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27 Cards in this Set

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Enterobacter microbiology

Gram neg, aerobic, motile bacilli


Enterobacter family


Major pathogenic species: cloacae

Enterobacter drug resistance

Chromosomal AmpC betalactamases that are constitutive and inducible + plasmid-encoded ESBLs and carbapenamases


prescence of beta-lactams required for activation of inducible beta-lactamses

ID carbapenamase producing enterobacter by

Modified Hodge Test

Common nosocomial enterobacter Dx

VAP, burn/surg wound infections, catherter or device related infections, post neurosurg meningitis

Enterobacter inherent resisance

Ampicillin, 1G cephs, macrolides


PNA/osteo treatment with beta-lctams may lead to formation of beta-lactamses

Treatment of carbapenamse-producing enterobacter

gentamicin, tobra, amik, colisitin


reserve nitrofurantoin and fosfomycin for uncomplicated UTIs

Drug resitance to which AB may develop while on therapy?

cefepime



double coverage often needed empirically

Citrobacter micro

Gram neg aerobic bacilli


normal gut flora


colonies on plates resemble e coli


C. species

freundii, amalonaticus, koseri

Clinical citrobacter Dx

nosomal pathogen found in immunocompromised hosts (UTIs, PNA, line infections common)



frequently express B-lactamse


Isolates may express ESBL or KPC



bacteria often polymicrobial

acinetobacter microbilology

gram neg coccobacilli or rod


common in environemnt and hospital


acinetobacter species

baumanni is major


Others: wolfii, junii, baylyi


a baumanni

low-grade pathogen


affects compromised hosts


Clinical acineto

Pan-resistant GNR


Risks: hosp, ICU, surgery, antibiotic exposure, catheters, ventilators

Acinetobacter lab isolations

often meaningless: common colonization unless


1. normally sterile site (ie blood)


2. found as dominant pathogen and heavy growth from potentially contam site


3. outbreak


4. good clinical correlation

Most active abx against acineto

imipenem, unasyn, colisitin, tigecycline, amikacin

abx with variable acineto activity

AG, cephs, minocycline, rifampin

Pseduomonas micro

gram neg non fermenting motile bacillus


blue-green pus


biofilm


non-fastidious (can inhibit variety of environments)


fasti = complex nutrition requirement

Pseduomonas drug resistance mechs

Efflux pumps


Chromosomal and inducle beta lactamases


Plasmid-mediated ESBL (TEM, SHV, CTX-M)


Altered permeability


Loss of protein porin OprD results in resist to carbapenemes

Clinical pseduo

common nosocomail pathogen esp in immunocompromised setting or foreign body (central line, urinary cath)



chornic CF colonizer



Pseduo MDR risk factors

Mutilple recetn abx use (past 90 days)


Hosp stay > 4 days


LTC


MDR strains treatment

colistin, polymyxin B

Which patients may require higher doses of Abx for pseduomonas treatment?

Prego, burns, CF, critical illness

Resistance to pip-tazo is not beta-lactamse realted

really no benefit of tazo vs. pip alone

Pseudomonas virulence

fimbriae


EC polysaccharides


flagella


exotoxin A


exoenzyme S


EC ezymes (alkaline phosphatase, phospholipase C)

Pseudomonas exotoxin a

important virulence factor


blocks eukaryotic cell protein synthesis by inhibiting EF-2 similar to dipthereia)

Other pseudomonas (or similar species)

burkholderia mallei, B pseduomalleli, B cepacia