The authors reply:
Le Guern and colleagues highlight the public health importance of ESBL-producing Enterobacterales, and they cite their data on colonization with ESBL-producing Enterobacterales. However, we would caution against direct comparisons between ESBL-producing Enterobacterales carriage and infection. Because of differences in virulence and other factors, the distribution of bacteria that cause infections can differ from that of colonizing flora. In a study of infections in 42 countries, E. coli and K. pneumoniae accounted for 91% of Enterobacterales with an ESBL phenotype.1 Another study of clinically significant isolates showed that E. coli and klebsiella species accounted for 93% of all ESBL-producing Enterobacterales.2 Furthermore, these bacteria have particular epidemiologic significance because they have contributed disproportionately to increasing rates of infection by ESBL-producing Enterobacterales, most likely because of dissemination of mobile genetic elements that have spread into highly successful lineages such as E. coli clonal group ST131.3,4 For these reasons, we, like many other investigators, chose a definition focused on E. coli and klebsiella species to study the epidemiology of ESBL-producing Enterobacterales.5
Footnotes
Since publication of their article, the authors report no further potential conflict of interest.
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