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BCPID Review > Abx Drug Resistance Genotype > Flashcards

Abx Drug Resistance Genotype Flashcards

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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
OprD | Resistance Mechanism
Porin Channel
26
OprD | Resistance to
Can make PsA resistance to carbapanems
27
TetA, TetB, TetC | Resistance mechanism
Efflux pump
28
TetA, TetB, TetC | Resistance to
Can make E.coli resistance to tetracycline
29
Erm | Resistance mechanism
Binding site change
30
Erm | Resistance to
Can cause plasmid-mediated resistance in clindamycin and macrolides
31
gyrA, gyrB, gyrC | Resistance mechanism
Binding site chanes
32
gyrA, gyrB, gyrC | Resistance to:
Can cause FQ resistance
33
# Mechanism of microbial Resistance Change in the binding site
changes at the site of action confer bacterial resistance
34
# Mechanism of microbial Resistance Enzymatic degradation
enzymes that hydrolyzes abx, disrupting their structure and rendering them inactive
35
# Mechanism of microbial Resistance Porin channells
Loss in porin channel confer reduced ability for abx to penetrate into the microbes
36
# Mechanism of microbial Resistance Efflux pump
Increased efflux pump activity reduces the concentration of abx inside the bacterial cells
37
HECKYES inducible AmpC-mediated resistance
H= Hafnia alvei E = Enterobacter cloacae C = Citrobacter freundii K = Klebsiella aerogenes Y = YErSinia enterocolitica
38
Mechanism of Resistance - Abx structural modifier
* Beta lactamases * Aminoglycoside modifying enzyme
39
Mechanism of Resistance - Decreased abx concentration at the site of action
Porin Deletion Efflux pumps
40
Mechanism of Resistance - Target Site Alterations
PBP2A (MRSA) DNA Gyrase / Type II Topoisomerases (FQ) Lipid A (polymyxin resistance)
41
Porin deletion
- Transport molecules in and out of the cell - Downregulation leads to decrease in antibacterial concentration at active site
42
Efflux pump
- Remove toxins from within bacteria - Upregulation may lead to increases in MIC resistance - May affect multiple classes of abx
43
Efflux pump example
- MexXY in PsA - - MexAB in PsA - AdeABC in A. baumanii
44
Altered target site - FQ
- Changes in DNA gyrase (gyrA/GryB) and topoisomerase IV (parC)
45
Altered target site - Beta lactam
- 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
Altered target site - Vancomycin
- VanA and VanB - resuults in vancomycin resistance by encoding changes from DAlaDala to Dala, Dlac - inducible expression in enterocci
47
Beta-Lactamases Classifications
48
# amber class A, bush jacoby - 2b TEM-1, SHV-1
- Activity PCNS, cephalosporins - inhibited by beta lactamases
49
blaZ
- specific to GPO - PCN resistance in staphylococci and enterococci - innoculum effect on cefazolin but not with oxacillin/nafcillin
50
# Amber class A, BJ: 2B TEM-10 SHV -12 CTX-m
ESBL CTXM most common resistance to most BetaLactam
51
# amber class 1, bj: 2f KPC IMI
Carbapenamase - result resistance to most b-lactam - effectively inhibited by novel B-lactamase inhibitor (e.g. aviibactam, vaborbactam, relebactam)
52
# Amber b, BJ: 3a IMP VIM NDM
- 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
# amber class C, bj1 AmpC CMY-2
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
# amber class D OXA type
- 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
# Amber D, bj 2D OXA-1
Oxacillinase
56
# Amber class D OXA - 51
-intrinsic to acinetobacter baumanni - requires upregulation for clinical for clinical carbapenem resistance
57
# amber class D OXA-48
- most common in nothern africa and souther Europpe - Results in carbapenem resistance, limited effect on extended spectrum cephalosporins - Identified primarily in enterobacterales
58
# amber class d OXA 23/24
- Result in high level carbapenem resistance - identified primarily in Acinetobacter spp
59
# Amber Class d OXA-10
-one of the most common OXA-type enzyme identified from PsA - primarily affects extended spectrum cephalosporins
60
Porin Deletion Example
- ompK25/ompK36 in K Pneumonia - OprD in psA - CarO in A. baumanii
61
Resistance in staphylococci
- 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
Resistance in Streptocoocci
-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
Resistance in enterococci
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
Resistance in Enterobactereles
-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
Resistance in P. Aeruginosa
-Resistance is more complex and less predictable than with enterobacterales -Multiple intrinsic B--lactamases - OprD porin necessary for entry of carbapenems into bacteria
66
Resistance with A. Baumanii
- 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
Resistance in stenotrophomonas maltophila
- 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

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