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Infections caused by naturally AmpC-producing Enterobacteriaceae: Can we use third-generation cephalosporins? A

A Mizrahi1, T Delerue2, H Morel2

  • 1Service de microbiologie clinique et dosage des anti-infectieux, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France; EA4043 Unité Bactéries Pathogènes et Santé, Université Paris-Sud Saclay, Chatenay-Malabry, France.

International Journal of Antimicrobial Agents
|November 5, 2019
PubMed

Insights

Third-generation cephalosporins (3GCs) may be ineffective against Gram-negative infections due to AmpC beta-lactamase overproduction in ESCPM bacteria. Guidelines recommend avoiding 3GCs for these infections.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Antibiotic resistance in Gram-negative bacteria, particularly Enterobacteriaceae, is a growing global health concern.
  • Resistance to third-generation cephalosporins (3GCs) is often mediated by beta-lactamases, including AmpC enzymes.
  • The ESCPM group (Enterobacter spp., Serratia marcescens, Citrobacter freundii, Providencia spp., Morganella morganii) characteristically possesses inducible AmpC beta-lactamases.

Purpose of the Study:

  • To review the literature on the clinical implications of using 3GCs for infections caused by ESCPM organisms.
  • To evaluate the risk associated with 3GC therapy in the context of AmpC overproduction.

Main Methods:

  • Narrative review of published literature.
  • Analysis of clinical studies, guidelines, and expert recommendations.

Main Results:

  • Overproduction of AmpC beta-lactamases, either inducible or constitutive, can lead to 3GC inactivation.
  • Clinical evidence suggests that 3GCs may not be effective for treating ESCPM infections.
  • Expert consensus and guidelines recommend against using 3GCs as definitive treatment for these infections.

Conclusions:

  • The risk of treatment failure with 3GCs is significant for infections caused by ESCPM organisms due to AmpC beta-lactamase activity.
  • Avoiding 3GCs is crucial for effective management of infections caused by this group of bacteria.
  • Further research may be needed to establish optimal therapeutic strategies.
Keywords:
AmpCAntibiotic therapyCephalosporinaseEnterobacteriaceae

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