SPICE organisms: Difference between revisions
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* Indole-positive [[Proteus]] (e.g. [[Proteus vulgaris]], but not [[Proteus mirabilis]]) |
* Indole-positive [[Proteus]] (e.g. [[Proteus vulgaris]], but not [[Proteus mirabilis]]) |
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* [[Citrobacter|'''Citrobacter''']] |
* [[Citrobacter|'''Citrobacter''']] |
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** [[ |
** [[Citrobacter koseri]] does ''not'' have an AmpC |
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* [[Enterobacter cloacae|'''Enterobacter cloacae''']], and now also '''[[Klebsiella aerogenes]]''' (previously ''Enterobacter aerogenes'') |
* [[Enterobacter cloacae|'''Enterobacter cloacae''']], and now also '''[[Klebsiella aerogenes]]''' (previously ''Enterobacter aerogenes'') |
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Revision as of 17:42, 4 September 2024
Background
- Gram-negative bacteria with inducible or derepressable beta-lactamases, primarily AmpC β-lactamase
Organisms
- Serratia
- Providencia
- Indole-positive Proteus (e.g. Proteus vulgaris, but not Proteus mirabilis)
- Citrobacter
- Citrobacter koseri does not have an AmpC
- Enterobacter cloacae, and now also Klebsiella aerogenes (previously Enterobacter aerogenes)
Also:
Management
- For Enterobacter cloacae, Klebsiella aerogenes, and Citrobacter freundii, avoid all penicillins and cephalosporins regardless of susceptibility testing
- Carbapenems still work, as do aminoglycosides
- Cefipime still works when MIC ≤2 mcg/mL
- For Serratia marcescens, Morganella morganii, and Providencia, treat based on susceptibility testing
- Less data for Hafnia alvei, Citrobacter youngae, and Yersinia enterocolitica, but reasonable to treat based on susceptibility testing
Further Reading
- Jones R, Baquero F, Privitera G, Inoue M, Widermann B. Inducible β-lactamase-mediated resistance to third-generation cephalosporins. Clin Microbio Infect. 1997;3(1):S7-S20.
- https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz173/5369903
