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BCPID Review > Abx Drug Resistance Genotype > Flashcards

Abx Drug Resistance Genotype Flashcards

1
Q

Gram Positive Resistance

VanA

Resistance mechanism

A

Cell wall modifying Enzyme

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2
Q

Gram Positive Resistance

VanA

Resistance to

A

Glycopeptides: vancomycin, Teicoplanin, Dalbavancin, Telavancin

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3
Q

Gram Positive Resistance

VanA

Alternative Abx

A

Oritavancin
Linezolid
Daptomycin

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4
Q

Gram Positive Resistance

VanB

Resistance mechanism

A

Cell wall modifying enzyme

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5
Q

Gram Positive Resistance

VanB

Resistance to

A

Vancomycin

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6
Q

Gram Positive Resistance

VanB

Alternative Abx

A

Teicoplanin
Dalbavancin
Telavancin
Oritavancin
Linezolid
Daptomycin

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7
Q

Gram Positive Resistance

MecA/MecC

Resistance mechanism

A

Low-affinity
PBP, PBP2a

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8
Q

Gram Positive Resistance

MecA/MecC

Alternative antibiotic

A

Ceftaroline
Ceftobiprole
Linezolid
Daptomycin
Vancomycin
Teicoplanin

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9
Q

Gram Positive Resistance

MecA/MecC

Resistance to

A

PCN
Carbapenems
All cephalosporin
except ceftaroline and ceftobiprole

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10
Q

Gram Negative Resistance

ampC

Resistance mechanism

A

Penicillinase, cephalosporinase
(Class C Serine beta lactamase)

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11
Q

Gram Negative Resistance

ampC

Resistance to

A

Penicillin
Most Cephalosporin

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12
Q

Gram Negative Resistance

ampC

Alternative abx

A

Cefepime (only if MIC is <2)
Ceftolazone-tazobactam)
Ertapenem
Imipenem-cislastin
Merrem
AMG
TMP/SMZ
FQ

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13
Q

Gram Negative Resistance

CTX-M
SHV
TEM
(ESBL)

Resistance mechanism

A

Penicillinase,
cephalosporinase
(Class A serine Beta Lactamase)

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14
Q

Gram Negative Resistance

CTX-M
SHV
TEM
(ESBL)

Resistance to

A

Penicillins
Penicillins-BLI combo
Most Cephalosporin
(Except cephamycin)
Aztreonam

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15
Q

Gram Negative Resistance

CTX-M
SHV
TEM
(ESBL)

Alternative abx

A

Ceftolazone-tazobactam
Ertapenem
Imipenem-cislastatin
Meropenem

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16
Q

Gram Negative Resistance

KPC

Resistance to

A

Penicillins
Penicillins-BLI combo
Cephalosporin
Carbapenems
Aztreonam

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17
Q

Gram Negative Resistance

KPC

Resistance mechanis

A

Penicillinase,
Cephalosporinase
Carbapenamase
(class A serine beta lactamase)

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18
Q

Gram Negative Resistance

KPC

Alternative abx

A

Ceftazidime-avibactam
Meropenem-vaborbactam
Imipenem-cislastatin-relebactam
Cefiderocol
AMG

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19
Q

Gram Negative Resistance

OXA-48
OXA-48 like

Resistamce mechanism

A

Penicillinase
Carbapenemase
(Class D serine beta lactamase)

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20
Q

Gram Negative Resistance

OXA-48
OXA-48 like

Resistance to:

A

Penicillins
Penicillins-BLI combo
Carbapenems
Aztreonams

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21
Q

Gram Negative Resistance

OXA-48
OXA-48 like

Alternative Antibiotics

A

Ceftazidime-avibactam
Cefiderocol
AMG

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22
Q

Gram Negative Resistance

IMP
VIM
NDM

Resistance mechanism

A

Penicillinase
Cephalosporinase
Carbapenamase
(Class B metallo-beta-lactamase)

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23
Q

Gram Negative Resistance

IMP
VIM
NDM

Resistance to

A

Penicillins
Penicillins-BLI combo
Cephalosporin
Carbapanem

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24
Q

Gram Negative Resistance

IMP
VIM
NDM

Alternative abx

A

Aztreonam+Ceftazidime-avibactam

Cefiderocol

Aztreonam is not hydrolyzed by metallo-beta-lactamase, however, strains enconding MBL frequency encodes other beta lactamase which can hydrolyzes drugs. If aztreonam is used, need. with combination of Avycas cause avibactam inhibits class A, C and some class D serine beta lactamases which may protect teh aztreonam from inactiviation of other enzyme

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25
Q

OprD

Resistance Mechanism

A

Porin Channel

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26
Q

OprD

Resistance to

A

Can make PsA resistance to carbapanems

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27
Q

TetA, TetB, TetC

Resistance mechanism

A

Efflux pump

28
Q

TetA, TetB, TetC

Resistance to

A

Can make E.coli resistance to tetracycline

29
Q

Erm

Resistance mechanism

A

Binding site change

30
Q

Erm

Resistance to

A

Can cause plasmid-mediated resistance in clindamycin and macrolides

31
Q

gyrA, gyrB, gyrC

Resistance mechanism

A

Binding site chanes

32
Q

gyrA, gyrB, gyrC

Resistance to:

A

Can cause FQ resistance

33
Q

Mechanism of microbial Resistance

Change in the binding site

A

changes at the site of action confer bacterial resistance

34
Q

Mechanism of microbial Resistance

Enzymatic degradation

A

enzymes that hydrolyzes abx, disrupting their structure and rendering them inactive

35
Q

Mechanism of microbial Resistance

Porin channells

A

Loss in porin channel confer reduced ability for abx to penetrate into the microbes

36
Q

Mechanism of microbial Resistance

Efflux pump

A

Increased efflux pump activity reduces the concentration of abx inside the bacterial cells

37
Q

HECKYES
inducible AmpC-mediated resistance

A

H= Hafnia alvei
E = Enterobacter cloacae
C = Citrobacter freundii
K = Klebsiella aerogenes
Y = YErSinia enterocolitica

38
Q

Mechanism of Resistance - Abx structural modifier

A
  • Beta lactamases
  • Aminoglycoside modifying enzyme
39
Q

Mechanism of Resistance - Decreased abx concentration at the site of action

A

Porin Deletion
Efflux pumps

40
Q

Mechanism of Resistance - Target Site Alterations

A

PBP2A (MRSA)
DNA Gyrase / Type II Topoisomerases (FQ)
Lipid A (polymyxin resistance)

41
Q

Porin deletion

A
  • Transport molecules in and out of the cell
  • Downregulation leads to decrease in antibacterial concentration at active site
42
Q

Efflux pump

A
  • Remove toxins from within bacteria
  • Upregulation may lead to increases in MIC resistance
  • May affect multiple classes of abx
43
Q

Efflux pump example

A
  • MexXY in PsA
    • MexAB in PsA
  • AdeABC in A. baumanii
44
Q

Altered target site - FQ

A
  • Changes in DNA gyrase (gyrA/GryB) and topoisomerase IV (parC)
45
Q

Altered target site - Beta lactam

A
  • PBP2A in staph aureus (meca) - high level of resistance to all be-lactam except ceftaroline
  • ## Upregulation of PBP5 in enterocccus faecium - ampicillin resisitance
  • PBP mutation in S. Pneumonia - some resistance may overcome using higher doses of amoxicillin
46
Q

Altered target site - Vancomycin

A
  • VanA and VanB
  • resuults in vancomycin resistance by encoding changes from DAlaDala to Dala, Dlac
  • inducible expression in enterocci
47
Q

Beta-Lactamases Classifications

A
48
Q

amber class A, bush jacoby - 2b

TEM-1, SHV-1

A
  • Activity PCNS, cephalosporins
  • inhibited by beta lactamases
49
Q

blaZ

A
  • specific to GPO
  • PCN resistance in staphylococci and enterococci
  • innoculum effect on cefazolin but not with oxacillin/nafcillin
50
Q

Amber class A, BJ: 2B

TEM-10
SHV -12
CTX-m

A

ESBL
CTXM most common
resistance to most BetaLactam

51
Q

amber class 1, bj: 2f

KPC
IMI

A

Carbapenamase
- result resistance to most b-lactam
- effectively inhibited by novel B-lactamase inhibitor (e.g. aviibactam, vaborbactam, relebactam)

52
Q

Amber b, BJ: 3a

IMP
VIM
NDM

A
  • metalo beta lactamases
  • Zion ion at binding sites
  • hydrolyezes all beta lactam except cefiderocol, do not hydrolyzes monobactam (aztreonam)
  • not inhibited. by any currently available B-lactamase inhibitor
  • VIM/IMP are most common in non fermenter - PsA, steno?
53
Q

amber class C, bj1

AmpC
CMY-2

A

Cephalosporinase
- production inducible in some species (Enterobacter spp, PsA, Citrobacter freundii, Serratia spp)
- Not inhibited by traditional be- lactamase inhibitor
- do not affect carbapenems susceptibility alone but when combinmed with other mechnaism can result in in vitro resistacne

54
Q

amber class D

OXA type

A
  • very diverse, often with limited spectrum
  • most common in non fermenter
  • may not result in carbapenem resistance as single mechanism
  • Not inhibited by tranditional B-lactatamses inhibitor like relebactam and vaborbactam
  • Avibactam has some inhibitory activity
55
Q

Amber D, bj 2D

OXA-1

A

Oxacillinase

56
Q

Amber class D

OXA - 51

A

-intrinsic to acinetobacter baumanni
- requires upregulation for clinical for clinical carbapenem resistance

57
Q

amber class D

OXA-48

A
  • most common in nothern africa and souther Europpe
  • Results in carbapenem resistance, limited effect on extended spectrum cephalosporins
  • Identified primarily in enterobacterales
58
Q

amber class d

OXA 23/24

A
  • Result in high level carbapenem resistance
  • identified primarily in Acinetobacter spp
59
Q

Amber Class d

OXA-10

A

-one of the most common OXA-type enzyme identified from PsA
- primarily affects extended spectrum cephalosporins

60
Q

Porin Deletion Example

A
  • ompK25/ompK36 in K Pneumonia
  • OprD in psA
  • CarO in A. baumanii
61
Q

Resistance in staphylococci

A
  • penicillin resistance mediated by penicillinases
  • B-lactam resistance mediated by PBP2 production (encded by mecA)
  • glycopeptide resistance rare
  • daptomycin resistance often driven by cell wall thickening, decreasing charge density and access to target site
62
Q

Resistance in Streptocoocci

A

-Azithromycin resistance driven by ribosome methlation
- FQ resistance caused by alteration in DNA gyrase and topoisomerase II
- Beta-lactam resistasnce most often due to PBP alteration

63
Q

Resistance in enterococci

A

E.faecalis
- resistance is limited, amp resistasnce is extremely rare
- Vancomycin resistance also a concern though is less common than faecium

E.faecium
- amp resistance may be mediated by PBP alterartions or penicillinase
- Vanco resistance mediated by VanA/VanB
- linezolid resistance results from target site alteration

64
Q

Resistance in Enterobactereles

A

-beta lactam resistance generally driven by B-lactamases
-FQ resistance generally due to target site alteration of efflux pump
-TCN resistance due to efflux pump or taget site alteration
-AMG resistance result from production of amg modifying enzumes and upregulation of efflux pump
-polymyxin resistance most often due to alteration in lipid A

65
Q

Resistance in P. Aeruginosa

A

-Resistance is more complex and less predictable than with enterobacterales
-Multiple intrinsic B–lactamases
- OprD porin necessary for entry of carbapenems into bacteria

66
Q

Resistance with A. Baumanii

A
  • high level resistance to multiple abx is common
  • Intrinsic production of beta-lactamase
  • Sulbactam resistance thought to be result of PBP alteration
  • Multiple porin and efflux pump associated with resistance have been identified
67
Q

Resistance in stenotrophomonas maltophila

A
  • intrinsic production of metallo-beta-lactamases and cephalsoporinase
  • multidrug resistance via efflux pumps
  • TMP resistance generally result from production of dihydrofolate reductase
  • SMZ resistnace due to dihydropteroate synthase alterations

BCPID Review (10 decks)

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