SPICE organisms: Difference between revisions
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**[[Carbapenems]] still work, as do [[aminoglycosides]] |
**[[Carbapenems]] still work, as do [[aminoglycosides]] |
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**[[Cefipime]] still works when MIC ≤2 mcg/mL |
**[[Cefipime]] still works when MIC ≤2 mcg/mL |
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*For [[Serratia marcescens]], [[Morganella morganii]], |
*For [[Serratia marcescens]], [[Morganella morganii]], [[Providencia]], and [[Proteus]] treat based on susceptibility testing |
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*Less data for [[Hafnia alvei]], [[Citrobacter youngae]], and [[Yersinia enterocolitica]], but reasonable to treat based on susceptibility testing |
*Less data for [[Hafnia alvei]], [[Citrobacter youngae]], and [[Yersinia enterocolitica]], but reasonable to treat based on susceptibility testing |
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Latest revision as of 19:54, 7 February 2025
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, Providencia, and Proteus 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
