You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is A patient on urinary catheter - catheter tip culture shown extended spectrum b-lactamase +ve Klebsiella. Which of the following drug you can give? and explain in detail?
(B) pH + b-lactamaseoKlebsiella infection at any site can produce bacteremia.[?]Extended-spectrum b-Lactam agents:-Enhanced activity against G- and some G+ bacteria; E.g., 3rd and 4th generation cephalosporins, carboxy- and ureidopenicillinsoExtended-spectrum b-Lactamases (ESBLs)-Enzymes produced by GNR that destroy certain extended-spectrum b-lactam agents, including 3rd generation cephalosporins.[?]Important resistance mechanisms to ft-lactam antibiotics:[?]b-lactamase resistance:oMany bacteria produce enzymes that are capable of destroying the b-lactam ring of penicillin, these enzymes are referred to as penicillinases or beta-lactamases, & make bacteria that possess them resistant to many penicillins. Clavulanic acid is a chemical that inhibits beta- lactamase enzymes, thereby increasing the longevity of beta-lactam antibiotics in the presence of penicillinase - producing bacteria.oClavamox is a combination of Amoxicillin & Clavulanate & is marketed under the trade name Augmentin.oZosyn, a similar combination of the beta-lactamase inhibitor Tazobactam & Piperacillin.oDrug of Choice: UTI: Cortimoxazole, Augmentin, Nitrofuration, levofloxacin/ ciprofloxacin-Other Serious infections:-Carbapenems:-Imipenem, Meropenem, Ertapenem (reliable activity vs ESBL-producing Enterobac-teriaceae). Fluoroquinolone + Aminoglycoside[?]ESBL-Producing Enterobacteriaceae:oExtended-spectrum beeta-lactamases: Any bacterial enzymes that are capable of inactivating third generation cephalosporins.-ESBL are Generally regarded as resistant to Penicillins & CephalosporinsFOUR MAIN TYPES OF RESISTANCE MECHANISMS IN GRAM NEGATIVE BACILLIDrug inactivationEnzymatic deactivation of beta lactam antibiotics by beta lactamases and deactivation of aminoglycosides by varios enzymes; beta -lactam/beta - lactamase inhibitor combination drugs have the potential to overcome some, but not all, beta-lactamasesAlteration of target siteAlteration of the DNA gyrase-bidning site for fluoroquinolones (Quinolone resistance-determing region)Reduced drug accumulation within the bacterial cellReduced drug permeability (via, for E.g., altering levels of outer membrane protein channels (porins) that are responsible for passive diffusion) and/or increased active efflux of the drugs across the cell surface.Alteration of metabolic pathwayPlasmid-encoded, drug-resistant dihydropteroate synthetase bypasses the chromosomal-encoded enzyme inhibited by sulfa drugs so the organism can still synthesize folic acid from para-aminobenzoic acid.[?]Effects of Acidic conditions on activities of Seven beta-lactamases:oTEM-1 (class A), KOXY (class A), IMP-1 (class B), AmpC (class C), MOX-1 (class C), OXA-5 (class D), and PSE-2 (class D)-& their inhibitors were measured.oEnzymatic activities of KOXY, IMP-1, and MOX-1 at pH 5.8 were slightly lower than those at pH 7.5.oActivities of PSE-2 & OXA-5 were greatly reduced at pH 5.8.oAll of the beta-lactamase inhibitors tested had poorer inhibitory activities at pH 5.8 than at pH 7.5 except clavulanic acid for TEM-1.