Bacteria are constantly evolving and finding ways around antibiotic treatment. One of the ways bacteria become resistant to antibiotics is by producing extended-spectrum beta-lactamase, or ESBL—an enzyme that breaks down many commonly used antibiotics.

ESBL infections are much more challenging to treat because doctors have fewer options for antibiotics to choose from. While some classes of antibiotics are still effective at treating ESBL infections, the options are limited, and some bacteria are already becoming resistant to them.

Which Bacteria Produce ESBL?

Enterobacterales bacteria are known to produce ESBL. Some researchers believe this order of bacteria has had a more significant impact on the medical field, public health, veterinary health, and the global community than any other bacteria.

Enterobacterales are responsible for a wide range of infections, including urinary tract infections, food poisoning, and the plague. They also cause infections in fish and other aquatic life and are responsible for various plant diseases. Many dangerous bacteria, like E. coli, salmonella, and K. pneumonia, belong to this order.

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How Does Antibiotic Resistance Happen?

There are several causes for antibiotic resistance. These bacteria have evolved to excrete the ESBL enzyme. Many factors may have contributed to this, including societal pressures for doctors to prescribe antibiotics inappropriately, such as prescribing an antibiotic for a viral infection (which need antivirals) to appease the patient or prescribing a broad-spectrum antibiotic when a more targeted one would do. Other factors include:

  • The use of strong antibiotics in hospitals.
  • The spread of bacterial infections in hospitals.
  • Using antibiotics for agricultural purposes.

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The Spread of ESBL Infections

Initially, ESBL infections were found in the hospital setting, but they quickly spread, first into nursing homes and then into the community. During the 1990s and 2000s, Enterobacteriaceae began being identified regularly in the community, most commonly as urinary infections caused by E. coli.

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Colonization vs Infection

People can be colonized or infected with ESBL-producing bacteria. "Colonized" means the bacteria are present in or on their body but are not causing an infection, while "infected" means the bacteria are causing an illness. Colonization can increase a person's risk of infection, especially people who are critically ill or immunocompromised, and people who are colonized are at risk spreading the bacteria to other people.

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Risk Factors for Hospital-Acquired Infection

Hospitalized people are at greater risk of getting an ESBL infectio, particularly those who are elderly, immunocompromised, recovering from recent surgery, have open wounds, or have drains or tubes in their body. People who have had long or repeated hospital stays, hospitalized patients with chronic illnesses like diabetes or cancer, and those who have received previous courses of antibiotic treatments are also at risk.

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Risk Factors for Community-Acquired Infection

The most common ESBL infection in the community is a urinary infection caused by E. coli. One study found that the people most at-risk for this type of community-acquired infection had a history of repeated UTIs, a urinary catheter, or prior antibiotic exposure within three months of the infection.

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Spread of ESBL Infections

ESBL infections commonly spread through direct contact with an infected person's bodily fluids, particularly wound drainage, blood, phlegm, urine, or stool. Contact with surfaces that are contaminated with the germ can spread ESBL infections, too, but casual contact, like hugging or holding hands, cannot.

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Preventing ESBL Infections

The best way to prevent an ESBL infection is to wash your hands. If you have an ESBL infection and are in the hospital, you will be placed in isolation to try to prevent spreading the infection to others. Your healthcare providers will wear yellow gowns and gloves while in your room and wash their hands with soap and water when they leave.

You will likely have a private room, and a sign will be posted outside letting staff and visitors know they must wear a gown and gloves before entering. If you have to leave your room for any reason, you will have to wear a gown and gloves, or your caregivers may cover you with a clean sheet. You will not be able to visit any common areas in the hospital, like the cafeteria, pantry, or lobby. Note that this will likely apply whether you have an active infection or are colonized with ESBL bacteria, until you have a culture that comes back negative.

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ESBL Mortality

Research shows that ESBL has a high mortality, especially for hospitalized patients. One study found that, after 21 days of onset, 38 percent of hospitalized patients with ESBL died. Researchers found that the main factor in this high mortality was inadequate antibiotic therapy within the first 72 hours of the infection.

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Treatment of ESBL

ESBL infections are still treated with antibiotics, but because they are resistant to many of the most common ones, options are somewhat limited. If they are not already, people with ESBL infections may need to be hospitalized so doctors can administer IV antibiotics. The Infection Disease Society of America recommends specific alternate treatments depending on the exact organism causing the infection.

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