ESBLs have exclusively been associated with Gram-negative bacterial infections up until this point. Gram-negative bacteria will turn pink when stained in order to be examined under a microscope. Bacteria have mechanisms built in to subvert the immune system and render medicines ineffective. Additionally, they have the capacity to acquire drug resistance randomly and pass on advantageous changes to the following generation. ESBLs can be produced by a wide range of bacterial species. The misuse or overuse of antibiotics is considered as the cause of the bacteria producing the drug-resistant enzymes, albeit this is still unknown to researchers. It is crucial to be aware that only a small number of the hundreds of distinct species found within each family and group of bacteria are able to create ESBLs. The infection can be transferred by anyone who comes into contact with a surface, object, animal, or another person that has been exposed to or infected with ESBL-producing bacteria. However, the majority of ESBL infections arises in medical facilities and entails exposure to contaminate fecal. A 2015 study found that the majority of patients with ESBL-producing bacterial infections had spent between 11 and 64 days in the hospital on average before becoming ill. Although the virus has historically been linked to those with compromised immune systems, hospitals, and nursing homes, it is now more common and ubiquitous. Numerous germs can survive on the surface of the skin for several days and can even spread through someone's breath. Some persons can behave as carriers, passing the pathogenic bacteria to others without showing any signs of infection or symptomatology. Every time exposure happens or is suspected, it is crucial to take additional precautions, such as increasing hand washing. The majority of ESBL-producing bacteria belong to the Enterobacteriaceae family, which generally inhabits the gastrointestinal tract without infecting humans. This is why many infections caused by ESBL irritate the gut lining. The immune system also promotes a rise in metabolism and waste elimination when the body is infected, which results in diarrhea.

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