Trends in Human Fecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M
Clin. Microbiol. Rev. October 2013 26(4): 744-758
Paul-Louis Woerther, Charles Burdet, Elisabeth Chachaty, and Antoine Andremont
Institut Gustave Roussy, Laboratoire de Microbiologie, Villejuif, Francea
Laboratoire de Bacteriologie, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, and EA3964 Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, Franceb
Département de Biostatistiques, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, Francec
In the last 10 years, extended-spectrum β-lactamase-producing enterobacteria (ESBL-E) have become one of the main challenges for antibiotic treatment of enterobacterial infections, largely because of the current CTX-M enzyme pandemic. However, most studies have focused on hospitalized patients, though today it appears that the community is strongly affected as well. We therefore decided to devote our investigation to trends in ESBL-E fecal carriage rates and comprehensively reviewed data from studies conducted on healthy populations in various parts of the world. We show that
(i) community ESBL-E fecal carriage, which was unknown before the turn of the millennium, has since increased significantly everywhere, with developing countries being the most affected;
(ii) intercontinental travel may have emphasized and globalized the issue; and
(iii) CTX-M enzymes, especially CTX-M-15, are the dominant type of ESBL. Altogether, these results suggest that CTX-M carriage is evolving toward a global pandemic but is still insufficiently described.
Only a better knowledge of its dynamics and biology will lead to further development of appropriate control measures.