Please be aware that this video is nearly 10 years old. Antibiotic sensitivity patterns and trends change with time. This video should be used for educational purposes only; please consult a more current reference before making patient management decisions!
Eric...your lectures are excellent overall and I have been delighted to listen to the many wonderful topics. However, please allow me to share a correction if I might... By definition, an ESBL is a mutation of earlier TAM and SHV type beta-lactamases which subsequently confer extended beta-lactamase resistance. However, this type of resistance is overcome by the addition of a beta-lactamase inhibitor (e.g. clavulanate). In the clinical microbiology laboratory the resistance to an indicator antibiotic (e.g. ceftriaxone, aztreonam, etc...) triggers the traditional confirmation test for an ESBL by adding clavulanate for which a three fold difference in antimicrobial resistance should be observed. Therefore, Piperacillin-tazobactam does represent a choice for therapy to a true ESBL but would NOT be an option for AMP-C or Carbapenamase type resistance.
vm610, thanks for the info. I don't think cefoperazone is currently available in the US, but it is elsewhere, so at the very least, I probably shouldn't have described ceftazidime as the only antipseudomonal 3rd gen ceph. Only issue with cefoperazone is that there is reportedly more resistence to it among members of the Enterobacteriaceae family (i.e. E.coli, Klebsiella, etc...) as compared to other 3rd gen cephalosporins, but this might be geographically variable.
U r the best teacher, amazing doctor, i have been looking for such concise information on GNB. And after 2 hr of search on various networks, u have summarized all the clinical pearls in this video. God bless u, and love you for this knowledge sharing 😍
According to a recent article (Sergio Ramírez-Estrada et al, Infect Drug Resist. 2016), in P. aeruginosa VAP, the initial combination of a b-lactam with an aminoglycoside has proved to be superior to monotherapy (Garnacho-Montero J et al,BMC Infect Dis. 2014). However, the right strategy is a de-escalation to monotherapy, when microbiological results show that both antibiotics are effective, even in neutropenic patients (Mokart D et al, Intensive Care Med. 2014).
In general, tazobactam is not a great inhibitor of amp-C beta-lactamases, so that "++“ should not be present in Table 1 with enterobacter and citrobacter. I know this is an old slide, but people still may come across this information. In that part of Table 1, the row w/ enterobacter should probably be + under Zosyn and ++ for cefepime only, on that slide. 3rd generation cephalosporins are even worse, so +/-, and that + would only because serratia is included in the same list.
Thanks for pointing these out - yes, the video is old and antibiotic susceptabilities evolve over time. Updating this whole series is on my to-do list, but unfortunately, that to-do list has things added to it faster than I can get to them.
It's an odd problem. For me, the lecture slides suddenly switched to super-low resolution, even for the portions I had previously viewed with a much better resolution. Today, same iPad, same wifi, the picture's great again.
Additionally, with the exception of Pseudomonas spp, Acinetobacter spp. and Stenotrophomonas spp, and Neisseria spp. that utilize glucose by oxidative-pathways all "enteric" gram-negative organisms are more accurately described as "facultative" organisms (i.e. aerobic and anaerobic).
