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CTX-M genes have become the most common ESBL genes due to their mobilization and
dissemination mechanisms, namely insertion sequences (e.g., ISEcpl, IS26, and ISCR1), integrons,
transposons, and plasmids (Bush & Fisher, 2011; Coque, Baquero, & Cantón, 2008). CTX-M-1
was first reported in Munich, Germany from a cefotaxime-resistant but ceftazidime-susceptible
Escherichia coli isolate recovered from the ear of a 4-month-old child with otitis media.
Succeeding enzymes were grouped under the CTX-M family due to their preferential hydrolytic
activity against cefotaxime. CTX-M enzymes were initially detected in Enterobacteriaciae,
including Escherichia coli, Klebsiella pneumoniae and Salmonella spp. but have increased in
prevalence among non-Enterobacteriaciae Gram-negative bacilli such as Pseudomonas
aeruginosa and Stenotrophomonas maltophila (Cantón, González-Alba, & Galán, 2012).
According to a study conducted by Tacão, Correia, and Henriques (2012), cefotaxime-resistant
strains recovered were identified as Pseudomonas spp. (i.e., P. fluorescens & P. putida),
Enterobacteriaciae such as Escherichia coli and Enterobacter spp., and Aeromonas spp.
Bush, K., Fisher, J.F. (2011). Epidemiological expansion, structural studies, and clinical
challenges of new beta-lactamases from Gram-negative bacteria. Annu. Rev.
Microbiol. 65, 455–478
Center for Disease Control and Prevention (2010). Healthcare-associated Infections. Retrieved
from https://www.cdc.gov/hai/settings/lab/lab_esbl.html.
D’Andrea, M.M., Arena, F., Pallecchi, L., & Rossolini, G.M. (2013). CTX-M-type beta-
lactamases: a successful story of antibiotic resistance. Int J Med Microbiol. 303, 05–17.
Liebana, E., Carattoli, A., Coque, T.M., Hasman, H., Magiorakos, A., Mevius, D. et al. (2013).
Public health risks of enterobacterial isolates producing extended-spectrum β-lactamases or
AmpC g-lactamases in food and food- producing animals: An EU perspective of
epidemiology, analytical methods, risk factors, and control options. Food Safety, 56,
1030-1037.
Tacão, M., Correia, A., & Henriques, I. (2012). Resistance to Broad-Spectrum Antibiotics in
Aquatic Systems: Anthropogenic Activities Modulate the Dissemination of blaCTX-M-Like
Genes. Appl Environ Microbiol. 78(12), 4134-4140. Retrieved from https://www.ncbi.
nlm.nih.gov/pmc/articles/PMC3370516/
Woerther, P.L., Burdet, C., Chachaty, E., & Andremont, A. (2013). Trends in human fecal
carriage of extended-spectrum beta-lactamases in the community: toward the
globalization of CTX-M. Clin Microbiol. 26, 744-758.