Multiresistant Enterobacteriaceae: new threat of an old problem.

The Enterobacteriaceae are among the most important causes of serious nosocomial and community-onset bacterial infections in humans, and resistance to antimicrobial agents in these species has become an increasingly relevant problem for healthcare providers. beta-lactam and fluoroquinolone antibiotics are important drug classes used to treat infections caused by Enterobacteriaceae. Emerging resistance mechanisms against these agents have recently been described in Enterobacteriaceae and include the production of newer beta-lactamases and plasmid-mediated quinolone resistance. The newer beta-lactamases consist of the following: plasmid-mediated AmpC beta-lactamases (e.g., ephamycin [CMY], CMY types), extended-spectrum beta-lactamases (e.g., cefotaxime [CTX], CTX-M first isolated at Munich) and carbapenem-hydrolyzing enzymes (e.g., Klebsiella pneumoniae carbapenemase [KPC], KPC types and the metallo-beta-lactamases). Recent developments in the epidemiology, clinical relevance and laboratory detection of infections caused by multiresistant Enterobacteriaceae with these new types of resistance mechanisms will be addressed in this review.