MIC 541-Exam 4- Antimicrobials V-2

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MIC 541-Exam 4- Antimicrobials V-2
2013-04-14 20:16:27
MIC 541 Exam Antimicrobials

MIC 541-Exam 4- Antimicrobials V-2
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  1. Extended spectrum
    • Broad spectrum
    • Cephalosporinases
    • Penicillinases
  2. Carbapenems are stable against all B-lactimases except?
  3. in the 70s was Penicillinase an issue?
    No, we had B-lactamase resistant penicillins and cephalosporins
  4. in the 70s what type of b-lactamase was a problem?
    Broad spectrum B-lactamases
  5. Why were broad spectrum B-lactamases such a problem in the 70s?
    • They made gram negative bacteria resistant to:
    • Penicillin
    • Ampicillin
    • Amoxicillin
    • Early Cephalosporins
  6. What made Gram negative bacteria resistant to Penicillin, Early cephalosporins, amoxicillin and ampicillin in the 70s?
    Broad spectrum B-lactamases
  7. In the 70s what way did they combat resistance with Broad spectrum B-lactamases?
  8. Why were laboratories unable to detect Cefatexim (cephalosporin) resistance in E. coli and Klebsiella?
    broad spectrum B-lactamases had mutated into Extended spectrum B-lactamases
  9. What practice came out the development of Extended Spectrum B-lactamases?
    • Reporting resistance to Penicillins and Cephalosporins
    • Create new anti-Beta-lactamases
  10. If an organism produced an ESBL, what considerations should be taken with laboratory test for susceptibility ?
    Need to consider that it might be resistant to penicillin, cephalosporins and aztreonam and use an inhibitor combination
  11. Why can ESBL be resistant o B-lactamase inhibitors?
    They can be produced at such a large quantity that they overwhelm the inhibtor
  12. ESBL are encoded where?
    On large plasmids
  13. Large plasmids that encode for ESBL often also encode for what other resistance?
    • Aminoglycosides
    • Trimthoprim
    • Sulfonamides
    • Chloramphenicol
  14. A plasmid that encodes for ____________ ___ large and often also encodes for resistance to aminoglycosides, Chloramphenicol, Sulfonamides and Trimethoprim?
  15. What are the most reliable drugs for treating ESBL carrying bacterial infections?
  16. Carbapenems are used to treat bacteria with what type of resistance?
  17. What other than Carbapenem can be used to treat ESBL bacteria?
    • Piperacillin/tazobactam
    • Amikacin
    • Tigecycline
    • Fosfomycin
    • amdinocillin
    • nitrofurantoin
  18. What type antibiotic is amikacin?
  19. When is tigecycline not active against ESBL?
    When the ESBL carrier is Proteus
  20. Nitrofurantoin is only active in what body part?
    The urine
  21. AmpC B-lactamases are what type of B-lactamases?
  22. Where are AmpC-lactamases coded at?
    The chromosome
  23. AmpC-lactamases are always produced in the cell?
    No, they are inducable
  24. What are the common features of AmpC-B-lactamases?
    • They are often inducable
    • Cephalosporinases
    • Resistant to B-lactamase inhibitors
    • Chromosomal
  25. Cephalosporinases include what notorious B-lactamase?
  26. Carbapenemases hydrolyze what?
    Carbapenems and other B-lactam drugs
  27. What features do Carbapenemases have?
    • hydrolyze carbapenems and other b-lactams
    • Major resistance problem
    • Their activity is through KPC and NDM-1 enzymes
  28. What are the two carbapenemases?
    • KPC
    • NDM-1
  29. What are KPC and NDM-1?
  30. What does KPC stand from?
    Klebsiella Pneumonia carbapenemase
  31. What is KPC like?
    ESBL that can also hydrolyze carbapenems
  32. Where did KPCs come from?
    New York state and New Jersey
  33. What bacteria carry KPCs?
    • K. pneumoniae
    • E.coli
    • E. cloacae
    • P. auruginosa
    • Acinetobacter
  34. What are KPC bacteria susceptible to?
    • polymixin (colistin, polymixin B) with tigecycline
    • +/- Rifampin
  35. Due to rising KPC bacteria to tigecycline and polymixin, what other drug is being added to the combination?
  36. How many chances do you have to combat KPC bacteria?
    Once, then resistance develops
  37. Where are KPC issues out of control?
    • Greece
    • Israel
    • NYC
  38. NYC, Greece and Israel have what similar issues with resistance?
  39. What does NDM-1 stand for?
    New Dehli Metallo-B-lactamase
  40. Where is NDM-1 endemic?
    • India
    • Pakistan
  41. 40% of people in India carry what B-lactamase in their normal flora?
  42. NDM-1 is what type of B-lactamase?
  43. What type of b-lactamase /infection type is becoming common in the community?
    NDM-1 UTI
  44. NDM-1 is worry-some, because it has jumped to what group?
  45. When was the last outbreak of NDM-1?
    Before Christmas in Denver