Antibiotic Treatment of Infections Caused by AmpC-Producing Enterobacterales.

IF 2 Q3 PHARMACOLOGY & PHARMACY
Pharmacy Pub Date : 2024-09-21 DOI:10.3390/pharmacy12050142
Gianpiero Tebano, Irene Zaghi, Monica Cricca, Francesco Cristini
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Abstract

AmpC enzymes are a class of beta-lactamases produced by Gram-negative bacteria, including several Enterobacterales. When produced in sufficient amounts, AmpCs can hydrolyze third-generation cephalosporins (3GCs) and piperacillin/tazobactam, causing resistance. In Enterobacterales, the AmpC gene can be chromosomal- or plasmid-encoded. Some species, particularly Enterobacter cloacae complex, Klebsiella aerogenes, and Citrobacter freundii, harbor an inducible chromosomal AmpC gene. The expression of this gene can be derepressed during treatment with a beta-lactam, leading to AmpC overproduction and the consequent emergence of resistance to 3GCs and piperacillin/tazobactam during treatment. Because of this phenomenon, the use of carbapenems or cefepime is considered a safer option when treating these pathogens. However, many areas of uncertainty persist, including the risk of derepression related to each beta-lactam; the role of piperacillin/tazobactam compared to cefepime; the best option for severe or difficult-to-treat cases, such as high-inoculum infections (e.g., ventilator-associated pneumonia and undrainable abscesses); the role of de-escalation once clinical stability is obtained; and the best treatment for species with a lower risk of derepression during treatment (e.g., Serratia marcescens and Morganella morganii). The aim of this review is to collate the most relevant information about the microbiological properties of and therapeutic approach to AmpC-producing Enterobacterales in order to inform daily clinical practice.

对产 AmpC 肠杆菌感染的抗生素治疗。
AmpC 酶是由革兰氏阴性细菌(包括几种肠杆菌)产生的一类β-内酰胺酶。当产生足够数量的 AmpC 时,可水解第三代头孢菌素(3GC)和哌拉西林/他唑巴坦,从而导致耐药性。在肠杆菌科细菌中,AmpC 基因可以是染色体编码的,也可以是质粒编码的。有些菌种,尤其是复合泄殖腔肠杆菌、产气克雷伯氏菌和弗氏柠檬酸杆菌,带有可诱导的染色体 AmpC 基因。在使用β-内酰胺类药物治疗期间,这种基因的表达会被抑制,导致 AmpC 过量产生,从而在治疗期间出现对 3GCs 和哌拉西林/他唑巴坦的耐药性。由于这种现象,在治疗这些病原体时,使用碳青霉烯类或头孢吡肟被认为是更安全的选择。然而,许多领域仍存在不确定性,包括每种β-内酰胺类药物的去势风险;哌拉西林/他唑巴坦与头孢吡肟相比的作用;重症或难治病例的最佳选择,如高接种量感染(如:呼吸机相关肺炎)、呼吸机相关肺炎和无法引流的脓肿)的最佳选择;临床病情稳定后降级的作用;以及治疗期间降级风险较低的菌种(如马氏沙雷氏菌和摩根氏菌)的最佳治疗方法。本综述旨在整理有关产 AmpC 肠杆菌的微生物特性和治疗方法的最相关信息,为日常临床实践提供参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pharmacy
Pharmacy PHARMACOLOGY & PHARMACY-
自引率
9.10%
发文量
141
审稿时长
11 weeks
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