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In general, treatment with cephalosporins results in induction of AmpC beta-lactamase. [2] Treatment with an aminoglycoside or carbapenem is usually indicated. Carbapenems are a class of beta-lactam antibiotics with a broad spectrum of antibacterial activity. They have a structure that renders them highly resistant to beta-lactamases.
Treatment is dependent on local trends of antibiotic resistance. Enterobacter huaxiensis and Enterobacter chuandaensis are two recently discovered species that exhibit especially antibiotic resistant characteristics. [9] Cefepime, a fourth-generation cephalosporin from the β-Lactam antibiotic class.
Treatment using cefepime and gentamicin has been reported. [11] A 2012 study in which Enterobacter cloacae was transplanted into previously germ-free mice resulted in increased obesity when compared with germ-free mice fed an identical diet, suggesting a link between obesity and the presence of Enterobacter gut flora. [12]
Carbapenem-resistant Enterobacteriaceae (CRE) have been defined as carbapenem-nonsusceptible and extended-spectrum cephalosporin-resistant Escherichia coli, Enterobacter aerogenes, Enterobacter cloacae complex, Klebsiella pneumoniae, or Klebsiella oxytoca. Some exclude ertapenem resistance from the definition. [5]
Tigecycline is indicated for the treatment of complicated intra-abdominal infections caused by; Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, vancomycin-susceptible Enterococcus faecalis, methicillin-resistant Staphylococcus aureus, Streptococcus anginosus grp., Bacteroides fragilis ...
Nacubactam is an investigational β-lactamase inhibitor being developed for the treatment of infections caused by carbapenem-resistant Enterobacteriaceae (CRE). It belongs to the diazabicyclooctane (DBO) class of compounds and exhibits a dual mechanism of action.
Antibiotic molecules that successfully traverse the porin channels may be removed by efflux pumps. Downregulation of the porin OprD2 is an important contributor to imipenem resistance. [39] Like the Enterobacteriaceae, Pseudomonas and Acinetobacter can express a wide range of antibiotic-deactivitating enzymes, including beta lactamases.
For the treatment of severe pneumonia (HABP and VABP), it is indicated in patients 18 years of age and older whose pneumonia is not responding to other, more commonly used antibiotics and is confirmed to be caused by one of the following Gram-negative organisms: Acinetobacter baumannii complex; Escherichia coli; Enterobacter cloacae complex
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