Jan Larmouth, MS, CIC Director, Infection Prevention and ...
Transcript of Jan Larmouth, MS, CIC Director, Infection Prevention and ...
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Jan Larmouth, MS, CIC
Director, Infection Prevention and IV Resource
SNHMC
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Biochemistry is not scary.
We all live in a 3 dimensional world.
Life happens at the molecular level.
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Wall, plasmid, DNA
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Gram positive cocci Gram negative bacilli (rods)
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Make things happen!
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Different classes have different chemical structures
Penicillin (methicillin)
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Glycopeptides (vancomycin)
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Beta-lactams (cephalosporins)
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Disrupt an essential process that is necessary for cell life: ◦ Cell wall synthesis
◦ DNA replication
Organisms change their structure and produce chemicals that protect them from the ABX
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Gram positive cocci
Clonal organism – not many spontaneous mutations
Normal skin flora – 30% of population
Methicillin worked well until around 1960s
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TP – transpeptidase
-lactam ring binds to TP (penicillin binding protein)
No cross links are formed = cell ruptures
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MRSA are genetically slightly different - acquired the mec A gene - PBP = different
Methicillin doesn’t fit anymore
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Gram positive cocci
Found in the gut – “fecal patina”
Some species – non-pathogenic and intrinsically resistant to many ABX
E. faecium/E. faecalis have acquired resistance to vancomycin
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3 different mechanisms of action:
◦ Inhibits cross linking in the cell wall
◦ Interferes with RNA production
◦ Damages the plasma membrane
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Nomenclature differs: ◦ not the bug but the enzyme
◦ Not one genus/species
Many species: E. coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, etc.
Most common: E. coli; K. pneumoniae
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First Generation: cefazolin, cefalexin, cefadroxil
Second Generation: cefamandole, cefoxitin, cefaclor, cefuroxime, loracarbef, cefotetan
Third generation: cefotaxime, cefpodoxime, ceftizoxime, ceftriaxone, ceftazidime, cefoperazone
Fourth generation: cefepime, cefozopran, cefpirome, cefquinome
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Activity is different
Generation1: ◦ Staph and Enterobacteriaceae
Generations 2, 3 and 4: ◦ Structure able to resist beta-lactamases – broader
spectrum
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