ESBL - Super Resistance, Should We Be Worried?

ESBL-producing bacteria have joined the growing number of antibiotic resistant pathogens that cause hospital-acquired infections. Resistant to most beta-lactam antibiotics, including penicillins and cephalosporins, washing hands is the most effective way of preventing the spread of ESBL producing bacteria.

ESBL stands for Extended-Spectrum Beta Lactamase, which are enzymes produced by bacteria capable of resisting the efficacy of antibiotics. ESBL does not refer to one specific type of bacteria, instead, ESBL refers to an antibiotic-resistance enabling enzyme that the bacteria are producing as a means of protecting themselves against attack.

It would seem that bacteria have responded to the worldwide overuse of antibiotics in farming and medicine by creating beta lactamase, an enzyme that grants the bacteria immunity to each new antibiotic they encounter.

Many different species of bacteria can produce the ESBL enzymes although the most common ESBL producing bacteria are E. coli and Klebsiella which together account for up to 95% of urinary tract infections.

Bacteria known to produce ESBL

• Escherichia coli.
• Klebsiella pneumoniae.
• Klebsiella oxytoca.
• Pseudomonas aeruginosa.
• Kluyvera species.
• Enterobacter aerogenes.
• Enterobacter cloacae.
• Proteus mirabilis.
• Haemophilus influenzae.
• Salmonella enterica.
• Neisseria gonorrhoeae.

Infection is spread by infected persons touching others, or shared usage of objects contaminated by infected persons. Most infections are contracted after hospital stays lasting 11 days or longer. Preventing the spread of hospital acquired infections is the best defence against them. Without a route of transmission, the bacteria cannot migrate to new hosts. Washing hands frequently and effectively is an obvious way of preventing transmission, as is sterilising equipment and keeping handles and surfaces clean.

It is not rude to remind care providers, hospital employees, work colleagues, family and friends to wash their hands frequently or before tending to you. Wash your own hands before handling other objects, eating or touching your face and thoroughly in hot water after using the toilet.

Symptoms

Symptoms caused by ESBL vary depending on which bacteria are involved and the location of the infection. The most common symptom is diarrhea, caused by the immune system's effort to rid the body of waste which may be contributing to the infection. The most common conditions caused by ESBL producing bacteria are:

• Urinary Tract Infection.
• Gastrointestinal infections with symptoms including diarrhea, dehydration, headaches, nausea and vomiting, fever, suppressed appetite.
• Pneumonia, with symptoms similar to the flu, but may have taken longer to develop or developed after a bout of the flu.
• Skin wounds, where the skin may be hot to the touch, may be red around the wound, and may seep clear fluids.
• Sepsis, with symptoms of fever, diarrhea, rapid heart beat, rapid breathing, nausea, vomiting and confusion.

Treatment

ESBL infections are sometimes mis-diagnosed causing delays in getting proper treatment. Once identified, most ESBL infections can be successfully treated with different types of antibiotics, usually a class of antibiotics called carbapenems, and sometimes with a combination of different types of antibiotics.

Prevention

• Politely request all health care providers wash their hands and any equipment before tending to you.
• Avoid touching your own face, especially around the nose, ears and mouth.
• Keep your skin well covered.
• Wash your hands frequently with warm water and soap.
• Keep your distance from infected persons.
• Wash all clothing and possessions once discharged from hospital.
• Steralise of disinfect surfaces and fixtures around the home.
• Avoid crowded areas.