Extended-spectrum beta-lactamase-producing enterobacteriaceae.

Extended-spectrum beta-lactamases (ESBL) were first observed in 1983. Since then, the number and variety of ESBLs have increased rapidly, particularly in France, and their distribution is now worldwide. The number of ESBLs has now reached more than 30, some of them spreading largely in several countries, such as SHV-4, in France. Intensive care units were first involved. Patients from nursing homes may recirculate ESBLs into acute care units. ESBL clinical epidemiology does not differ from other enterobacteriaceae. Digestive tract is the main reservoir, hands are the route of transmission. Infection develops in about 50% of colonized patients, more than one-half being urinary tract infections. Risk factors for colonization or infection are length of exposure to an epidemic strain and frequency of health-care-worker contact. Strategies for containing spreading of ESBL-producing strains include use of barrier precautions for carriers. Judicious use of antimicrobial agents is also important, by decreasing antibiotic selective pressure.