, Rafael Canton, Marek Gniadkowski, Patrice Nordmann, Gian Maria Rossolini, Guillaume Arlet, Juan Ayala, Teresa M Coque, Izabela Kern-Zdanowicz, Francesco Luzzaro, Laurent Poirel, Neil Woodford

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794 Citations (Scopus)


Since around 2000 - earlier in Poland and Spain and later in France and the UK - dramatic shifts have occurred in the prevalence and types of extended-spectrum beta-lactamases (ESBLs) in Europe. Before this watershed, most producers were nosocomial isolates, often Klebsiella spp. or Enterobacter spp. from specialist care units, and had mutant TEM or SHV ESBLs. Subsequently, CTX-M ESBLs have become dominant, with much greater penetration into Escherichia coli, and with many infections in 'complicated community' patients, usually with underlying disease, recent antibiotic usage, or healthcare contact. The degree of clonality among producers varies with the country, as does the enzyme type produced, with group 9 (CTX-M-9 and -14) enzymes dominant in Spain and group 1 enzymes (particularly CTX-M-3 and -15) dominant elsewhere. Irrespective of the particular enzyme, most producers are multiresistant. These changing patterns present major therapeutic and infection control challenges, with the public health intervention points unclear.
Original languageEnglish
Pages (from-to)165-174
Number of pages10
JournalJournal of Antimicrobial Chemotherapy
Issue number2
Publication statusPublished - Feb 2007


  • Community-Acquired Infections
  • Enterobacter
  • Enterobacteriaceae Infections
  • Escherichia coli
  • Escherichia coli Infections
  • Europe
  • Humans
  • Klebsiella
  • Klebsiella Infections
  • Mutation
  • beta-Lactamases

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