肠杆菌科的beta-内酰胺类抗生素耐药.ppt

E. coli susceptibility Report Ampicillin R Piperacillin R Cephalothin R Cefoxitin S Cefotaxime R Ceftazidime I Ceftriaxone R Aztreonam I Cefepime S Pip/Tazo I Imipenem S Laboratory detection of ESBLs Resistance or intermediate to third-generation cephalosporins. Cefoxitin and cefotetan susceptible. ESBL disk diffusion test (clavulanate inhibition) E-test ESBL strip Confirmatory ESBL MIC test (Microscan) K. pneumoniae, K. oxytoca, E. coli, P. mirabilis E. coli ESBL susceptibility report Ampicillin R Piperacillin R Cephalothin R Cefoxitin S Cefotaxime R Ceftazidime I?R Ceftriaxone R Aztreonam I?R Cefepime S?R Pip/Tazo I Imipenem S Enterobacter cloacae susceptibility report Ampicillin R Piperacillin R Cephalothin R Cefoxitin R Cefotaxime R Ceftazidime I Ceftriaxone R Aztreonam I Cefepime S Pip/Tazo R Imipenem S AmpC b-lactamases Chromosomally encoded-cell wall turnover Enterobacter sp., Citrobacter sp., Serratia sp., Morganella sp. Even E. coli. Third-generation cephalosporins are not good inducers of AmpC b-lactamase Third-generation cephalosporin resistant strains are derepressed—meaning that the AmpC b-lactamase is not inducible anymore. AmpC mutants are cephamycin resistant E. coli susceptibility report Ampicillin R Piperacillin R Cephalothin R Cefoxitin R Cefotaxime R Ceftazidime I Ceftriaxone R Aztreonam I Cefepime S Pip/Tazo R Imipenem S What do you do? Other concepts to know about AmpC b-lactamases They are transferred on plasmids as well. CMY, LAT, BIL, MOX, ACC, FOX, DHA Almost all ceftriaxone-resistant Salmonella isolated in the United States carry a plasmid-mediated AmpC b-lactamase called CMY-2. E. coli UTI isolates carry plasmid-mediated AmpC b-lactamases Mechanisms of Carbapenem Resistance Carbapenemase hydrolyzing enzymes Porin loss “OprD” ESBL or AmpC + porin loss Carbapenemases The most versatile family of ?-lactamases Two major groups based on the hydrolytic mechanism at the active site Serine at the active site: class A