TAILIEUCHUNG - Chapter 130. Streptococcal and Enterococcal Infections (Part 12)

Enterococci may be resistant to penicillins via two distinct mechanisms. The first is β-lactamase production (mediating resistance to penicillin and ampicillin), which has been reported for E. faecalis isolates from several locations in the United States and other countries. Because the amount of β-lactamase produced may be insufficient for detection by routine antibiotic susceptibility testing, isolates from serious infections should be screened specifically for βlactamase production with a chromogenic cephalosporin or another method. For the treatment of β-lactamase–producing strains, vancomycin, ampicillin/sulbactam, amoxicillin/clavulanate, imipenem, or meropenem may be used in combination with gentamicin. . | Chapter 130. Streptococcal and Enterococcal Infections Part 12 Enterococci may be resistant to penicillins via two distinct mechanisms. The first is P-lactamase production mediating resistance to penicillin and ampicillin which has been reported for E. faecalis isolates from several locations in the United States and other countries. Because the amount of P-lactamase produced may be insufficient for detection by routine antibiotic susceptibility testing isolates from serious infections should be screened specifically for P-lactamase production with a chromogenic cephalosporin or another method. For the treatment of P-lactamase-producing strains vancomycin ampicillin sulbactam amoxicillin clavulanate imipenem or meropenem may be used in combination with gentamicin. The second mechanism of penicillin resistance is not mediated by P-lactamase and may be due to altered penicillin-binding proteins. This intrinsic penicillin resistance is common among E. faecium isolates which routinely are more resistant to 0-lactam antibiotics than are isolates of E. faecalis. Moderately resistant enterococci MICs of penicillin and ampicillin 16-64 pg mL may be susceptible to high-dose penicillin or ampicillin plus gentamicin but strains with MICs of 200 pg mL must be considered resistant to clinically achievable levels of 0-lactam antibiotics including imipenem and meropenem. Vancomycin plus gentamicin is the recommended regimen for infections due to enterococci with high-level intrinsic resistance to 0-lactams. Vancomycin-resistant enterococci VRE first reported from clinical sources in the late 1980s have become common in many hospitals. Three major vancomycin resistance phenotypes have been described VanA VanB and VanC. The VanA phenotype is associated with high-level resistance to vancomycin and to teicoplanin a related glycopeptide antibiotic not currently available in the United States. VanB and VanC strains are resistant to vancomycin but susceptible to teicoplanin although .

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