Carbapenemases - Revision history

Aidan: Text replacement - " species]]" to "]]"

2022-01-25T16:44:01Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 16:44, 25 January 2022
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	**'''SPM-1''' (Sao Paulo metallo-β-lactamase) has been found in [[Pseudomonas aeruginosa]] in Brazil		**'''SPM-1''' (Sao Paulo metallo-β-lactamase) has been found in [[Pseudomonas aeruginosa]] in Brazil
	**'''GIM-1''' (German imipenemase) is in a class 1 integron on a plasmid and has been found in [[Pseudomonas aeruginosa]]		**'''GIM-1''' (German imipenemase) is in a class 1 integron on a plasmid and has been found in [[Pseudomonas aeruginosa]]
	**'''SIM-1''' (Seoul imipenemase) is in a class 1 integron and has been found in [[Pseudomonas ~~species~~]] and [[Acinetobacter ~~species~~]]		**'''SIM-1''' (Seoul imipenemase) is in a class 1 integron and has been found in [[Pseudomonas]] and [[Acinetobacter]]
	*Class D		*Class D
	**Found mostly in [[Acinetobacter baumannii complex]]		**Found mostly in [[Acinetobacter baumannii complex]]

Aidan: /* Background */

2020-09-24T13:18:49Z

Background

← Older revision		Revision as of 13:18, 24 September 2020
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	*Enzymes that hydrolyze [[carbapenems]]		*Enzymes that hydrolyze [[carbapenems]]
	*Includes members of all Ambler classes, ~~which~~ ~~are~~ in Bush-Jacoby classes 2df, 2f, 3a, and 3b		*Includes members of all Ambler classes, and corresponds to Bush-Jacoby classes 2df, 2f, 3a, and 3b
	**Class A (2f): KPC, IMI		**Class A (2f): KPC, IMI
	**Class B (3a and 3b): NDM, IMP, VIM		**Class B (3a and 3b): NDM, IMP, VIM

Aidan: /* Specific Carbapenemases */

2020-09-24T13:14:38Z

Specific Carbapenemases

← Older revision		Revision as of 13:14, 24 September 2020
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	===Specific Carbapenemases===		===Specific Carbapenemases===

			*Class A carbapenemases
⚫	*'''IMI-1''' confers resistance to [[carbapenems]] but not to [[cephalosporins]][[CiteRef::teo2013en]]
			**'''KPC''' ([[Klebsiella pneumoniae]] carbapenemase) is the most common carbapenemase, located on a plasmids and found most commonly in [[Klebsiella pneumoniae]]
			**'''GES-1''' (Guiana extended spectrum) is located on plasmids
			**'''SME''' ([[Serratia marcescens]] enzyme) is chromasomal and found in [[Serratia marcescens]]
			**'''NMC-A''' (not metalloenzyme carbapenemase) is chromasomal and found in [[Enterobacter cloacae]]
		⚫	**'''IMI-1''' (imipenem-hydrolyzing β-lactamase) is chromasomal and found in [[Enterobacter cloacae]] and confers resistance to [[carbapenems]] but possibly not to [[cephalosporins]][[CiteRef::teo2013en]]
			*Class B carbapenemases (metallo-β-lactamases)
			**'''VIM-2''' (Verona integron-encoded metallo-β-lacamase) is the most common metallo-β-lactamase worldwide, is on a multiple-intergron cassette, and is mostly found in [[Pseudomonas aeruginosa]]
			**'''IMP''' (active on imipenem) is on a conjugative plasmid and is mostly found in [[Pseudomonas aeruginosa]] but has also been found in [[Enterobacterales]]
			**'''NDM''' (New Delhi metallo-β-lactamase) is transmitted by horizontal gene transfer and is most commonly found in [[Escherichia coli]], [[Klebsiella pneumoniae]], and other [[Enterobacterales]]
			**'''SPM-1''' (Sao Paulo metallo-β-lactamase) has been found in [[Pseudomonas aeruginosa]] in Brazil
			**'''GIM-1''' (German imipenemase) is in a class 1 integron on a plasmid and has been found in [[Pseudomonas aeruginosa]]
			**'''SIM-1''' (Seoul imipenemase) is in a class 1 integron and has been found in [[Pseudomonas species]] and [[Acinetobacter species]]
			*Class D
			**Found mostly in [[Acinetobacter baumannii complex]]

	==Management==		==Management==

Aidan: /* Management */

2020-09-21T12:15:53Z

Management

← Older revision		Revision as of 12:15, 21 September 2020
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	*Directed by susceptibility testing		*Directed by susceptibility testing
			*See also [[Carbapenem-resistant organisms#Management\|carbapenem-resistant organisms]]
	*For ESBLs and AmpCs, consider:
	**[[Ceftazidime-avibactam]] (not active against metallo-β-lactamases)
	**[[Meropenem-vaborbactam]] (limited activity against metallo-β-lactamases and oxacillinases)
	*For metallo-β-lactamases, consider:
	**[[Colistin]], though increasing resistance
	**[[Tigecycline]]
	**[[Fosfomycin]]
	**[[Aztreonam-avibactam]]
	**[[Cefiderocol]]
	**[[Eravacycline]]
	**[[Plazomicin]]
	*For carbapenem-resistant [[Pseudomonas aeruginosa]], consider:
	**[[Cefiderocol]]
	**[[Imipenem-relebactam]]

	[[Category:Gram-negative bacilli]]		[[Category:Gram-negative bacilli]]

Aidan at 22:48, 17 September 2020

2020-09-17T22:48:09Z

Aidan at 22:43, 17 September 2020

2020-09-17T22:43:58Z

← Older revision		Revision as of 22:43, 17 September 2020
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	*Enzymes that hydrolyze [[carbapenems]]		*Enzymes that hydrolyze [[carbapenems]]
	*Includes members of ~~most~~ Ambler classes		*Includes members of all Ambler classes
	**Class A: KPC, IMI		**Class A: KPC, IMI
	**Class B: NDM, IMP, VIM		**Class B: NDM, IMP, VIM

Aidan at 22:36, 17 September 2020

2020-09-17T22:36:12Z

← Older revision		Revision as of 22:36, 17 September 2020
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	**Positive for metallo-β-lactamase if zone diameter increases ≥5 mm from mCIM		**Positive for metallo-β-lactamase if zone diameter increases ≥5 mm from mCIM
	***Ignore pinpoint colonies within any zones of inhibition in the eCIM		***Ignore pinpoint colonies within any zones of inhibition in the eCIM
			*Rosco discs
			**Class A: attenuated by boronic acid
			**Class B: attenuated by diploconic acid
			**Class C: attenuated by both cloxacillin and boronic acid
			**Class D: not attenuated by boronic acid, diploconic acid, or cloxacillin
			***Needs special discs, or PCR testing

	===Inhibitors===		===Inhibitors===
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	*'''Vaborbactam:''' active against KPC, but limited activity against MBLs and OXA-48, [[Pseudomonas]], or [[Acinetobacter]]		*'''Vaborbactam:''' active against KPC, but limited activity against MBLs and OXA-48, [[Pseudomonas]], or [[Acinetobacter]]

	=== Specific Carbapenemases ===		===Specific Carbapenemases===

	* '''IMI-1''' confers resistance to [[carbapenems]] but not to [[cephalosporins]][[CiteRef::teo2013en]]		*'''IMI-1''' confers resistance to [[carbapenems]] but not to [[cephalosporins]][[CiteRef::teo2013en]]

	==Management==		==Management==

Aidan at 13:07, 15 September 2020

2020-09-15T13:07:07Z

← Older revision		Revision as of 13:07, 15 September 2020
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	*Enzymes that hydrolyze [[carbapenems]]		*Enzymes that hydrolyze [[carbapenems]]
	*Includes members of most Ambler classes		*Includes members of most Ambler classes
	**Class A: KPC		**Class A: KPC, IMI
	**Class B: NDM, ~~IMI~~, VIM		**Class B: NDM, IMP, VIM
	**Class C: AmpCs		**Class C: AmpCs
	**Class D: OXA-48		**Class D: OXA-48
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	*'''Tazobactam:''' active against [[Pseudomonas]], but limited activity against carbapenemases otherwise		*'''Tazobactam:''' active against [[Pseudomonas]], but limited activity against carbapenemases otherwise
	*'''Vaborbactam:''' active against KPC, but limited activity against MBLs and OXA-48, [[Pseudomonas]], or [[Acinetobacter]]		*'''Vaborbactam:''' active against KPC, but limited activity against MBLs and OXA-48, [[Pseudomonas]], or [[Acinetobacter]]

			=== Specific Carbapenemases ===

			* '''IMI-1''' confers resistance to [[carbapenems]] but not to [[cephalosporins]][[CiteRef::teo2013en]]

	==Management==		==Management==

Aidan: /* Management */

2020-09-14T21:19:43Z

Management

← Older revision		Revision as of 21:19, 14 September 2020
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	*Directed by susceptibility testing		*Directed by susceptibility testing
	*For ESBLs and AmpCs:		*For ESBLs and AmpCs, consider:
	**[[Ceftazidime-avibactam]] (not active against metallo-β-lactamases)		**[[Ceftazidime-avibactam]] (not active against metallo-β-lactamases)
	**[[Meropenem-vaborbactam]] (limited activity against metallo-β-lactamases and oxacillinases)		**[[Meropenem-vaborbactam]] (limited activity against metallo-β-lactamases and oxacillinases)
	*For metallo-β-lactamases:		*For metallo-β-lactamases, consider:
	**[[Colistin]]		**[[Colistin]], though increasing resistance
	**[[Tigecycline]]		**[[Tigecycline]]
	**[[Fosfomycin]]		**[[Fosfomycin]]
			**[[Aztreonam-avibactam]]
			**[[Cefiderocol]]
			**[[Eravacycline]]
			**[[Plazomicin]]
			*For carbapenem-resistant [[Pseudomonas aeruginosa]], consider:
			**[[Cefiderocol]]
			**[[Imipenem-relebactam]]

	[[Category:Gram-negative bacilli]]		[[Category:Gram-negative bacilli]]

Aidan: /* Management */

2020-09-14T21:15:42Z

Management

← Older revision		Revision as of 21:15, 14 September 2020
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	==Management==		==Management==

			*Directed by susceptibility testing
⚫	*[[Ceftazidime-avibactam]] (not active against metallo-β-lactamases)
			*For ESBLs and AmpCs:
⚫	*[[Meropenem-vaborbactam]] (limited activity against metallo-β-lactamases and oxacillinases)
		⚫	**[[Ceftazidime-avibactam]] (not active against metallo-β-lactamases)
⚫	*[[Colistin]]
		⚫	**[[Meropenem-vaborbactam]] (limited activity against metallo-β-lactamases and oxacillinases)
⚫	*[[Tigecycline]]
			*For metallo-β-lactamases:
		⚫	**[[Colistin]]
		⚫	**[[Tigecycline]]
			**[[Fosfomycin]]

	[[Category:Gram-negative bacilli]]		[[Category:Gram-negative bacilli]]

← Older revision		Revision as of 22:48, 17 September 2020
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	*Enzymes that hydrolyze [[carbapenems]]		*Enzymes that hydrolyze [[carbapenems]]
	*Includes members of all Ambler classes		*Includes members of all Ambler classes, which are in Bush-Jacoby classes 2df, 2f, 3a, and 3b
	**Class A: KPC, IMI		**Class A (2f): KPC, IMI
	**Class B: NDM, IMP, VIM		**Class B (3a and 3b): NDM, IMP, VIM
	**Class C: AmpCs		**Class C: AmpCs (occasionally weakly active against [[carbapenems]])
	**Class D: OXA-48		**Class D (2df): OXA-48

	===Identification===		===Identification===

	*Screening is done by identifying isolates with decreased susceptibility to one or more [[carbapenems]]		*'''Screening''' is done by identifying isolates with decreased susceptibility to one or more [[carbapenems]]
	**Testing "not susceptible" to [[ertapenem]] is the most sensitive indicator		**Testing "not susceptible" to [[ertapenem]] is the most sensitive indicator
	**Typically also resistant to third-generation [[cephalosporins]], as well, with the exception of SME in [[Serratia marcescens]] and IMI		**Typically also resistant to third-generation [[cephalosporins]], as well, with the exception of SME in [[Serratia marcescens]] and IMI
	*A [[modified Hodge test]] can confirm the presence of a carbapenemase, but is no longer routinely recommended		*A [[modified Hodge test]] can confirm the presence of a carbapenemase, but is no longer routinely recommended
	*Modified carbapenem inactivation method (mCIM)		*'''Modified carbapenem inactivation method (mCIM)'''
	**Place meropenem disc in a suspension of the test isolate, and incubate at 35ºC for 4 hours		**Place meropenem disc in a suspension of the test isolate, and incubate at 35ºC for 4 hours
	**Remove disc, squeezing out excess fluid, and place on a lawn of susceptible [[Escherichia coli]]		**Remove disc, squeezing out excess fluid, and place on a lawn of susceptible [[Escherichia coli]]
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	**Negative if zone diameter is clear ≥19 mm		**Negative if zone diameter is clear ≥19 mm
	**Indeterminate if clear diameter 16 to 18 mm, or pinpoint colonies ≥19 mm		**Indeterminate if clear diameter 16 to 18 mm, or pinpoint colonies ≥19 mm
	*EDTA-modified carbapenem inactivation method (eCIM)		*'''EDTA-modified carbapenem inactivation method (eCIM)'''
	**Only done if mCIM is positive, to test for metallo-β-lactamases		**Only done if mCIM is positive, to test for metallo-β-lactamases
	**As above for mCIM, but adds EDTA to the tube		**As above for mCIM, but adds EDTA to the tube
	**Positive for metallo-β-lactamase if zone diameter increases ≥5 mm from mCIM		**Positive for metallo-β-lactamase if zone diameter increases ≥5 mm from mCIM
	***Ignore pinpoint colonies within any zones of inhibition in the eCIM		***Ignore pinpoint colonies within any zones of inhibition in the eCIM
	*Rosco discs		*'''Double disc diffusion''' (using Rosco discs)
	**Class A: attenuated by boronic acid		**Class A: attenuated by boronic acid
	**Class B: attenuated by diploconic acid		**Class B: attenuated by diploconic acid