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Previous Volume 352:380-391 January 27, 2005 Number 4 Next

The New -Lactamases

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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The -lactamases are the major defense of gram-negative bacteria against -lactam antibiotics. -Lactamases can be broadly divided into enzymes with a serine residue at the active site, similar to bacterial penicillin-binding proteins, from which they probably evolved,¹ and metalloenzymes with zinc ion as a cofactor and with a separate heritage.² Both are ancient enzymes. The serine group is estimated from current sequence diversity to have evolved with bacteria over the past 2 billion years.³

Since -lactam antibiotics came into clinical use, -lactamases have coevolved with them.⁴ Early events were an increase in their prevalence in organisms in which the enzyme . . . [Full Text of this Article]

Classification of -Lactamases

The New -Lactamases

TEM-Type ESBLs (Class A)

SHV-Type ESBLs (Class A)

CTX-M–Type ESBLs (Class A)

Other Class A ESBLs

OXA-Type ESBLs (Class D)

Plasmid-Mediated AmpC Enzymes (Class C)

Carbapenemases (Classes A, B, and D)

Factors Influencing -Lactamase Expression

Genetics of -Lactamases

Prevalence

Detection

Risk Factors for Infection

Treatment

In Vitro Data

Studies in Humans

Outbreak Control

Conclusions

Source Information

From the Department of Infectious Diseases, Lahey Clinic, Burlington, Mass., and Harvard Medical School, Boston (G.A.J.); and the Department of Geographic Medicine and Infectious Diseases, Tufts–New England Medical Center and Tufts University School of Medicine, Boston (L.S.M.-P.).

Address reprint requests to Dr. Jacoby at Lahey Clinic, 41 Mall Rd., Burlington, MA 01805, or at george.a.jacoby@lahey.org.

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