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#OLILT #IDtwitter
ESBL vs AmpC🦠what is the difference in resistance & tx?
Resistance
ESBLs ➡️ encoded by plasmid genes
AmpC ➡️encoded by plasmid genes OR "inducible resistance" via derepression of chromosomal🧬genes
⚠️can👀susceptible but resistance develops ON therapy!
ESBL vs AmpC🦠what is the difference in resistance & tx?
Resistance
ESBLs ➡️ encoded by plasmid genes
AmpC ➡️encoded by plasmid genes OR "inducible resistance" via derepression of chromosomal🧬genes
⚠️can👀susceptible but resistance develops ON therapy!
Treatment➡️Carbapenems➡️𝟏st line💊of choice
However➡️rate of carbapenem resistance is📈➡️today I was asked about cefepime tx
AmpC➡️typically resistant to some/ALL cephalosporins BUT cefepime is STABLE against AmpC! (unless other mechanisms of resistance are present)
However➡️rate of carbapenem resistance is📈➡️today I was asked about cefepime tx
AmpC➡️typically resistant to some/ALL cephalosporins BUT cefepime is STABLE against AmpC! (unless other mechanisms of resistance are present)
ESBL➡️typically can hydrolyze cefepime, data for ⤴️innoculum infections or if MIC >1 shows ⤴️ failure, some data shows ⤴️mortality if using cefepime REGARDLESS of MIC😳
aac.asm.org/content/59/12/…
aac.asm.org/content/59/12/…
#OLILT MICU @HeavnerPharmD
🧐10 things on the differential for an⤴️INR? (⚡️shock liver, warfarin, DIC etc)
No ⏰ to 🤔&wait, lets narrow this differential by✅a Factor VIII🩸‼️
Factor VIII ▶️produced by non-hepatic cells ▶️ ⤴️/normal in liver disease (LD)
1/2👇🏻
🧐10 things on the differential for an⤴️INR? (⚡️shock liver, warfarin, DIC etc)
No ⏰ to 🤔&wait, lets narrow this differential by✅a Factor VIII🩸‼️
Factor VIII ▶️produced by non-hepatic cells ▶️ ⤴️/normal in liver disease (LD)
1/2👇🏻
On the other🤚🏻, there is ↗️consumption of FVIII in DIC▶️ levels are expected to be↘️low‼️
Warfarin🛑TONS (II, VII, IX, X)of clotting factors EXCEPT FVIII, so levels will be ⤴️with residual warfarin effects!
🔑Rule OUT LD as a cause of coagulopathy if↘️VIII
#foamed
Warfarin🛑TONS (II, VII, IX, X)of clotting factors EXCEPT FVIII, so levels will be ⤴️with residual warfarin effects!
🔑Rule OUT LD as a cause of coagulopathy if↘️VIII
#foamed
Thanks to Brooke for the acronym from her @ASHPOfficial MCM clinical pearls slideset! 👏🏻
@accpcritprn @EMCCC2 @PharmacyCCEd
@accpcritprn @EMCCC2 @PharmacyCCEd
