SPICE organisms: Difference between revisions

Latest revision as of 14:44, 25 October 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)
And maybe 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

@@ Line 1: / Line 1: @@
-= Definition =
+== Background ==
-* Gram-negative bacteria with inducible or derepressable beta-lactamases, primarily chromosomal AmpC
+* Gram-negative bacteria with inducible or derepressable beta-lactamases, primarily [[AmpC β-lactamase]]
-= Organisms =
+== Organisms ==
-* ''Serratia'' spp.
+* [[Serratia]]
-* ''Providencia''
+* [[Providencia]]
-* Indole-positive ''Proteae'' (e.g. ''Proteus vulgaris'', but not ''Proteus mirabilis'')
+* Indole-positive [[Proteus]] (e.g. [[Proteus vulgaris]], but not [[Proteus mirabilis]])
-* ''Citrobacter'' spp.
+* [[Citrobacter|'''Citrobacter''']]
-** ''C. koseri'' does ''not'' have an AmpC
+** [[Citrobacter koseri]] does ''not'' have an AmpC
+* [[Enterobacter cloacae|'''Enterobacter cloacae''']], and now also '''[[Klebsiella aerogenes]]''' (previously ''Enterobacter aerogenes'')
-* ''Enterobacter cloacae''
+* And maybe also:
+** [[Hafnia alvei]]
+** [[Morganella morganii]]
+** [[Cronobacter]]
+** [[Edwardsiella]]
+== Management ==
-Also:
+* For [[Enterobacter cloacae]], [[Klebsiella aerogenes]], and [[Citrobacter freundii]], avoid all penicillins and cephalosporins regardless of susceptibility testing
-* ''Hafnia alvei''
+**[[Carbapenems]] still work, as do [[aminoglycosides]]
-* ''Acinetobacter'', though not inducible or AmpC (merely very resistant_
+**[[Cefipime]] still works when MIC ≤2 mcg/mL
-* ''Morganella morganii''
+*For [[Serratia marcescens]], [[Morganella morganii]], and [[Providencia]], treat based on susceptibility testing
-* ''Cronobacter''
+*Less data for [[Hafnia alvei]], [[Citrobacter youngae]], and [[Yersinia enterocolitica]], but reasonable to treat based on susceptibility testing
-* ''Edwardsiella''
+== Further Reading ==
-= Treatment =
-* ''Not'' penicillins or cephalosporins, as resistance will develop within a few days
-* Carbapenems still work, as do aminoglycosides
-= Further Reading =
 * Jones R, Baquero F, Privitera G, Inoue M, Widermann B. [https://doi.org/10.1111/j.1469-0691.1997.tb00643.x Inducible β-lactamase-mediated resistance to third-generation cephalosporins]. ''Clin Microbio Infect''. 1997;3(1):S7-S20.