Abstract

First, the paper gives a brief general overview of the mechanisms that allow bacteria to become refractory to treatment with antibacterial agents. Second, the paper discusses the epidemiology of E. coli and K. pneumoniae and their ability to produce enzymes that degrade III generation cephalosporins or carbapenems. The third part of the paper addresses possible solutions to the problem in practice or development.

Bacteria can overcome antibacterial treatment by antibiotic resistance, antibiotic tolerance, growth as a biofilm or intracellular persistence. E. coli resisting 3rd generation cephalosporins is a problem in Estonia, K. pneumoniae resisting carbapenemis is a potential liability. The prevalence of ESBL (extended spectrum beta lactamase) in Estonia is the lowest in Eastern Europe, yet it is higher than in Scandinavia. The risk factors for dissemination of ESBL are visiting Asia or Africa, use of fluoroquinolones, and diabetes. Fosfomycin, a newcomer in the Estonian market, may prove useful for prevention or treatment of beta lactam resistant infections.