#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!
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)
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/…
For more readings check these resources out
cmr.asm.org/content/31/2/e…
idstewardship.com/gram-negative-… @IDstewardship
ncbi.nlm.nih.gov/pmc/articles/P…
Feel free to comment with your own pearls!
Also excellent review by @emilylheil tandfonline.com/doi/full/10.15…
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