The burden of antibiotic-resistant infections among Gram-negative bacteria is increasing. Resistance to third-generation cephalosporins (3GCs) in Enterobacteriaceae is mainly conferred by the acquisition of β-lactamases or by deregulation of natural genetically-encoded β-lactamase enzymes. Enterobacteriaceae such as Enterobacter spp., Serratia marcescens, Citrobacter freundii, Providencia spp. and Morganella morganii (ESCPM group) possess chromosomally-encoded inducible AmpC β-lactamases. AmpC can be overproduced as a response to β-lactam antibiotic exposure or by constitutive dysfunction of the AmpC regulation system. This overproduction can lead to the inactivation of 3GCs. Based on small clinical studies, international guidelines and expert recommendations suggest that 3GCs should be avoided as definitive therapy for infections caused by ESCPM group organisms. In this narrative review, we discuss the published literature and evaluate the risk related to 3GC use in the case of documented ESCPM infection.
Keywords: AmpC; Antibiotic therapy; Cephalosporinase; Enterobacteriaceae.
Copyright © 2019 Elsevier Ltd. All rights reserved.
[Mechanisms of Resistance in Enterobacteriaceae Towards Beta-Lactamase Antibiotics]E Susić. Acta Med Croatica 58 (4), 307-12. PMID 15700687.Except for Salmonella spp., all Enterobacteriaceae produce intrinsic chromosomal encoded beta-lactamases which, beside their physiologic role in cell-wall synthesis and n …
Antibiotic Therapy for Inducible AmpC β-Lactamase-Producing Gram-negative Bacilli: What Are the Alternatives to Carbapenems, Quinolones and Aminoglycosides?PN Harris et al. Int J Antimicrob Agents 40 (4), 297-305. PMID 22824371. - ReviewSome bacteria that possess chromosomally determined AmpC β-lactamases may express these enzymes at a high level following exposure to β-lactams, either by induction or se …
Emergence of Antibiotic Resistance During Therapy for Infections Caused by Enterobacteriaceae Producing AmpC Beta-Lactamase: Implications for Antibiotic UseSH Choi et al. Antimicrob Agents Chemother 52 (3), 995-1000. PMID 18086837.Enterobacter spp., Serratia marcescens, Citrobacter freundii, and Morganella morganii are characterized by chromosomally encoded AmpC beta-lactamases and possess the abil …
Species-specific Mutation Rates for ampC Derepression in Enterobacterales With Chromosomally Encoded Inducible AmpC β-LactamaseR Kohlmann et al. J Antimicrob Chemother 73 (6), 1530-1536. PMID 29566147.Our data might help to predict the risk of treatment failure with oxyimino-cephalosporins in infections by different Enterobacterales with inducible AmpC. Moreover, we ma …
Important and Emerging Beta-Lactamase-Mediated Resistances in Hospital-Based Pathogens: The Amp C EnzymesRN Jones. Diagn Microbiol Infect Dis 31 (3), 461-6. PMID 9635237. - ReviewResistance to third-generation cephalosporins mediated by beta-lactamases is an increasing problem for clinical therapeutics. A wide range of Enterobacteriaceae produce t …