Mutation Rate of AmpC β-Lactamase-Producing Enterobacterales and Treatment in Clinical Practice: A Word of Caution

Alexis Maillard; Laurent Dortet; Tristan Delory; Matthieu Lafaurie; Alexandre Bleibtreu; Treatment of AmpC producing Enterobacterales study group

doi:10.1093/cid/ciae160

Mutation Rate of AmpC β-Lactamase-Producing Enterobacterales and Treatment in Clinical Practice: A Word of Caution

Clin Infect Dis. 2024 Jul 19;79(1):52-55. doi: 10.1093/cid/ciae160.

Authors

Alexis Maillard¹, Laurent Dortet^{2

3

4}, Tristan Delory⁵, Matthieu Lafaurie⁶, Alexandre Bleibtreu^{1

7}; Treatment of AmpC producing Enterobacterales study group

Collaborators

Treatment of AmpC producing Enterobacterales study group:
Elie Azoulay, Adrien Joseph, Jean-Michel Molina, Matthieu Lafaurie, Béatrice Bercot, Alexis Maillard, Olivier Paccoud, Alexandre Bleibtreu, Jérôme Robert, Laurence Drieux, Juliette Bernier, Antoine Villa, Éric Maury, Laure Surgers, Dorothée Chopin, Valérie Lalande, Jacques Tankovic, Tristan Delory, Adrien Contejean, Hélène Poupet, Luc Mouthon, Christophe Baillard, Lélia Escaut, Stéphane Jaureguiberry, Gaëlle Cuzon, Laurent Dortet, Khalil Chaibi, Fatma El Alaoui, Jean-Ralph Zahar

Affiliations

¹ Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France.
² Department of Bacteriology-Hygiene, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France.
³ Faculty of Medicine, UMR-1184, Inserm, University Paris-Saclay, Le Kremlin-Bicêtre, France.
⁴ French National Reference Center for Antimicrobial Resistance, Le Kremlin-Bicêtre, France.
⁵ Clinical Research Unit, Annecy-Genevois Hospital, Epagny-Metz-Tessy, France.
⁶ Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France.
⁷ Inserm U1135, Cimi-Paris, Paris, France.

PMID: 38527853
DOI: 10.1093/cid/ciae160

Abstract

In a retrospective multicenter study of 575 patients with bloodstream infections or pneumonia due to wild-type AmpC β-lactamase-producing Enterobacterales, species with low in vitro mutation rates for AmpC derepression were associated with fewer treatment failures due to AmpC overproduction (adjusted hazard ratio, 0.5 [95% CI, .2-.9]). However, compared to cefepime/carbapenems, using third-generation cephalosporins as definitive therapy remained associated with this adverse outcome (15% vs 1%).

Keywords: AmpC β-lactamase; Enterobacterales; antibiomicrobial therapy; bloodstream infection; pneumonia.

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Publication types

Multicenter Study

MeSH terms

Aged
Anti-Bacterial Agents* / pharmacology
Anti-Bacterial Agents* / therapeutic use
Bacteremia / drug therapy
Bacteremia / microbiology
Bacterial Proteins* / genetics
Cephalosporins / pharmacology
Cephalosporins / therapeutic use
Enterobacteriaceae Infections* / drug therapy
Enterobacteriaceae Infections* / microbiology
Enterobacteriaceae* / drug effects
Enterobacteriaceae* / enzymology
Enterobacteriaceae* / genetics
Female
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Mutation Rate*
Retrospective Studies
beta-Lactamases* / genetics
beta-Lactamases* / metabolism

Substances

beta-Lactamases
AmpC beta-lactamases
Bacterial Proteins
Anti-Bacterial Agents
Cephalosporins