Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae

The epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) has shifted markedly over the past two decades from a predominantly hospital-associated phenomenon to one of global public health concern. These organisms, most commonly Escherichia coli and Klebsiella pneumoniae, harbour enzymes capable of inactivating a broad range of penicillins and cephalosporins, and are carried both in clinical settings and in the community. Rates of faecal carriage vary widely, with prevalence exceeding 50 % in some regions of South and Southeast Asia and rising steadily in parts of Europe, North America and Africa. Transmission pathways include person-to-person spread, ingestion of contaminated food or water, environmental reservoirs and international travel. International surveillance networks have documented increasing proportions of ESBL-E among urinary tract and bloodstream isolates, reflecting both clonal expansion of successful lineages and horizontal transfer of resistance genes, particularly those of the CTX-M family. Risk factors for acquisition include recent antibiotic use, hospitalisation, comorbidities and travel to high-prevalence areas, while emerging evidence implicates food-production chains and recreational water sources. The global dissemination of key enzyme variants such as CTX-M-15 underscores the need for integrated surveillance, antimicrobial stewardship and infection-control measures across human, animal and environmental health sectors.

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Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae publication trend

The graph below shows the total number of articles in epidemiology of extended-spectrum beta-lactamase-producing enterobacteriaceae across all publications each year (not limited to Nature Index journals).

Technical terms

Extended‐spectrum beta‐lactamase (ESBL): An enzyme that confers resistance to penicillins and cephalosporins by hydrolysing their beta-lactam ring.

Enterobacteriaceae: A family of Gram-negative bacteria, including E. coli and K. pneumoniae, many of which are common gut commensals and opportunistic pathogens.

Carriage (or colonisation): The presence of bacteria in or on a host without causing active disease, often measured by faecal or rectal swabs.

Metagenomic sequencing: High-throughput analysis of genetic material recovered directly from environmental or clinical samples to profile microbial communities and resistance genes.

Mobile genetic elements (MGEs): DNA segments such as plasmids, transposons or insertion sequences that facilitate horizontal gene transfer between bacteria.

Surveillance network: A coordinated system of laboratories and reporting mechanisms that monitor the occurrence and trends of infectious agents and resistance patterns.

References

1. Gut microbiome perturbation, antibiotic resistance, and Escherichia coli strain dynamics associated with international travel: a metagenomic analysis. The Lancet Microbe (2023).
2. Proton pump inhibitors increase the risk of carbapenem-resistant Enterobacteriaceae colonization by facilitating the transfer of antibiotic resistance genes among bacteria in the gut microbiome. Gut Microbes (2024).
3. Increasing proportions of extended-spectrum β-lactamase-producing isolates among Escherichia coli from urine and bloodstream infections: results from a nationwide surveillance network, Finland, 2008 to 2019. Eurosurveillance (2023).
4. Assessing the impact of recreational water use on carriage of antimicrobial resistant organisms. The Science of The Total Environment (2023).
5. Trends in Human Fecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M. Clinical Microbiology Reviews (2013).