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Published: Thu, April 13, 2017
World | By Lorena Waters

Infections caused by ESBL-producing E. coli


ESBL (Extended-Spectrum Beta-Lactamase) -producing E. coli are antibiotic-resistant strains of E. coli. E. coli are very common bacteria that normally live harmlessly in the gut. ESBL-producing strains produce an enzyme called extended-spectrum beta lactamase, which makes them more resistant to cephalosporin antibiotics. Many ESBL-producing strains are also resistant to antibiotics belonging to other classes. This makes the infections harder to treat.

The types of infections that ESBL-producing E. coli can cause range from urinary tract infections, to - the more serious end of the spectrum - cases where they enter the bloodstream and cause blood poisoning. Infections with ESBL-producing E. coli are most common among the elderly, or those who have recently been in hospital or received antibiotic treatment. ESBL-producing E. coli are extremely rare in simple cystitis.

Infections caused by ESBL-producing E. coli are a growing worldwide phenomenon and are not unique to the UK. The Health Protection Agency is one of the leading institutions worldwide in terms of research in this area and has been providing advice about these infections for many years and in particular, produced a report on the increasing frequency of these infections in 2005.

Since 2003 the Agency has been working with NHS hospital microbiologists to ensure they are aware of these infections and are able to advise and provide information to their GPs and hospitals about the diagnosis and treatment of these infections. The Agency has also published a lot of information in scientific journals and issued advice directly to GPs via its website and leaflets. It also continues to review the activity of new antibiotics against bacteria with these enzymes.

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The second theory for the origin of these infections, which also requires more research, is that migration could be a source. ESBL-producing E. coli in their gut, though it should be stressed that most of these will be carrying it harmlessly, and it will not cause them any illness .

The figure being quoted in the average of 30,000 cases of infection due to ESBL-producing E. coli each year in the UK is an estimate. This estimate takes into account all cases, whether they cause urinary tract infections or blood poisoning; However this estimate still needs to be verified.

The Agency's monitoring shows that around 20,000 people a year in the UK (excluding Scotland) are affected by blood poisoning caused by E. coli. Of these, around 2,000 cases are caused by ESBL-producing E. coli (these figures cover blood poisoning only and not urinary tract infections). The Agency will be widening this surveillance system shortly and its eight regional laboratories will be carrying out surveillance of ESBLs in other types of infection (e.g. urinary infections) so that more complete picture of numbers and trends can be established. Any introduction of mandatory surveillance, as we currently have for MRSA or C difficile, would be the responsibility of the Department of Health.

For further information about ESBL-producing E.coli go to: http://www.hpa.org.uk/infections/topics_az/esbl/

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