What is the difference between ESBL and carbapenemase? (2024)

What is ESBL and carbapenemase?

Carbapenems are one of the few remaining antibiotics that can treat ESBL-producing germs, but resistance enzymes that destroy these antibiotics are on the rise, too. The more we rely on this important class of antibiotics, the greater the risk of spreading resistance to them.

ESBLs are a lot like another superbug called CPE (Carbapenemase Producing Enterobacterales). The difference is that CPE is even more resistant to antibiotics than ESBLs. For most people most of the time, ESBLs live harmlessly in the bowel and do not cause infection.

Enterobacterales that are resistant to carbapenems by any mechanism are called carbapenem-resistant Enterobacterales (CRE) (those that produce carbapenemases are called 'carbapenemase-producing Enterobacteriaceae' (CP-CRE, or CPE for short)) and Enterobacteriaceae that produce ESBL enzymes are called 'ESBLs'.

Carbapenemases are β-lactamases with versatile hydrolytic capacities. They have the ability to hydrolyze penicillins, cephalosporins, monobactams, and carbapenems. Bacteria producing these β-lactamases may cause serious infections in which the carbapenemase activity renders many β-lactams ineffective.

Extended-spectrum beta-lactamases (ESBLs) are enzymes that confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins, and the monobactam aztreonam. Infections with ESBL-producing organisms have been associated with poor outcomes.

Carbapenems are a class of beta-lactam antibiotic that are active against many aerobic and anaerobic gram-positive and gram-negative organisms.

What is an ESBL infection? ESBL stands for extended spectrum beta-lactamase. It's an enzyme found in some strains of bacteria. ESBL-producing bacteria can't be killed by many of the antibiotics that doctors use to treat infections, like penicillins and some cephalosporins.

The two most common bacteria that produce ESBLs are E. coli — or Escherichia coli — and Klebsiella pneumoniae — both of which are found in your gut even when you are healthy. Most E. coli strains and types are harmless, but some of them can cause infections leading to stomach pains and diarrhea.

Carbapenem-resistant Enterobacterales (CRE) Enterobacterales are a large order of different types of germs (bacteria) that commonly cause infections in healthcare settings. Examples of germs in the Enterobacterales order include Escherichia coli (E. coli) and Klebsiella pneumoniae.

Carbapenem-resistant Enterobacteriaceae (CRE) are Enterobacteriaceae that are non-susceptible to carbapenem antibiotics. Carbapenemase-producing Enterobacteriaceae (CPE) are defined as any of the CRE that harbour a gene encoding carbapenemase (a β-lactamase).

What is the most common carbapenemase?

pneumoniae carbapenemase (KPC): This was first identified in the United States around 2001 and is the most common carbapenemase in the United States. New Delhi Metallo-beta-lactamase (NDM): A less common carbapenemase in the United States but concerning because it can be resistant to even more antibiotics than KPC.

In Ireland, the terms carbapenemase producing Enterobacteriaceae (CPE) and carbapenem resistant Enterobacteriaceae (CRE) are often used interchangeably by healthcare workers when referring to a family of bacteria that live in the bowel.

Generic and brand names of carbapenems include: Doribax. Doripenem. Ertapenem.

The most effective carbapenemases, in terms of carbapenem hydrolysis and geographical spread, are KPC, VIM, IMP, NDM and OXA-48 types [Poirel et al. 2012]. KPCs inactivate all beta-lactam antibiotics and are only partially inhibited by beta-lactamase inhibitors like clavulanic acid, tazobactam and boronic acid.

Carbapenemases allow bacteria to become resistant to carbapenems and other β-lactam antibiotics. The genes that encode carbapenemases are typically found on mobile gene elements called plasmids, which means they can be easily transferred between different types of bacteria.

How are ESBL bacterial infections diagnosed? Your healthcare provider will take a sample of urine, stool, infected tissue, or blood. He or she may also take a swab of the area around the rectum or of another place in the body. The sample, swab, or both are sent to a lab and tested for ESBL bacteria.

A person can be either colonized or infected with ESBL. If a person is colonized, it means that the germ is present on their skin or in a body opening, but they have no signs of illness. If a person is infected, it means that the germ is present on their skin or in a body opening and it's causing illness.

We also highlight important features of the carbapenems that are presently in clinical use: imipenem-cilastatin, meropenem, ertapenem, doripenem, panipenem-betamipron, and biapenem.

Carbapenems are a class of very effective antibiotic agents most commonly used for the treatment of severe bacterial infections. This class of antibiotics is usually reserved for known or suspected multidrug-resistant (MDR) bacterial infections.

The carbapenem class of antibiotics includes meropenem, imipenem, ertapenem, and doripenem. These antibiotics are often used as the last line of treatment for infections caused by resistant Gram-negative bacteria including Pseudomonas aeruginosa.

Can you ever get rid of ESBL?

Most ESBL infections can be treated successfully once your doctor has found a medication that can stop the resistant bacteria. After your infection is treated, your doctor will likely give you good hygiene practices. These can help ensure you don't develop any other infections that can also resist antibiotics.

The clinical diagnosis/condition of the study subjects as the reason for blood culture was mostly suspected sepsis. Among those infected by the ESBL producing bacteria 63.9% were diagnosed as sepsis, 13.9% each were diagnosed as SIRS and other infections, and 8.3% suffered from fever.

Carbapenems are considered the most reliable treatment for infections caused by ESBL- producing bacteria.

ESBL bacteria can be spread from person to person on contaminated hands of both patients and healthcare workers. The risk of transmission is increased if the person has diarrhoea or has a urinary catheter in place as these bacteria are often carried harmlessly in the bowel.

Because ESBL is discovered on clinical specimen (e.g., urine cultures), you will still know when an infection occurs due to an ESBL-producing bacteria. Patients that we know are carrying ESBL-producing bacteria will no longer require isolation or Contact Precautions.

In a retrospective study that evaluated treatment with ertapenem administered through outpatient parenteral antibiotic therapy (OPAT) in patients with urinary tract infections caused by ESBL-EB, the mean duration of antimicrobial treatment was 11.2 days [15].

The major concern with OXA carbapenemases is their ability to rapidly mutate and expand their spectrum of activity. Studies by Mathers et al. [85] reported frequent detection of class D among the Enterobacteriaceae family making this a threat and a major public health problem worldwide [85].

CRE are a major concern for patients in healthcare settings because they are resistant to carbapenem antibiotics, which are considered the last line of defense to treat multidrug-resistant bacterial infections.

Carbapenems do not cover atypical bacteria because these bacteria lack a cell wall that carbapenems attack.

Extended Spectrum Beta-Lactamase (ESBL) and Carbapenemase-producing Enterobacteriaceae (CPE) are enzymes normally produced by micro-organisms (bugs) in the gut, such as E coli and Klebsiella. These organisms live harmlessly in the gut but occasionally can cause urine, abdominal and bloodstream infections.

What are the 5 types of CRE?

This testing includes phenotypic testing for carbapenemase activity and molecular identification of the five carbapenemases most frequently identified in CRE: KPC, NDM, VIM, OXA-48-type, and IMP.

The two most common types of CRE in the United States are carbapenem-resistant Klebsiella bacteria and carbapenem-resistant Escherichia coli (E. coli), according to the CDC.

Phenotypically, carbapenems resistance is in due to the two key mechanisms, like structural mutation coupled with β-lactamase production and the ability of the pathogen to produce carbapenemases which ultimately hydrolyze the carbapenem.

CPE (carbapenemase-producing Enterobacterales) are bacteria (bugs) that live in the gut. CPE are a type of superbug. These are bugs that are resistant to many antibiotics. This means that some antibiotics that were used to treat them no longer work very well.

Enterobacterales are a type of bacteria that usually live in your gut. Carbapenemase-producing Enterobacterales (CPE) are a group of bacteria that have become resistant to many antibiotics, making them more difficult to treat. CPE can spread from person to person via shared objects or people's hands.

The term CE is used interchangeably with CPE (continuing professional education). Before you enroll in a CE course, is important to evaluate whether the course will be accepted for CE credit for your EA renewal.

Carbapenems are some of the strongest antibiotics and are often used for treating severe healthcare-associated infections. CRE are Enterobacteriaceae that are resistant to carbapenem antibiotics. Typically, they also are resistant to most other antibiotics.

Imipenem/cilastatin/relebactam was approved by the FDA in adults with limited or no alternative treatment options for treatment of cUTI or cIAI in 2019,¹⁵ and for treatment of HAP and VAP in 2020,¹⁶ and by the EMA for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment ...

Tebipenem and sulopenem are carbapenems with oral formulations that have been studied in phase 3 trials. Each typically has a broad spectrum of activity, including streptococci, methicillin-susceptible strains of staphylococci, Enterobacterales (including ESBL-producing strains), and many anaerobes.

The most important and clinically relevant carbapenemases are KPC, IMP/VIM/NDM, and OXA-48. However, several carbapenemases belonging to the different classes are less frequently detected.

What are the symptoms of carbapenemase?

What are the symptoms of CRE? Symptoms of CRE infection will vary depending on the site of infection (e.g. a cough if in the lungs, urinary symptoms if in the bladder). A person may also have general symptoms of infection, such as fever and chills. Some people may carry CRE but may not be sick and may have no symptoms.

Antimicrobial Chemotherapy

The carbapenems have an extremely broad spectrum of antimicrobial activity and are highly resistant to a variety of β-lactamases. Antimicrobial activity of carbapenem antibiotics is extremely high. Many multi-drug-resistant hospital-acquired bacteria are often sensitive to carbapenems.

Polymyxin B or inhaled colistin are possible antibiotics for the treatment of localized pneumonia due to CRE, and commonly used in cycstic fibrosis patients. [27] Tigecycline and aminoglycosides are effective treatments for pneumonia when susceptible, but have poor lung penetration.

Carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae (CPE) are Gram-negative bacteria that are resistant to the carbapenem class of antibiotics, considered the drugs of last resort for such infections.

Most ESBL infections are spread by direct contact with an infected person's bodily fluids (blood, drainage from a wound, urine, bowel movements, or phlegm). They can also be spread by contact with equipment or surfaces that have been contaminated with the germ.

The two most common bacteria that produce ESBLs are E. coli — or Escherichia coli — and Klebsiella pneumoniae — both of which are found in your gut even when you are healthy. Most E. coli strains and types are harmless, but some of them can cause infections leading to stomach pains and diarrhea.

Can ESBL be cleared? Some children can be cleared of ESBL. This depends on the use of antibiotics, whether they have any drains / tubes or devices, and whether they have any ongoing health conditions. The infection control nurses will be able to advise you.

coli, 18 had had several consecutive negative cultures after shedding ESBL–E. coli for a median of 7.5 months (range, 0–39 months), 16 had died while still carrying ESBL–E. coli (median duration of carriage, 9 months; range, 0–38 months), and 3 had been lost to follow-up.

Most ESBL infections can be treated successfully once your doctor has found a medication that can stop the resistant bacteria. After your infection is treated, your doctor will likely give you good hygiene practices. These can help ensure you don't develop any other infections that can also resist antibiotics.

How serious is ESBL?

ESBL infections usually occur in the urinary tract, lungs, skin, blood, or abdomen. ESBL infections are serious and can be life-threatening.

ESBL-producing bacteria can't be killed by many of the antibiotics that doctors use to treat infections, like penicillins and some cephalosporins. This makes it harder to treat. An infection with ESBL germs can be in any part of the body, including blood, organs, skin, and sites where surgery was done.

Carbapenems are generally considered the drug of choice for the treatment of ESBL-EC infections.

These germs (or ESBL bacteria, for short) break down several types of antibiotic medicine. So when you get sick because of ESBL bacteria, the infection is harder to treat and you may need different antibiotics. Infections caused by ESBL bacteria usually affect the urinary tract and gut (intestine).

These enzymes can often be excreted. Extended-spectrum β-lactamases (ESBLs) mediate resistance to all penicillins, third generation cephalosporins (e.g. ceftazidime, cefotaxime, and ceftriaxone) and aztreonam, but not to cephamycins (cefoxitin and cefotetan) and carbapenems (Bonnet, 2004).