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- Gram-negative, aerobic, motile bacilli of the Enterobacteriaceae family.
- Opportunistic human pathogen includes: E. cloacae (most common), E. aerogenes, E. gergoviae and Pantoea agglomerans.
- E. sakazakii now classified as Cronobacter.
- High levels of drug resistance often seen and due to:
- (1) Chromosomal AmpC beta-lactamases that are constitutive and inducible
- β-lactams must be present for activation of inducible beta-lactamases, so initial susceptibility reports may not detect resistance that can arise during therapy.
- (2) Plasmid-encoded extended-spectrum β-lactamases (ESBLs)
- (3) Carbapenemases
- Other resistance mechanisms
- Alterations in active site of penicillin-binding protein
- Defects in outer membrane permeability that reduce diffusion of beta-lactams into cell
- Presence of efflux pumps that move beta-lactams out of cell
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