Introduction
Penicillin and Cephalosporins are common antibiotics used for managing bacterial infections. However, these antibiotics become ineffective against ESBL infections. In Europe, ESBL-inducing bacteria were initially identified in 1983. This article discusses the symptoms, treatment, and prevention of ESBL infection.
Which Bacteria Produce ESBL?
ESBL is a form of enzymes or chemicals produced by bacteria. The bacteria produce ESBL to develop resistance to several third-generation antibiotics. Some of the bacteria producing ESBL are:
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Escherichia Coli (e.coli): Although the bacteria is frequently found in guts and is harmless, it can cause food poisoning or infections. The ESBLs produced, frequently by E.coli, are CTX-M enzymes (Cefotaximase).
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Klebsiella: A harmless bacteria in the mouth, gut, and nose. The bacteria can also cause urinary tract infections. As the colonies of bacteria are found in a hospital environment, it causes infections to spread within hospitals. Strains of Klebsiella producing ESBL are Klebsiella pneumoniae and oxytoca.
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Other Bacteria: ESBL is produced rarely by bacteria such as Enterobacter species, Salmonella species, Morganella morganii, Proteus mirabilis, Serratia marcescens, and Pseudomonas aeruginosa.
Penicillin, Cephalosporins, and Monobactam aztreonam are antibiotics used to treat most E. Coli and Klebsiella infections. If these bacteria produce ESBL, the antibiotics become ineffective against the bacteria. Therefore, the healthcare provider must devise other treatment plans for managing antibiotic-resistant bacteria.
What Is ESBL Infection?
The ESBL enzymes or chemicals make the beta-lactam antibiotics ineffective in treating bacterial infections. The bacteria are found frequently in the bowel but can cause infections in wounds, the urinary tract, lungs, or the blood of individuals with weakened immunity.
ESBL infection often spreads in the hospital by doctors, nurses, or other healthcare professionals when they touch surfaces, people, or objects contaminated with the bacteria. Bacteria causing ESBL infections result in poor outcomes. The infections are severe and life-threatening and require specific antibiotics for treatment.
How Does One Get an ESBL Infection?
The water or soil contaminated with human and animal feces may contain ESBL bacteria. One can get an ESBL infection by touching water or dirt that contains the bacteria. Alternatively, touching animals with these bacteria can also cause ESBL infections.
Some infections, such as MRSA (Methicillin-Resistant Staphylococcus Aureus), are resistant to antibiotics and can increase the individual’s vulnerability to developing subsequent ESBL infection. The bacteria can be transferred by touching an infected person or an ESBL bacteria-contaminated surface. Other modes of transmission include shaking hands with a contaminated person, breathing on someone, or using an object touched by others.
Colonization is the spread of microorganisms by certain people without being infected. In colonization, the individual's body carries the bacteria without being actively infected. Such individuals can pass on infection but need not be treated.
What Are the Infections Caused by ESBL Bacteria?
ESBL bacteria are not of concern in healthy and fit individuals. The ESBL bacteria induce infections when they enter the body parts where they are unusually found, among old or immunocompromised. The condition can also develop in individuals undergoing long-term antibiotic therapy, prolonged hospital stay, or having a urinary catheter or cannula. The infections caused by ESBL bacteria are:
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Urinary tract infection (common).
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Skin infection.
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Diarrhea.
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Pneumonia.
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Life-threatening blood and lung infection develops.
The infections are difficult to treat due to their resistance to antibiotics.
What Are the Symptoms of ESBL Infection?
Symptoms of the ESBL infection depend on the bacteria causing the infection. Individuals who develop a UTI (Urinary Tract Infection) have a burning sensation while urinating and urinate more frequently. The ESBL bacteria causing skin infections result in reddened skin around the infection site, with fluid oozing out of the area. Gut infections cause a loss of appetite, bloody stool, stomach cramps, diarrhea, excessive bloating or gas, and fever. When the ESBL infection enters the blood, it causes disorientation, fever, chills, nausea, vomiting, and breathing problems.
If adequate hygiene and cross-contamination protocols are not followed, there is a risk for ESBL bacteria to spread from person to person. Poor hygiene is the predominant cause for the infection to spread.
How Is ESBL Infection Diagnosed?
Patients suspected of ESBL infection are microbiologically tested with a swab or specimen of the infected area in a laboratory setting. The infection must be diagnosed quickly to initiate timely treatment.
How Is an ESBL Infection Treated?
There are limited oral and intravenous antibiotic options for treating ESBL bacteria. Quick diagnosis helps stop ineffective antibiotics immediately. Most ESBL infections are successfully treated with medications that control resistant bacteria and good hygiene practices.
1. Medications
Drugs that can treat ESBL infections are:
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Carbapenems: It is one of the best medications against E.coli and Klebsiella pneumoniae bacteria causing ESBL infections.
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Fosfomycin: The medication is effective against ESBL bacterial infections.
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Colistin: The medications are prescribed during rare instances when other medications have failed to control ESBL infections.
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Non-beta lactam antibiotics.
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Beta-lactamase inhibitors.
2. Lifestyle Modifications
If a patient has colonization of ESBL but no active infections, the doctor will prescribe a special diet and hygiene regimen to prevent the infection from spreading. The doctor will also advise the individual to wash anything they have touched and avoid contact with people until the colonization is managed.
These treatment approaches ensure individuals do not develop subsequent infections that resist antibiotics.
How to Prevent ESBL Infection?
Washing hands frequently is one of the best methods to prevent ESBL infection. Handwashing is essential when one is in a healthcare or hospital facility. If the individual has contacted an ESBL-infected person, they must wash their hands immediately. Individuals caring for an infected individual must wear gloves. Healthcare providers handling instruments in hospitals or healthcare settings must use gloves.
Individuals who have had ESBL infection should wash their clothes, bedding, or other objects they have touched, worn, or slept separately to prevent the spread of the infection. Patients with ESBL infection in hospital settings are kept under contact isolation. In a hospital, contact isolation is a designated location where infections are kept isolated and do not spread to other patients. Remaining isolated for several hours or days is crucial, depending on the severity of the infection.
Conclusion
ESBL is a bacterial infection that causes infection within the hospital and the community. These bacteria are resistant to most of the frequently used antibiotics. Fewer drugs are available to act against infections produced by these bacteria. Patients require hospitalization and complex treatment to be cured of infections.
