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AmpC-Producing Beta-Lactamases - #PHARMFAX

AmpC-producing organisms make beta-lactam/beta-lactamase combos and most cephalosporins and penicillins ineffective.

 

AmpC-producing organisms make beta-lactam/beta-lactamase combos and most cephalosporins and penicillins ineffective. AmpC genes are inducible, meaning continued exposure increases enzyme production.


For example, sensitivities may show ceftriaxone is effective, and the bug increases AmpC gene expression resulting in treatment failure. The acronym SPACE or SPICE was commonly used, but emerging pathogens focus has shifted towards Hafnia alvei, Enterobacter cloacae, Citrobacter freudndii, Klebsiella aerogenes, and Tersinia enterocolotica.


Cefepime is the exception ineffective beta-lactams with ampC organisms. Cefepime can be utilized since it poorly induces ampC expression and miniminaly hydrolyzed by the enzyme. Carbapenems are also first-line therapy or when cefepime MIC is > 4 for moderate to severe infections caused by amp-C producing enterobacterales.


IDSA recommends nitrofurantoin and Bactrim for uncomplicated cystitis. Single-dose aminoglycosides and fosfomycin can be considered. For complicated UTI or pyelonephritis, Bactrim and Fluoruoquinolones. Additionally, these agents can be considered as step-down oral therapy from IV regimens, when appropriate.


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Extended-spectrum Beta-lactamases - https://www.instagram.com/p/CtvagCGA544/


IV/PO MRSA ABX - https://www.instagram.com/p/Cthjg9qA_HW/


IV/PO PsA ABX - https://www.instagram.com/p/CtQfaB7gJOj/


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