Table 2 A clinical approach to β-lactamases
From: Antibiotic strategies in the era of multidrug resistance
Type of β-lactamase | Classic microorganisms or types | Clinical prescribing challenges |
|---|---|---|
Extended-spectrum β-lactamases | Escherichia coli Klebsiella species Proteus species | Variability of in vitro activity consistently predicting in vivo efficacy Collateral damage of selection by certain antibiotic classes |
AmpC | Serratia species Pseudomonas aeruginosa Indole + Proteus Citrobacter species Enterobacter species | Collateral benefit of possibly preventing selection of resistance by limiting antibiotics with activity against certain bacteria (as an example, pseudomonal-sparing antibiotic regimens) |
Carbapenemases | KPC (Ambler Class A) NDM (Ambler Class B) Oxa-typea (Class D) | Selection risk by intensity and duration of prior antibiotic therapy Consideration of the role of combination therapy in treatment |