Antibiotic therapy for inducible AmpC β-lactamase-producing Gram-negative bacilli: what are the alternatives to carbapenems, quinolones and aminoglycosides?

被引:100
作者
Harris, P. N. A. [1 ]
Ferguson, J. K. [1 ,2 ,3 ]
机构
[1] John Hunter Hosp, Dept Microbiol, Hunter Area Pathol, New Lambton, NSW 2305, Australia
[2] Univ Newcastle, Newcastle, NSW 2300, Australia
[3] Univ New England, Armidale, NSW, Australia
关键词
Enterobacter; Citrobacter; Serratia; Cefepime; Piperacillin/tazobactam; Trimethoprim/sulfamethoxazole; Ceftriaxone; Cefotaxime; BROAD-SPECTRUM CEPHALOSPORIN; NONCONVULSIVE STATUS EPILEPTICUS; INDUCED ASEPTIC-MENINGITIS; IN-VITRO ACTIVITY; TRIMETHOPRIM-SULFAMETHOXAZOLE; PIPERACILLIN-TAZOBACTAM; ENTEROBACTER-CLOACAE; ANTIMICROBIAL SUSCEPTIBILITY; RESISTANT ENTEROBACTERIACEAE; MULTIDRUG-RESISTANT;
D O I
10.1016/j.ijantimicag.2012.06.004
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Some bacteria that possess chromosomally determined AmpC beta-lactamases may express these enzymes at a high level following exposure to beta-lactams, either by induction or selection for derepressed mutants. This may lead to clinical failure even if an isolate initially tests susceptible in vitro, a phenomenon best characterised by third-generation cephalosporin therapy for Enterobacter bacteraemia or meningitis. Several other Enterobacteriaceae, such as Serratia marcescens, Citrobacter freundii, Providencia spp. and Morganella morganii (often termed the 'ESCPM' group), may also express high levels of AmpC. However, the risk of clinical failure with beta-lactams that test susceptible in vitro is less clear in these species than for Enterobacter. Laboratories frequently do not report beta-lactam or beta-lactamase inhibitor combination drug susceptibilities for ESCPM organisms, encouraging alternative therapy with quinolones, aminoglycosides or carbapenems. However, quinolones and carbapenems present problems with selective pressure for multiresistant organisms, and aminoglycosides with potential toxicity. The risk of emergent AmpC-mediated resistance for non-Enterobacter spp. appears rare in clinical studies. Piperacillin/tazobactam may remain effective and may be less selective for AmpC derepressed mutants than cephalosporins. The potential roles for agents such as cefepime or trimethoprim/sulfamethoxazole are also discussed. Clinical studies that better define optimal treatment for this group of bacteria are required. Crown Copyright (C) 2012 Published by Elsevier B. V. on behalf of International Society of Chemotherapy. All rights reserved.
引用
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页码:297 / 305
页数:9
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