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Skip to 0 minutes and 8 secondsThe epidemiology of extended-spectrum beta-lactamases and carbapenemases can be very complex. However, there are some basic points to highlight from a biologic and geographic perspective. Regarding extended-spectrum beta-lactamases, it's worth noting that enzymes belonging to the CTX-M families are the most widely disseminated ESBLs. The prevalence of ESBLs, both CTX-M, as well as other types, varies within patient populations, meaning between those who have disease onset in the community compared to those who have disease onset in the hospital, and also geographically. This table shows the prevalence rates of ESBLs among E. coli and Klebsiella pneumonia isolates by country or region. The highest prevalence rates are seen in India where they can be well above 80%, whilst in China they are above 60%.

Skip to 1 minute and 15 secondsRates as high as 30% are seen in East and Southeast Asia, Latin America, and Southern Europe, whilst in Australasia, Northern Europe, and North America these rates range between 5% and 10%.

Skip to 1 minute and 34 secondsRegarding carbapenemases, it's important to highlight that they are a biochemically diverse group which includes members of Ambler's class A, B, and C. Reports of its dissemination are increasing worldwide, but they still have distinct geographic niches, which we will now review. In the case of KPC these enzymes are endemic to the United States, Colombia, Brazil, Italy, Greece and Israel. Whilst NDM type of Metallo-beta-lactamases are frequently encountered in the Indian subcontinent and are also endemic in the Balkan states. The newest threat which is posed by the OXA-48 type of enzymes started in Turkey, where it is now epidemic. And it has quickly spread through Northern Africa and also the Middle East.

Epidemiology of ESBLs and Carbapenemases

In Step 2.5 you reviewed the basic concepts used to describe resistant Gram-negative bacteria, particularly those that are able to destroy beta-lactam antibiotics.

The prevalence and distribution of Gram-negative bacteria harbouring beta-lactamases varies among regions of the world, and even within countries. Knowledge of these differences is of clinical important in our increasingly connected world.

In this video, Dr. Rossana Rosa highlights the key basic points to note about the epidemiology of ESBLs and Carbapenemases from a geographic and biological perspective.

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This video is from the free online course:

Challenges in Antibiotic Resistance: Gram Negative Bacteria

The British Society for Antimicrobial Chemotherapy