Global epidemiology of CTX-M β-lactamases: temporal and geographical shifts in genotype

Research output: Contribution to journalReview articlepeer-review


External organisations

  • Public Health England
  • Magus Strategic Communications Ltd


Globally, rates of ESBL-producing Enterobacteriaceae are rising. We undertook a literature review, and present the temporal trends in blaCTX-M epidemiology, showing that blaCTX-M-15 and blaCTX-M-14 have displaced other genotypes in many parts of the world. Explanations for these changes can be attributed to: (i) horizontal gene transfer (HGT) of plasmids; (ii) successful Escherichia coli clones; (iii) ESBLs in food animals; (iv) the natural environment; and (v) human migration and access to basic sanitation. We also provide explanations for the changing epidemiology of blaCTX-M-2 and blaCTX-M-27. Modifiable anthropogenic factors, such as poor access to basic sanitary facilities, encourage the spread of blaCTX-M and other antimicrobial resistance (AMR) genes, such as blaNDM, blaKPC and mcr-1. We provide further justification for novel preventative and interventional strategies to reduce transmission of these AMR genes.


Original languageEnglish
Pages (from-to)2145-2155
Number of pages11
JournalJournal of Antimicrobial Chemotherapy
Issue number8
Early online date25 May 2017
Publication statusPublished - 1 Aug 2017


  • Animals, Disease Transmission, Infectious, Enterobacteriaceae/enzymology, Enterobacteriaceae Infections/epidemiology, Gene Transfer, Horizontal, Genotype, Global Health, Humans, Molecular Epidemiology, Phylogeography, Spatio-Temporal Analysis, beta-Lactamases/genetics