ESBL-producing Enterobacteriaceae, an Unnoticed Pandemic with Challenges in Clinical Practice, a mini-review.

Antimicrobial resistance in gram-negative bacilli is an ecological problem with a major impact on public health. Extended-spectrum β-lactamases (ESBLs) are enzymes that inactivate broad-spectrum antibiotics, penicillins, third and fourth generation cephalosporins. There are many factors associated with the global spread of ESBLs, such as the use of over-the-counter antibiotics, the food industry, travel abroad, and the lack of implementation of control strategies in hospitals and at the community level. Fecal carriers of ESBLs are increasingly commonly encountered in routine hospital settings as many hospitals have implemented rectal screening for ESBLs, however, the utility of this clinical practice and the routine isolation of patients carrying these bacteria has controversial benefits. There are challenges in selecting suitable patients for empirical therapy with carbapenems for the treatment of presumed severe ESBLs infections. Inappropriate empirical therapy is associated with high mortality in bloodstream infections. Carbapenems are the standard of care for severe invasive ESBL-E infections outside the urinary tract, however, overuse of carbapenems may lead to the emergence of carbapenem-resistant Enterobacterales. This mini review is intended to contribute to understanding about ESBLs as a global ecological problem, causing a considerable impact on health care services and posing enormous challenges in everyday antimicrobial therapy.