June 9, 2022

ESBL in the Elderly: A Problem on the Rise?

Written by: Omnia Tantawi, MSc

ESBLs are a class of enzymes that can break down penicillin and other antibiotics, making them ineffective against certain bacteria. They're often carried by Escherichia coli bacteria, which live in the intestines of healthy people. Some E. coli strains produce more ESBLs than others, which makes them more likely to cause infection and spread throughout the body.

ESBLs were first identified in the late 1980s when they were found in Klebsiella pneumoniae strains isolated from patients at a hospital in France. 

It usually causes mild symptoms in healthy individuals but can lead to severe infections in people with weakened immune systems such as the elderly.


Prevalence of ESBL

The prevalence of ESBLs has increased dramatically over the last two decades, with an incidence rate of about 2% among nosocomial isolates in Europe and North America. So much so that it's becoming harder for doctors to treat common infections like urinary tract infections in recent years. However, increased travel and trade have meant that ESBLs are being seen more often in Europe and North America.

There's a higher prevalence in nursing homes and hospitals where ESBLs have been reported in community-acquired infections, especially for those who have recently had urinary tract infections (UTIs).

In fact, there were several studies to point out the spread of ESBL infections in nursing homes compared to other settings, which means that elderly people need safety measures and protocol changes to avoid this medical condition, which can sometimes be life-threatening.1


What Causes This Type of Infection?

The exact cause of ESBLs isn't known yet. It's believed that they're passed through close contact with infected animals or people, but this hasn't been proven yet either. It's also possible that they're spread through contaminated water sources like lakes or rivers; this would explain why infections have been found worldwide since they were first discovered in 2008!

It's believed that the widespread of ESBL infections in the elderly goes back to cross-contamination with other residents. Thus, there have been some recommendations to test for this regularly and practice a good hygiene routine to avoid the widespread nature of this disease.2


The Risk Factors for ESBL Include:

There are several risk factors for acquiring ESBL infections: surgery or long-term hospitalization; antibiotic use in the past 10 years such as fluoroquinolones, carbapenems, or cephalosporins; age 60 or older; having diabetes mellitus or chronic kidney disease and being immunocompromised due to HIV/AIDS or cancer treatment.

Similarly, infections caused by gram-negative bacteria such as Escherichia coli and Klebsiella pneumonia can also be risk factors for ESBLs because they are capable of producing these types of enzymes naturally due to their genetic makeup. This means that they do not need to be acquired from another source which makes them especially dangerous because they can spread easily through contact with contaminated surfaces or objects such as bedding sheets or clothing items like shirts.

Additionally, people with diabetes or chronic kidney disease are at higher risk for ESBL infections. They may also be more likely to develop complications after infection than other people would be. These complications can include bacteremia (bloodstream infection), pneumonia, urinary tract infections, wound infections, and meningitis (inflammation of the membranes around the brain).


How Can You Get ESBL?

There are several ways you can get an ESBL infection: by coming into contact with someone else who has one; by taking antibiotics that contain cephalosporins or carbapenems; or by breathing in dust from contaminated soil or water.3

If you do get ESBL-resistant bacteria, it's essential to treat them quickly, so they don't spread to other parts of your body or cause other problems!


Symptoms of ESBL Infections

The signs and symptoms of ESBL infection vary extensively depending on the type of bacteria causing the infection and to which body organ it has spread its infection. Nevertheless, below is a list of symptoms you should look out for:

  • Pain while urinating
  • Blood in the urine
  • Persistent need to urinate
  • Nausea
  • Vomiting
  • Diarrhea 
  • Stomach pain
  • Reduced appetite
  • Fatigue
  • Imbalance and dizziness
  • Fever and chills


Treatment of ESBL Infections

The decision of which treatment course to take for ESBL infections will largely depend on the severity of your case. Generally, Carbapenemsare usually the go-to drug for high antimicrobial resistance.

It's important to consult your doctor before taking any antibiotics to avoid additional resistance and worsening of your condition.


To Sum Up

ESBL-infections in the elderly have been proven throughout the scientific literature. The reason for this is that they have compromised immune systems and live in a shared community with other elderly people who can be infected as a result of their reduced immunity.47

The best way to avoid getting ESBL-infections in elderly people is to follow hygiene best practices like frequently cleansing your hands, maintaining your space by not sharing your personal items, and disinfecting common areas, especially bathrooms and kitchens.



  1. Ae R, Sasahara T, Yoshimura A, Kosami K, Hatakeyama S, Sasaki K, et al. Prolonged carriage of ESBL-producing enterobacterales and potential cross-transmission among residents in geriatric long-term care facilities. Scientific Reports 2021 11:1 [Internet]. 2021 Nov 3 [cited 2022 Jun 5];11(1):1–9. Available from: https://www.nature.com/articles/s41598-021-01190-w
  2. Goltsman G, Baumohl Y, Gal G, Buckman Z, Proshkin V, Lubart E. To check or not to check. Rectal ESBL colonization in hospitalized elderly patients. American Journal of Infection Control [Internet]. 2018 Nov 1 [cited 2022 Jun 5];46(11):1236–9. Available from: http://www.ajicjournal.org/article/S0196655318306382/fulltext
  3. ESBL-producing Enterobacterales | HAI | CDC [Internet]. [cited 2022 Jun 5]. Available from: https://www.cdc.gov/hai/organisms/ESBL.html
  4. Blom A, Ahl J, Månsson F, Resman F, Tham J. The prevalence of ESBL-producing Enterobacteriaceae in a nursing home setting compared with elderly living at home: a cross-sectional comparison. BMC Infectious Diseases [Internet]. 2016 Mar 4 [cited 2022 Jun 5];16(1). Available from: /pmc/articles/PMC4778276/
  5. Jallad MA, Naoufal R, Irani J, Azar E. Extended spectrum beta-lactamase carriage state among elderly nursing home residents in beirut. Scientific World Journal. 2015;2015.
  6. Ku NS, Kim YC, Kim MH, Song JE, Oh DH, Ahn JY, et al. Risk factors for 28-day mortality in elderly patients with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia. Arch GerontolGeriatr [Internet]. 2014 Jan [cited 2022 Jun 5];58(1):105–9. Available from: https://pubmed.ncbi.nlm.nih.gov/23988261/
  7. Ku NS, Kim YC, Kim MH, Song JE, Oh DH, Ahn JY, et al. Risk factors for 28-day mortality in elderly patients with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia. Archives of Gerontology and Geriatrics. 2014 Jan 1;58(1):105–9.
Article written by Omnia Tantawi, MSc
Omnia is an Assistant Lecturer and Medical Researcher from Egypt. She’s an integral part in many research projects that proved promising in revolutionizing the future of Medicine. As a Research Scholar, she’s particularly interested in Personalized & Molecular Medicine because she believes that this is the prospect of the healthcare industry and can be applied to all medical and pharmaceutical specializations. But at heart she remains a wordsmith, so she currently works as a Medical Writer. This transition was fairly easy with an Academic Medical background, ability to adapt to different audiences and passion for research and creation. She always takes the most complex or mundane topics and turn it into a must-read with an unparalleled style. In her free time, she likes to read books, tunes in Netflix or enjoys the outdoors.

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