Extended spectrum beta- lactamases (ESBLs) are enzymes that can be produced by bacteria, including E coli infections, leading to resistance to common drugs and making the illness harder to treat. Aberdeen University consultant microbiologist Dr Ian Gould said some countries were seeing an increasing number of cases of ESBLs that were resistant to all antibiotics – and the same could happen in the UK. He said in the past few years in Scotland the proportion of cases of ESBLs associated with infections such as E coli had risen from zero to up to 20 per cent. But with fears of resistance to all antibiotics on the horizon, Dr Gould expressed concern that new treatments could be at least ten to 15 years away. His comments come ahead of a major specialist conference – the World Healthcare Associated Infection Forum – taking place in France next week. Dr Gould said the situation with ESBLs mirrored that with MRSA five years ago, when few new treatment options existed. "There are no new drugs and people are getting pretty worried. We have had two or three new drugs for MRSA, which is at least making the clinical issues a bit easier to deal with, even if we are still struggling to control it in hospitals in terms of it spreading. With the ESBLs, it seems the organisms are proving even more adept than MRSA at developing resistance." Dr Gould said ESBL enzymes were able to destroy all the commonly used antibiotics in hospitals, meaning they had to use the "reserve antibiotics" known as carbapenems. "And needless to say once we start using carbapenems, these bugs produce more enzymes called carbapenemases, which break down the carbapenems," he said. "We are getting as near to a doomsday bug as we ever thought we would. This is focusing our minds increasingly, as there are no new drug candidates in the pipeline for the next decade at least, if not 15 years." Dr Gould said the UK had seen slower development of resistance in ESBL cases so far, but this was starting to change. He said in Scotland in the past five years, levels of E coli and other bacteria producing ESBL enzymes had increased from zero to between 10 and 20 per cent. "If you go to India it is virtually 100 per cent now. That is what we want to avoid," Dr Gould said. The 2nd World HAI Forum is taking place in Veyrier-du-Lac, France, from Monday. WHAT IS ESBL? EXTENDED-SPECTRUM Beta-Lactamases (ESBLs) are enzymes that can be produced by bacteria, making them resistant to the antibiotics most widely used in hospitals. They were first found in the mid-1980s and were mostly seen in hospitals. But a new class of ESBL – called CTX-M enzymes – has emerged, resistant to many antibiotics and they have been found outwith hospitals.