SPICE organisms: Difference between revisions
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== Background == |
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* Gram-negative bacteria with inducible or derepressable beta-lactamases, primarily [[AmpC β-lactamase]] |
* Gram-negative bacteria with inducible or derepressable beta-lactamases, primarily [[AmpC β-lactamase]] |
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* [[Edwardsiella]] |
* [[Edwardsiella]] |
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== Management == |
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* For [[Enterobacter cloacae]], [[Klebsiella aerogenes]], and [[Citrobacter freundii]], avoid all penicillins and cephalosporins regardless of susceptibility testing |
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* ''Not'' penicillins or cephalosporins, as resistance will develop within a few days |
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**[[Carbapenems]] still work, as do [[aminoglycosides]] |
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**[[Cefipime]] still works when MIC ≤2 mcg/mL |
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*For [[Serratia marcescens]], [[Morganella morganii]], and [[Providencia]], 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 |
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== Further Reading == |
== Further Reading == |
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Revision as of 20:08, 24 November 2021
Background
- Gram-negative bacteria with inducible or derepressable beta-lactamases, primarily AmpC β-lactamase
Organisms
- Serratia species
- Providencia
- Indole-positive Proteus species (e.g. Proteus vulgaris, but not Proteus mirabilis)
- Citrobacter species
- C. koseri does not have an AmpC
- Enterobacter cloacae, and now also Klebsiella aerogenes (previously Enterobacter aerogenes)
Also:
- Hafnia alvei
- Acinetobacter, though not inducible or AmpC (merely very resistant_
- Morganella morganii
- Cronobacter
- Edwardsiella
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
