AmpC cephalosporinases in Escherichia coli

Abstract

Escherichia coli is an important pathogen causing nosocomial infections. A significant problem in the treatment of infections caused by these microorganisms is their increasing resistance to β-lactam antibiotics, including third and fourth generation cephalosporins. The production of β-lactamases enzymes such as extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases is among the main mechanisms for resistance to third generation cephalosporins. The genes encoding AmpC cephalosporinases are chromosomal (cAmpC) or plasmid-mediated (pAmpC). In E. coli, the expression of the ampC genes may be conditioned by the constitutive expression of low level ampC chromosomal genes. These strains remain susceptible to β-lactam antibiotics. However, mutations in the promoter region of the ampC may result in increased level of expression of chromosomal ampC genes. This can leads to resistance to cephalosporins. Resistance to cephalosporins in E. coli can be also associated with plasmid-mediated AmpC β−lactamases (pAmpC). In E. coli the presence of one or more plasmid-mediated AmpC β−lactamases along with the neglible expression of chromosomal encoded AmpC enzyme can leads to resistance to broad-spectrum cephalosporins. This review is focused on a resistance mechanisms associated with the production of AmpC cephalosporinases in clinical E. coli isolates.