Extended-spectrum beta-lactamase

Literak I, Dolejska M, Radimersky T et al (2010) Antimicrobial-resistant faecal Escherichia coli in wild mammals in central Europe multrresistant Escherichia coli producing extended-spectrum beta-lactamases in wild boars. J Appl Microbiol 108(5) 1702-1711... 

Poeta P, Radhouani H, Igrejas G et al (2008) Seagulls of the Berlengas natural reserve of Portugal as carriers of fecal Escherichia coli harboring CTX-M and TEM extended-spectrum beta-lactamases. Appl Environ Microbiol 74(23) 7439-7441... 

Chen H, Shu W, Chang X et al (2010) The profile of antibiotics resistance and integrons of extended-spectrum beta-lactamase producing thermotolerant coliforms isolated from the Yangtze River basin in Chongqing. Environ Pollut 158(7) 2459-2464... 

Girlich D, Poirel L, Nordmann P (2011) Diversity of clavulanic acid-inhibited extended-spectrum beta-lactamases iaAeromonas spp. from the Seine River, Paris, France. Antimicrob Agents Chemother 55(3) 1256-1261... 

Bassetti M, Righi E, Fasce R, Molinari MR Rosso R, Di Biagio A, Mussap M, Pallavicini FB, Viscoli C. (2007) Efficacy of Ertapenem in the treatment of early ventilator-associated pneumonia caused by extended-spectrum beta-lactamase-producing organisms in an intensive care unit. J Antimicrob Chemother 60 433 35. 

Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases a clinical update. Clin Microbiol Rev. 2005 18 657-686. 

Philippon A, Labia R, Jacoby G. Extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1989 33(8) 1131-6. 

Gniadkowski M. Evolution of extended-spectrum beta-lactamases by mutation. Clin Microbiol Infect. 2008 14(Suppl l) ll-32. 

Pitout JD. Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae changing epidemiology and drug treatment choices. Drugs. 2010 70 313-33. 

D.L. Paterson, W.C. Ko and S. Mohapatra et al. Klebsiella pneumoniae bacteremia impact of extended spectrum beta-lactamase (ESBL) production in a global study of 216 patients (abstract). 37 Interscience Conference on Antimicrobial Agents and Chemotherapy Sept. 28-Oct. 1 Toronto, Ontario, Canada, 1997. 

The concentration of meropenem in breast milk was evaluated in a study of a 41-year-old woman treated for a postpartum urinary tract infection caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli with meropenem 1 g IV q 8 h. Levels were taken from five samples, and ranged from 0.246 mcg/mL to 0.644 mcg/mL. The average breast milk concentration was 0.48 mcg/mL. It was found that the levels were comparable to those of imipenem in breast milk [75 ]. 

There are many beta-lactamases and they can be classified differently by type of substrate, replacement of genes (chromosomes or plasmids), and place of production. A few of these enzymes directly hydrolyze penicillins (penicillinases), others hydrolyze cephalosporins (cephalosporinases), and others extend to a broad spectrum of substrates. A few bacteria have the ability to induce synthesis of beta-lactamase. Synthesis of beta-lactamase, which in a normal condition is suppressed, is induced in the presence of some beta-lactam antibiotics. 

Obstetric infections can be treated with penicillin-beta-lactamase inhibitors such as amoxicillin-clavulanic acid, with extended spectrum penicillins (with or without beta-lacamase inhibitors if justified by local resistance surveillance data), with a first or second generation cephalosporin combined with metronidazole. In severe cases of streptococcal infection high doses of penicillin in combination with clindamycin is the treatment of choice. In amnionitis, maternal morbidity resolves with delivery. In endometritis, antibiotics should be stopped after the... 

Mechanism of Action Piperacillin inhibits cell wall synthesis by binding to bacterial cell membranes. Tazobactam inactivates bacterial beta-lactamase. Therapeutic Effect Piperacillin is bactericidal in susceptible organisms. Tazobactam protects piperacillin from enzymatic degradation, extends its spectrum of activity, and prevents bacterial overgrowth. 

Amoxycillin is also used in combination with clavulanate potassium. The formulation of amoxycillin with clavulanic acid protects amoxycillin from degradation by beta lactamase enzymes and effectively extends the antibiotic spectrum of amoxycillin to include P lactamase producing bacteria normally resistant to amoxycillin and other betalactam antibiotics. 

Piperacillin-Tazobactam (Zesyn) [Anribioric/Extended Spectrum Penicillin, Beta Lactamase Inhibitor] Uses Infxns of skin, bone, resp urinary tract, abd, sepsis Action PCN plus 3-lactamase inhibitor bactericidal i cell wall synth Dose Adults. 3.375-4.5 g IV q6h i in renal insuff Caution [B, M] Contra PCN or 3-lactam sensitivity Disp Powder for inj frozen, premix inj 3.25, 3.375, 4.5 g SE D, HA, insomnia, GI upset, serum sickness-like Rxn, pseudomembranous colitis Interactions T Effects W/ probenecid T effects OF anticoagulants, MTX i effects W/ macrolides, tetracyclines i effects OF OCPs EMS T Effects of anticoagulants monitor for signs of electrolyte disturbances and hypovolemia d/t D such as X- K+ may cause allergic Rxn in pts sensitive to PCN OD May cause N/V/D, resp difficulty, and Szs symptomatic and supportive... 

Wilson SE, Nord CE. CUnical trials of extended spectrum penicillin/beta-lactamase inhibitors in the treatment of intra-abdominal infections. European and North American experience. Am J Smg 1995 169(Suppl 5A) S21-6. 

Ticarcillin disodium/clavulanate potassium (Tunentin) is an extended-spectrum penicillin and inhibits beta-lactamase. 

Ticarcillin, an extended-spectrum penicillin that inhibits beta lactamase, is indicated in infections of the lower respiratory tract, urinary tract, bones and joints, skin and skin structures, and septicemia when caused by susceptible organisms. 

Extended spectrum, antipseudomonal, beta-lactamase sensitive ticarcillin, piperacillin, azlocillin... 

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