AmpC Induction Risk Trainer<\/title>\n<style>\n:root {\n --bg: #f3f8fb;\n --card: #ffffff;\n --header1: #0d7d8c;\n --header2: #145b8f;\n --ink: #1c2b33;\n --ink-light: #54707a;\n --ink-faint: #8aa0a8;\n --border: #dde8ec;\n --teal: #0d9488;\n --teal-dark: #0b766c;\n --teal-bg: #e6f7f5;\n --amber: #c2780c;\n --amber-bg: #fdf3e0;\n --rose: #c23a3a;\n --rose-bg: #fceaea;\n --green: #2f8a4d;\n --green-bg: #e7f6ec;\n --grey: #6b7a82;\n --grey-bg: #eef2f4;\n --shadow: 0 2px 10px rgba(20,60,70,0.08);\n --shadow-lg: 0 8px 28px rgba(20,60,70,0.14);\n --radius: 12px;\n}\n* { box-sizing: border-box; margin: 0; padding: 0; }\nhtml { scroll-behavior: smooth; }\nbody {\n font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, sans-serif;\n background: var(--bg);\n color: var(--ink);\n line-height: 1.55;\n -webkit-text-size-adjust: 100%;\n}\n#app-header {\n background: linear-gradient(120deg, var(--header1), var(--header2));\n color: #fff;\n padding: 14px 16px;\n box-shadow: var(--shadow);\n}\n#app-header .title-row { display: flex; align-items: center; gap: 10px; max-width: 980px; margin: 0 auto; }\n#app-header .logo-wrap { flex-shrink: 0; display:flex; align-items:center; }\n#app-header .logo-wrap img { height: 44px; width: auto; border-radius: 50%; box-shadow: 0 2px 8px rgba(0,0,0,0.25); }\n#app-header h1 { font-size: 16px; font-weight: 700; letter-spacing: 0.2px; }\n#app-header h1 span { display: block; font-size: 10.5px; font-weight: 500; opacity: 0.85; text-transform: uppercase; letter-spacing: 1px; margin-top: 2px; }\n\n\/* TOP NAVIGATION *\/\n#tab-bar {\n position: sticky; top: 0; z-index: 50;\n display: flex; gap: 2px; overflow-x: auto;\n background: #fff; border-bottom: 2px solid var(--teal);\n padding: 0 8px;\n -webkit-overflow-scrolling: touch;\n scrollbar-width: thin;\n}\n.tab-btn {\n flex: 0 0 auto;\n padding: 12px 14px; background: transparent; border: none; cursor: pointer;\n font-family: inherit; font-size: 12.5px; font-weight: 700; color: var(--ink-light);\n white-space: nowrap; border-bottom: 3px solid transparent; transition: all 0.2s;\n}\n.tab-btn .tab-emoji { margin-right: 5px; }\n.tab-btn:hover { color: var(--ink); background: var(--teal-bg); }\n.tab-btn.active { color: var(--teal-dark); border-bottom-color: var(--teal); background: var(--teal-bg); }\n\n#content-area { max-width: 900px; margin: 0 auto; padding: 18px 14px 50px; }\n.tab-panel { display: none; animation: fadeUp 0.35s ease; }\n.tab-panel.active { display: block; }\n@keyframes fadeUp { from { opacity: 0; transform: translateY(8px); } to { opacity: 1; transform: translateY(0); } }\n\n.card {\n background: var(--card); border: 1px solid var(--border); border-radius: var(--radius);\n padding: 18px; margin-bottom: 16px; box-shadow: var(--shadow);\n}\n.card h2 { font-size: 17px; color: var(--header2); margin-bottom: 4px; display: flex; align-items: center; gap: 8px; }\n.card .subtitle { color: var(--ink-light); font-size: 12.5px; margin-bottom: 12px; font-style: italic; }\n.card h3 { font-size: 14px; color: var(--ink); margin: 14px 0 8px; font-weight: 700; }\n.card ul { padding-left: 20px; font-size: 13.5px; color: var(--ink); }\n.card ul li { margin-bottom: 8px; }\n.card p { font-size: 13.5px; color: var(--ink); margin-bottom: 8px; }\n\n.note-box { background: var(--teal-bg); border-left: 4px solid var(--teal); border-radius: 8px; padding: 10px 14px; margin: 10px 0; font-size: 12.5px; }\n.note-box .note-title { font-weight: 700; color: var(--teal-dark); margin-bottom: 3px; }\n.flag-box { background: var(--amber-bg); border-left: 4px solid var(--amber); border-radius: 8px; padding: 10px 14px; margin: 10px 0; font-size: 12.5px; }\n.flag-box .flag-title { font-weight: 700; color: var(--amber); margin-bottom: 3px; }\n.warn-box { background: var(--rose-bg); border-left: 4px solid var(--rose); border-radius: 8px; padding: 10px 14px; margin: 10px 0; font-size: 12.5px; }\n.warn-box .warn-title { font-weight: 700; color: var(--rose); margin-bottom: 3px; }\n.disclaimer-strip {\n background: var(--grey-bg); border: 1px dashed var(--ink-faint); border-radius: 8px;\n padding: 10px 14px; margin-bottom: 14px; font-size: 11.5px; color: var(--ink-light);\n}\n.disclaimer-strip strong { color: var(--rose); }\n\n\/* Genotype comparison table *\/\ntable.v-table { width: 100%; border-collapse: collapse; margin: 10px 0; font-size: 12.5px; }\ntable.v-table th { background: var(--header2); color: #fff; padding: 8px; text-align: left; font-weight: 700; }\ntable.v-table td { padding: 8px; border-bottom: 1px solid var(--border); vertical-align: top; color: var(--ink); }\ntable.v-table tr:nth-child(even) td { background: #f7fbfc; }\n\n\/* Step boxes for treatment *\/\n.step-row { display: flex; gap: 12px; margin: 12px 0; flex-wrap: wrap; }\n.step-box {\n flex: 1 1 200px; background: var(--card); border: 2px solid var(--teal);\n border-radius: var(--radius); padding: 14px;\n}\n.step-box .step-num {\n display: inline-flex; align-items: center; justify-content: center;\n width: 28px; height: 28px; border-radius: 50%; background: var(--teal);\n color: #fff; font-weight: 800; font-size: 14px; margin-bottom: 8px;\n}\n.step-box h4 { font-size: 13px; font-weight: 700; color: var(--header2); margin-bottom: 6px; }\n.step-box p { font-size: 12.5px; margin-bottom: 0; }\n.step-arrow { display: flex; align-items: center; color: var(--teal); font-size: 22px; font-weight: 700; padding-top: 6px; align-self: center; }\n\n\/* Decision flowchart *\/\n.flow-wrap { margin: 12px 0; }\n.flow-node {\n border-radius: 10px; padding: 11px 14px; margin: 8px 0; font-size: 12.5px;\n}\n.flow-node-action { background: var(--teal-bg); border: 2px solid var(--teal); }\n.flow-node-decision { background: var(--amber-bg); border: 2px solid var(--amber); font-weight: 700; }\n.flow-node-positive { background: var(--rose-bg); border: 2px solid var(--rose); }\n.flow-node-negative { background: var(--green-bg); border: 2px solid var(--green); }\n.flow-node-label { font-size: 11px; font-weight: 700; text-transform: uppercase; letter-spacing: 0.5px; margin-bottom: 3px; opacity: 0.75; }\n.flow-connector {\n display: flex; align-items: flex-start; gap: 8px; margin: 2px 0 2px 18px;\n}\n.flow-connector-line { color: var(--ink-faint); font-size: 18px; line-height: 1; }\n.flow-branch { flex: 1; }\n.flow-branch-label { font-size: 11px; font-weight: 700; color: var(--ink-light); margin-bottom: 4px; text-transform: uppercase; letter-spacing: 0.5px; }\n\n\/* Flashcards *\/\n.deck-wrap { display: flex; flex-direction: column; align-items: center; gap: 14px; }\n.flashcard-3d { width: 100%; max-width: 420px; height: 200px; perspective: 1200px; cursor: pointer; }\n.flashcard-inner { width: 100%; height: 100%; position: relative; transform-style: preserve-3d; transition: transform 0.6s; }\n.flashcard-3d.flipped .flashcard-inner { transform: rotateY(180deg); }\n.flash-face { position: absolute; width: 100%; height: 100%; backface-visibility: hidden; border-radius: 12px; padding: 18px; display: flex; flex-direction: column; align-items: center; justify-content: center; text-align: center; border: 2px solid var(--teal); box-shadow: var(--shadow); }\n.flash-front { background: #fff; }\n.flash-back { background: var(--teal); color: #fff; transform: rotateY(180deg); }\n.flash-front .fc-q { font-size: 14px; font-weight: 700; color: var(--header2); margin-bottom: 6px; }\n.flash-front .hint { font-size: 11px; color: var(--ink-faint); }\n.flash-back p { font-size: 12.5px; line-height: 1.5; color: #fff; }\n.deck-controls { display: flex; gap: 10px; align-items: center; }\n.deck-counter { font-size: 12.5px; color: var(--ink-light); }\n\n\/* Quiz *\/\n#xp-row { display: flex; justify-content: space-between; align-items: center; margin-bottom: 10px; font-size: 12px; color: var(--ink-light); }\n#xp-badge { background: var(--teal); color: #fff; padding: 4px 10px; border-radius: 12px; font-weight: 700; }\n.q-progress { font-weight: 700; color: var(--header2); }\n.q-text { font-size: 14px; font-weight: 600; margin-bottom: 12px; }\n.q-opt {\n display: block; width: 100%; text-align: left; padding: 10px 12px; margin-bottom: 8px;\n border: 2px solid var(--border); border-radius: 8px; background: #fff; cursor: pointer;\n font-family: inherit; font-size: 13px; color: var(--ink); transition: all 0.2s;\n}\n.q-opt:hover:not(.disabled) { border-color: var(--teal); background: var(--teal-bg); }\n.q-opt.correct { background: var(--green-bg); border-color: var(--green); color: var(--green); font-weight: 700; }\n.q-opt.wrong { background: var(--rose-bg); border-color: var(--rose); color: var(--rose); }\n.q-opt.disabled { pointer-events: none; }\n.q-feedback { font-size: 12.5px; padding: 10px 12px; border-radius: 8px; margin: 10px 0; display: none; }\n.q-feedback.show { display: block; }\n.q-feedback.fb-correct { background: var(--green-bg); border: 1px solid var(--green); }\n.q-feedback.fb-wrong { background: var(--rose-bg); border: 1px solid var(--rose); }\n#quiz-result { text-align: center; padding: 20px 10px; }\n#quiz-result .big-score { font-size: 36px; font-weight: 800; color: var(--teal-dark); margin: 8px 0; }\n\n.btn {\n padding: 9px 18px; background: var(--teal); color: #fff; border: none;\n border-radius: 8px; font-family: inherit; font-size: 13px; font-weight: 700; cursor: pointer;\n transition: all 0.2s; box-shadow: 0 2px 6px rgba(13,148,136,0.25);\n}\n.btn:hover { background: var(--teal-dark); transform: translateY(-1px); }\n.btn-outline {\n padding: 9px 18px; background: transparent; color: var(--teal-dark); border: 2px solid var(--teal);\n border-radius: 8px; font-family: inherit; font-size: 13px; font-weight: 700; cursor: pointer;\n}\n.confetti-piece {\n position: fixed; top: -10px; width: 8px; height: 14px; opacity: 0.9; z-index: 999;\n animation: confFall linear forwards;\n}\n@keyframes confFall { to { transform: translateY(105vh) rotate(540deg); opacity: 0.4; } }\n\n@media (max-width: 480px) {\n .flashcard-3d { max-width: 100%; height: 180px; }\n .step-row { flex-direction: column; }\n .step-arrow { transform: rotate(90deg); align-self: flex-start; margin-left: 14px; }\n table.v-table { font-size: 11.5px; }\n}\n<\/style>\n<\/head>\n<body>\n\n<div id=\"app-header\">\n <div class=\"title-row\">\n <div class=\"logo-wrap\"><img decoding=\"async\" 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\" alt=\"microregistrar\" style=\"height:44px; width:auto; flex-shrink:0;\"><\/div>\n <h1>Risk of Induction of AmpC Trainer<span>Organism Risk \u00b7 Inducer\/Substrate Logic \u00b7 Drug Selection<\/span><\/h1>\n <a href=\"https:\/\/microregistrar.moodlecloud.com\" target=\"_blank\" style=\"margin-left:auto; color:rgba(255,255,255,0.75); font-size:10.5px; text-decoration:none; white-space:nowrap; align-self:center; border:1px solid rgba(255,255,255,0.3); border-radius:6px; padding:3px 8px; flex-shrink:0;\">microregistrar | Infection Institute<\/a>\n <\/div><\/div>\n\n<div id=\"tab-bar\">\n <button class=\"tab-btn active\" onclick=\"showTab('risk', this)\"><span class=\"tab-emoji\">\ud83c\udfaf<\/span>Organism Risk<\/button>\n <button class=\"tab-btn\" onclick=\"showTab('quadrant', this)\"><span class=\"tab-emoji\">\ud83d\udd11<\/span>Inducers & Substrates<\/button>\n <button class=\"tab-btn\" onclick=\"showTab('treat', this)\"><span class=\"tab-emoji\">\ud83d\udc8a<\/span>Treatment & Practice<\/button>\n <button class=\"tab-btn\" onclick=\"showTab('revise', this)\"><span class=\"tab-emoji\">\ud83c\udccf<\/span>Revise & Test<\/button>\n<\/div>\n\n<div id=\"content-area\">\n \n <div id=\"tab-risk\" class=\"tab-panel active\">\n\n <div class=\"disclaimer-strip\">\n <strong>Revision aid, not clinical guidance.<\/strong> Content is for FRCPath exam preparation. Always confirm current treatment choices against local antibiogram data and national guidelines for real patients.\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83d\udccb One-page quick glance \u2014 last-minute revision<\/h2>\n <p class=\"subtitle\">Both key tables, plus the drug of choice, all in one place. Full explanations follow below and in the other tabs.<\/p>\n\n <h3>Organism risk stratification<\/h3>\n <table class=\"v-table\">\n <tr><th>Risk category<\/th><th>Organisms<\/th><\/tr>\n <tr><td><strong>Moderate\u2013high risk<\/strong><br>8\u201340% likelihood on treatment<\/td><td>Enterobacter cloacae, Klebsiella aerogenes, Citrobacter freundii<\/td><\/tr>\n <tr><td><strong>Low risk<\/strong><br><5% likelihood<\/td><td>Serratia marcescens, Morganella morganii, Providencia species<\/td><\/tr>\n <tr><td><strong>Less common \/ poorly studied<\/strong><\/td><td>Hafnia alvei, Citrobacter youngae, Yersinia enterocolitica<\/td><\/tr>\n <\/table>\n\n <h3>Inducers & substrates quadrant<\/h3>\n <table class=\"v-table\">\n <tr><th><\/th><th>Strong inducer<\/th><th>Weak inducer<\/th><th>Non-inducer<\/th><\/tr>\n <tr><td><strong>Substrate<\/strong><\/td><td>Aminopenicillins, 1st-gen cephalosporins, cephamycins<\/td><td>Piperacillin, ceftriaxone, ceftazidime, aztreonam<\/td><td>\u2014<\/td><\/tr>\n <tr><td><strong>Not a substrate<\/strong><\/td><td>Imipenem, ertapenem, meropenem<\/td><td>Cefepime<\/td><td>Fluoroquinolones, cotrimoxazole, aminoglycosides, tetracyclines, other non-beta-lactams<\/td><\/tr>\n <\/table>\n\n <div class=\"note-box\">\n <div class=\"note-title\">Drug of choice<\/div>\n <strong>Cefepime<\/strong> first-line for moderate\u2013high-risk organisms (weak inducer + not a substrate \u2014 the safest combination). If unavailable: a <strong>carbapenem<\/strong> for serious infection, or a <strong>non-beta-lactam<\/strong> (ciprofloxacin, cotrimoxazole, aminoglycoside) if susceptible and safe per local resistance pattern\/patient profile.\n <\/div>\n <div class=\"flag-box\">\n <div class=\"flag-title\">Two exam traps to remember<\/div>\n <em>Citrobacter koseri<\/em> does <strong>not<\/strong> carry AmpC (unlike <em>C. freundii<\/em>). Piperacillin\/ceftriaxone\/ceftazidime\/aztreonam are <strong>weak inducers but good substrates<\/strong> \u2014 they can look safe initially, then fail mid-treatment as a derepressed mutant is selected.\n <\/div>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83c\udfaf Why this topic keeps coming up<\/h2>\n <p>This has been examined in several different formats: straightforward risk-stratification questions, “which antibiotic to avoid,” “which antibiotics are safer\/less risky,” “drug of choice,” and “which organism carries the highest risk” \u2014 presented as both standalone MCQs and clinical vignettes\/cases.<\/p>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83e\uddec What AmpC induction actually is<\/h2>\n <p class=\"subtitle\">The regulatory switch behind “safe on day 1, resistant by day 5”<\/p>\n <ul>\n <li>Certain Enterobacterales carry a <strong>chromosomally encoded class C beta-lactamase (AmpC)<\/strong>, normally expressed at very low (“basal”) levels.<\/li>\n <li>Two regulatory proteins control this: <strong>AmpR<\/strong> (a transcriptional regulator that can act as either repressor or activator) and <strong>AmpD<\/strong> (an enzyme that recycles cell-wall breakdown products, called muropeptides, generated during normal peptidoglycan turnover).<\/li>\n <li>Exposure to certain beta-lactams increases the pool of unrecycled muropeptides. These bind AmpR and flip it from repressor to <strong>activator<\/strong>, switching on high-level, but usually <strong>transient<\/strong>, AmpC expression \u2014 this is “induction.”<\/li>\n <li>The clinically dangerous scenario is <strong>stable derepression<\/strong>: a spontaneous mutation (commonly in <em>ampD<\/em>) that locks AmpC into constitutive high-level production, which <strong>persists even after the inducing drug is stopped<\/strong> \u2014 this is how resistance can emerge mid-treatment on an isolate that was fully susceptible at the start.<\/li>\n <\/ul>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83d\udcca Organism risk stratification<\/h2>\n <p class=\"subtitle\">Figures below are as stated in current IDSA guidance (2024 update) \u2014 confidence high, directly sourced<\/p>\n <table class=\"v-table\">\n <tr><th>Risk category<\/th><th>Organisms<\/th><\/tr>\n <tr><td><strong>Moderate\u2013high risk<\/strong><br>8\u201340% likelihood of clinically significant AmpC derepression during treatment<\/td><td>Enterobacter cloacae, Klebsiella aerogenes (formerly Enterobacter aerogenes), Citrobacter freundii<\/td><\/tr>\n <tr><td><strong>Low risk<\/strong><br><5% likelihood<\/td><td>Serratia marcescens, Morganella morganii, Providencia species<\/td><\/tr>\n <tr><td><strong>Less common \/ poorly studied<\/strong><br>Carry inducible chromosomal ampC genes, but insufficient clinical data to confidently place a risk figure on them<\/td><td>Hafnia alvei, Citrobacter youngae, Yersinia enterocolitica<\/td><\/tr>\n <\/table>\n <div class=\"note-box\">\n <div class=\"note-title\">Source check<\/div>\n These exact figures and groupings match the IDSA 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections, which explicitly states an 8\u201340% range of inducible resistance for the moderate\u2013high-risk trio, <5% for the low-risk group, and separately flags Hafnia alvei, Citrobacter youngae, and Yersinia enterocolitica as under-studied. Confidence: high.\n <\/div>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83d\udd24 Mnemonics \u2014 use with a little caution<\/h2>\n <ul>\n <li><strong>“ECK”<\/strong> \u2014 <u>E<\/u>nterobacter cloacae, <u>C<\/u>itrobacter freundii, <u>K<\/u>lebsiella aerogenes \u2014 the classic “big 3” moderate\u2013high-risk organisms, and the most solidly evidence-based grouping.<\/li>\n <li><strong>“HECK-Yes”<\/strong> \u2014 an extended mnemonic adding <u>H<\/u>afnia alvei and <u>Ye<\/u>rsinia enterocolitica to the ECK core. This is a more recently proposed teaching device (seen in continuing-education\/opinion pieces) rather than a term used in the IDSA guidance itself \u2014 useful for recall, but be aware it bundles organisms with genuinely different levels of evidence behind them. Confidence in the mnemonic as a memory aid: high; confidence that it reflects a formally validated risk category: moderate (~75%) \u2014 flagging this distinction because it blurs a “well-evidenced trio” with a “poorly-studied trio” under one acronym.<\/li>\n <\/ul>\n <div class=\"flag-box\">\n <div class=\"flag-title\">Common trap<\/div>\n <em>Citrobacter koseri<\/em> does <strong>not<\/strong> carry an inducible chromosomal AmpC \u2014 do not confuse it with <em>Citrobacter freundii<\/em>, which does.\n <\/div>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83e\uddea Extra mechanistic detail \u2014 mutation rates<\/h2>\n <p>In-vitro studies calculating species-specific mutation rates to AmpC derepression found a <strong>high mean mutation rate (~3 \u00d7 10\u207b\u2078)<\/strong> for <em>Enterobacter cloacae<\/em> complex, <em>Klebsiella aerogenes<\/em>, <em>Citrobacter freundii<\/em> complex, and <em>Hafnia alvei<\/em> \u2014 versus <strong>considerably lower rates<\/strong> in <em>Providencia<\/em> species, <em>Serratia<\/em> species, and especially <em>Morganella morganii<\/em>. This mechanistic data helps explain <em>why<\/em> the risk stratification above looks the way it does, rather than simply describing that it does.<\/p>\n <\/div>\n\n <\/div>\n\n \n <div id=\"tab-quadrant\" class=\"tab-panel\">\n\n <div class=\"card\">\n <h2>\ud83d\udd11 Two independent properties, not one<\/h2>\n <p>Every beta-lactam can be described by <strong>two separate properties<\/strong> with respect to AmpC:<\/p>\n <ul>\n <li>How strongly it <strong>induces<\/strong> ampC expression (strong \/ weak \/ non-inducer).<\/li>\n <li>Whether it is a good <strong>substrate<\/strong> for the AmpC enzyme once expressed \u2014 i.e. whether AmpC can actually hydrolyse and destroy it.<\/li>\n <\/ul>\n <div class=\"note-box\">\n <div class=\"note-title\">Why this matters<\/div>\n These two properties are <strong>independent<\/strong> \u2014 a drug can strongly induce AmpC yet remain completely stable to it (safe), or barely induce it at all yet be destroyed the moment AmpC is switched on by something else (dangerous). This mismatch is the basis of nearly every exam question on this topic.\n <\/div>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83e\uddee The quadrant table<\/h2>\n <table class=\"v-table\">\n <tr><th><\/th><th>Strong inducer<\/th><th>Weak inducer<\/th><th>Non-inducer<\/th><\/tr>\n <tr><td><strong>Substrate<\/strong> (hydrolysed by AmpC)<\/td><td>Aminopenicillins, 1st-generation cephalosporins, cephamycins<\/td><td>Piperacillin, ceftriaxone, ceftazidime, aztreonam<\/td><td>\u2014<\/td><\/tr>\n <tr><td><strong>Not a substrate<\/strong> (stable to AmpC hydrolysis)<\/td><td>Imipenem, ertapenem, meropenem<\/td><td>Cefepime<\/td><td>Fluoroquinolones, cotrimoxazole, aminoglycosides, tetracyclines, other non-beta-lactams<\/td><\/tr>\n <\/table>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83d\udd0e Reading the four corners<\/h2>\n <ul>\n <li><strong>Strong inducer + substrate<\/strong> (aminopenicillins, 1st-gen cephalosporins, cephamycins) \u2014 the “obviously bad” corner: these drive AmpC expression up <em>and<\/em> get destroyed by it. Intrinsically unreliable against organisms with inducible AmpC.<\/li>\n <li><strong>Weak inducer + substrate<\/strong> (piperacillin, ceftriaxone, ceftazidime, aztreonam) \u2014 the <strong>exam-favourite “danger zone.”<\/strong> These look deceptively safe because they don’t strongly switch on AmpC themselves, but if a resistant subpopulation is selected (by any trigger, including a different concurrent drug or spontaneous derepression), these agents will fail \u2014 because they are still readily hydrolysed once AmpC is up.<\/li>\n <li><strong>Strong inducer + not a substrate<\/strong> (carbapenems: imipenem, ertapenem, meropenem) \u2014 potently switch AmpC on, but remain effective anyway because AmpC cannot hydrolyse them. This is why carbapenems are safe against high-risk organisms despite being the strongest inducers.<\/li>\n <li><strong>Weak inducer + not a substrate<\/strong> (cefepime) \u2014 the best combination available among the cephalosporins: minimal induction <em>and<\/em> resistance to hydrolysis. This dual property is exactly why cefepime is the preferred first-line agent for moderate\u2013high-risk organisms.<\/li>\n <li><strong>Non-inducer, not relevant as a substrate<\/strong> (fluoroquinolones, cotrimoxazole, aminoglycosides, tetracyclines, other non-beta-lactams) \u2014 AmpC only hydrolyses beta-lactams, so non-beta-lactam classes are simply outside this whole system.<\/li>\n <\/ul>\n <div class=\"flag-box\">\n <div class=\"flag-title\">Exam pearl<\/div>\n If a question describes an organism from the moderate\u2013high-risk group responding well initially to ceftriaxone\/ceftazidime\/piperacillin, then relapsing with a resistant isolate during the same admission \u2014 that is a description of the “weak inducer + substrate” trap, not treatment failure due to non-compliance or a new infection.\n <\/div>\n <\/div>\n\n <\/div>\n\n \n <div id=\"tab-treat\" class=\"tab-panel\">\n\n <div class=\"card\">\n <h2>\ud83d\udc8a Drug of choice<\/h2>\n <ul>\n <li><strong>Cefepime<\/strong> is preferred first-line for infections due to moderate\u2013high-risk organisms (Enterobacter cloacae, Klebsiella aerogenes, Citrobacter freundii) \u2014 it combines weak AmpC induction with resistance to AmpC hydrolysis.<\/li>\n <li>If cefepime is not available (not stocked in every UK trust): a <strong>carbapenem<\/strong> for serious infection, or a <strong>non-beta-lactam<\/strong> (ciprofloxacin, cotrimoxazole, an aminoglycoside, etc.) if the isolate is susceptible and this is safe based on local resistance patterns and the individual patient’s profile.<\/li>\n <\/ul>\n <div class=\"note-box\">\n <div class=\"note-title\">Added nuance from current guidance (not in the original source notes, included for completeness)<\/div>\n IDSA 2024 guidance refines the cefepime recommendation by MIC: cefepime is preferred when the <strong>cefepime MIC is \u22642 \u00b5g\/mL<\/strong>. For isolates with a cefepime MIC of <strong>4\u20138 \u00b5g\/mL<\/strong>, a carbapenem is preferred instead \u2014 this MIC range has been associated with a substantially higher likelihood of co-existing ESBL production, and one cited cohort found notably worse outcomes when cefepime was used in that specific subgroup. Confidence: high (directly stated in the current IDSA guidance), but included as supplementary detail since it wasn’t part of the original notes.\n <\/div>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83d\uddc2\ufe0f How this gets tested \u2014 recap<\/h2>\n <p>Keep an eye out for these question framings, all covering the same underlying logic:<\/p>\n <ul>\n <li>“Which organism carries the highest risk of AmpC-mediated resistance emerging on treatment?”<\/li>\n <li>“Which antibiotic should be avoided \/ is safest in this scenario?”<\/li>\n <li>“What is the most appropriate drug of choice for this infection?”<\/li>\n <li>A case vignette showing initial improvement then relapse with a resistant organism during a single admission.<\/li>\n <\/ul>\n <\/div>\n\n <div class=\"card\">\n <h2>\u2696\ufe0f Stewardship & evolving evidence<\/h2>\n <ul>\n <li>Always cross-check against your <strong>local antibiogram<\/strong> and trust\/national guidelines \u2014 regional resistance patterns and formulary availability (e.g. cefepime is not stocked everywhere in the UK) affect real-world choices.<\/li>\n <li>The role of <strong>piperacillin-tazobactam<\/strong> versus cefepime for AmpC-risk organisms remains an area of ongoing debate in the literature, with some studies suggesting comparable outcomes for lower-risk infections and others favouring cefepime\/carbapenems \u2014 this module reflects current mainstream teaching rather than a settled, unanimous consensus.<\/li>\n <\/ul>\n <\/div>\n\n <\/div>\n\n \n <div id=\"tab-revise\" class=\"tab-panel\">\n\n <div class=\"card\">\n <h2>\ud83c\udccf Flashcard deck<\/h2>\n <div class=\"deck-wrap\">\n <div class=\"flashcard-3d\" id=\"fc-card\" onclick=\"this.classList.toggle('flipped')\">\n <div class=\"flashcard-inner\">\n <div class=\"flash-face flash-front\">\n <div class=\"fc-q\" id=\"fc-front-text\"><\/div>\n <div class=\"hint\">Tap to flip<\/div>\n <\/div>\n <div class=\"flash-face flash-back\">\n <p id=\"fc-back-text\"><\/p>\n <\/div>\n <\/div>\n <\/div>\n <div class=\"deck-controls\">\n <button class=\"btn-outline\" onclick=\"fcNav(-1)\">\u2190 Prev<\/button>\n <span class=\"deck-counter\" id=\"fc-counter\">1 \/ 12<\/span>\n <button class=\"btn-outline\" onclick=\"fcNav(1)\">Next \u2192<\/button>\n <\/div>\n <\/div>\n <\/div>\n\n <div class=\"card\">\n <h2>\ud83c\udfaf Quick test<\/h2>\n <div id=\"xp-row\"><span id=\"xp-badge\">XP: 0<\/span><span class=\"q-progress\" id=\"q-progress\">Q1<\/span><\/div>\n <div id=\"quiz-body\"><\/div>\n <div id=\"quiz-result\" style=\"display:none;\"><\/div>\n <\/div>\n\n <\/div>\n\n<\/div>\n<script>\nfunction showTab(id, btn) {\n document.querySelectorAll('.tab-panel').forEach(p => p.classList.remove('active'));\n document.querySelectorAll('.tab-btn').forEach(b => b.classList.remove('active'));\n document.getElementById('tab-' + id).classList.add('active');\n btn.classList.add('active');\n window.scrollTo({top: 0, behavior: 'smooth'});\n notifyHeightChange();\n}\n\n\/* ========== Flashcards ========== *\/\nconst cards = [\n [\"AmpC \u2014 the basic switch\", \"AmpR (regulator) + AmpD (recycles muropeptides) normally keep ampC repressed. Certain beta-lactams cause muropeptide build-up that flips AmpR into an activator, inducing AmpC. Stable derepression (often an ampD mutation) locks in high-level AmpC production even after the drug is stopped \u2014 this is the dangerous, persistent form.\"],\n [\"Moderate\u2013high risk organisms\", \"Enterobacter cloacae, Klebsiella aerogenes (formerly Enterobacter aerogenes), Citrobacter freundii \u2014 8-40% risk of clinically significant AmpC derepression during treatment (IDSA 2024 figures).\"],\n [\"Low risk organisms\", \"Serratia marcescens, Morganella morganii, Providencia species \u2014 less than 5% risk of clinically significant AmpC derepression.\"],\n [\"Less-common \/ poorly studied organisms\", \"Hafnia alvei, Citrobacter youngae, Yersinia enterocolitica \u2014 carry inducible chromosomal ampC genes but lack robust clinical data to confidently assign a risk figure.\"],\n [\"Common trap \u2014 Citrobacter koseri\", \"Citrobacter koseri does NOT carry an inducible chromosomal AmpC gene \u2014 don't confuse it with Citrobacter freundii, which does.\"],\n [\"The two independent properties\", \"Every beta-lactam has TWO separate properties re: AmpC \u2014 how strongly it INDUCES expression, and whether it's a good SUBSTRATE (gets hydrolysed) once AmpC is expressed. These don't always move together.\"],\n [\"Strong inducer + substrate\", \"Aminopenicillins, 1st-generation cephalosporins, cephamycins \u2014 drive AmpC up AND get destroyed by it. The 'obviously bad' corner.\"],\n [\"Weak inducer + substrate \u2014 the exam trap\", \"Piperacillin, ceftriaxone, ceftazidime, aztreonam \u2014 look safe (don't induce much) but are readily hydrolysed once AmpC is switched on by any trigger. Classic cause of apparent mid-treatment relapse with a resistant isolate.\"],\n [\"Strong inducer + NOT a substrate\", \"Carbapenems (imipenem, ertapenem, meropenem) \u2014 strongly induce AmpC but are stable to its hydrolysis, so remain effective anyway.\"],\n [\"Weak inducer + NOT a substrate\", \"Cefepime \u2014 minimal induction AND resistant to hydrolysis. The best combination among cephalosporins, and the reason it's preferred first-line.\"],\n [\"Drug of choice\", \"Cefepime first-line for moderate-high-risk organisms. If unavailable: carbapenem for serious infection, or a non-beta-lactam (ciprofloxacin, cotrimoxazole, aminoglycoside) if susceptible and safe per local resistance pattern\/patient profile.\"],\n [\"Cefepime MIC nuance (added detail)\", \"IDSA 2024: cefepime preferred if MIC is at or below 2 microgram\/mL. At MIC 4-8, a carbapenem is preferred instead, due to a higher chance of co-existing ESBL production in that MIC range.\"]\n];\nlet fcIndex = 0;\nfunction fcRender() {\n document.getElementById('fc-front-text').textContent = cards[fcIndex][0];\n document.getElementById('fc-back-text').textContent = cards[fcIndex][1];\n document.getElementById('fc-counter').textContent = (fcIndex + 1) + ' \/ ' + cards.length;\n document.getElementById('fc-card').classList.remove('flipped');\n}\nfunction fcNav(dir) {\n fcIndex = (fcIndex + dir + cards.length) % cards.length;\n fcRender();\n}\nfcRender();\n\n\/* ========== Quiz ========== *\/\nconst quiz = [\n {q: \"Which trio of organisms is classified as moderate-to-high risk (8-40%) for clinically significant AmpC derepression during treatment?\",\n opts: [\"Serratia marcescens, Morganella morganii, Providencia spp.\", \"Enterobacter cloacae, Klebsiella aerogenes, Citrobacter freundii\", \"Citrobacter koseri, Hafnia alvei, Yersinia enterocolitica\", \"Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis\", \"Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia\"],\n correct: 1, fb: \"Enterobacter cloacae, Klebsiella aerogenes (formerly Enterobacter aerogenes), and Citrobacter freundii make up the classic moderate-high-risk trio, with an 8-40% risk of clinically significant AmpC derepression during therapy per IDSA 2024 guidance.\"},\n\n {q: \"A patient's urine culture grows Citrobacter koseri. What is true regarding AmpC risk?\",\n opts: [\"It carries the same high AmpC risk as Citrobacter freundii\", \"It does not carry an inducible chromosomal AmpC gene, unlike C. freundii\", \"It is classified as low risk alongside Serratia and Morganella\", \"It cannot be treated with any beta-lactam\", \"It is a classic HECK-Yes organism\"],\n correct: 1, fb: \"Citrobacter koseri does not carry an inducible chromosomal AmpC gene \u2014 this is a common point of confusion with the AmpC-positive Citrobacter freundii.\"},\n\n {q: \"Which organisms are described as 'less common \/ poorly studied' with respect to AmpC risk, despite carrying inducible chromosomal ampC genes?\",\n opts: [\"Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis\", \"Enterobacter cloacae, Citrobacter freundii, Klebsiella aerogenes\", \"Hafnia alvei, Citrobacter youngae, Yersinia enterocolitica\", \"Serratia marcescens, Morganella morganii, Providencia spp.\", \"Pseudomonas aeruginosa, Stenotrophomonas maltophilia\"],\n correct: 2, fb: \"IDSA 2024 guidance specifically names Hafnia alvei, Citrobacter youngae, and Yersinia enterocolitica as carrying inducible chromosomal ampC genes without sufficient clinical data to confidently assign a risk category.\"},\n\n {q: \"Why are carbapenems generally safe to use against organisms with inducible AmpC, despite being strong inducers of AmpC expression?\",\n opts: [\"They do not induce AmpC at all\", \"They are excellent AmpC substrates so resistance never develops\", \"They are not hydrolysed by AmpC, so induction does not translate into treatment failure\", \"AmpC only affects Gram-positive organisms\", \"Carbapenems are not beta-lactams\"],\n correct: 2, fb: \"Carbapenems are strong AmpC inducers but poor substrates for the enzyme \u2014 AmpC cannot effectively hydrolyse them, so they remain clinically effective despite triggering high-level expression.\"},\n\n {q: \"Which group of beta-lactams represents the classic 'exam trap' \u2014 weak inducers of AmpC that are nonetheless readily hydrolysed once AmpC is expressed?\",\n opts: [\"Carbapenems (imipenem, ertapenem, meropenem)\", \"Aminopenicillins and 1st-generation cephalosporins\", \"Piperacillin, ceftriaxone, ceftazidime, aztreonam\", \"Fluoroquinolones and aminoglycosides\", \"Cefepime alone\"],\n correct: 2, fb: \"Piperacillin, ceftriaxone, ceftazidime, and aztreonam are weak inducers but good substrates \u2014 they look safe initially but can fail if AmpC becomes derepressed during treatment, by any trigger.\"},\n\n {q: \"What combination of properties makes cefepime the preferred agent for moderate-high-risk AmpC organisms?\",\n opts: [\"Strong inducer and good substrate\", \"Strong inducer and poor substrate\", \"Weak inducer and good substrate\", \"Weak inducer and poor substrate (resistant to hydrolysis)\", \"Non-inducer and good substrate\"],\n correct: 3, fb: \"Cefepime combines weak AmpC induction with resistance to AmpC-mediated hydrolysis (poor substrate) \u2014 the best available combination among cephalosporins, which is why it is preferred.\"},\n\n {q: \"Which of the following is classified as a NON-inducer and is simply outside the AmpC induction\/substrate system entirely?\",\n opts: [\"Ceftazidime\", \"Piperacillin\", \"Ciprofloxacin\", \"Cefoxitin (a cephamycin)\", \"Aztreonam\"],\n correct: 2, fb: \"Ciprofloxacin, like other fluoroquinolones, cotrimoxazole, aminoglycosides, and tetracyclines, is a non-beta-lactam \u2014 AmpC only hydrolyses beta-lactams, so these classes are irrelevant to this system.\"},\n\n {q: \"What is the underlying molecular event that switches AmpC from basal (low) expression to induced (high) expression?\",\n opts: [\"A plasmid is acquired from another bacterium\", \"Muropeptides accumulate from cell wall turnover and bind AmpR, converting it from a repressor to an activator\", \"The bacterium undergoes conjugation\", \"AmpD is upregulated, increasing muropeptide recycling\", \"The ribosome is inhibited, triggering a stress response\"],\n correct: 1, fb: \"Beta-lactam exposure increases unrecycled muropeptides, which bind AmpR and switch it from a transcriptional repressor to an activator, inducing high-level (though usually transient) AmpC expression.\"},\n\n {q: \"What distinguishes transient induction from stable derepression of AmpC?\",\n opts: [\"Transient induction requires no antibiotic exposure at all\", \"Stable derepression is typically due to a mutation (often in ampD) and persists even after the inducing drug is stopped\", \"Stable derepression only occurs in Gram-positive organisms\", \"Transient induction cannot cause treatment failure\", \"There is no clinically meaningful difference between the two\"],\n correct: 1, fb: \"Stable derepression usually arises from a mutation (commonly in ampD) that locks in constitutive high-level AmpC expression, unlike transient induction which resolves once the inducing drug is removed \u2014 this persistence is what makes it clinically dangerous.\"},\n\n {q: \"A patient with a Klebsiella aerogenes bacteraemia is started on ceftriaxone, initially improves, then relapses on day 6 with a resistant isolate of the same organism. What does this most likely represent?\",\n opts: [\"A new, unrelated hospital-acquired infection\", \"Selection of an AmpC-derepressed mutant during ceftriaxone therapy (weak inducer, good substrate)\", \"Antibiotic non-compliance by the patient\", \"An allergic reaction to ceftriaxone\", \"Laboratory contamination of the repeat culture\"],\n correct: 1, fb: \"This is the classic presentation of the 'weak inducer + good substrate' trap: ceftriaxone doesn't strongly induce AmpC but is destroyed once AmpC is derepressed, allowing a resistant subpopulation to be selected during therapy.\"},\n\n {q: \"According to current IDSA guidance, at which cefepime MIC range is a carbapenem preferred instead of cefepime for E. cloacae, K. aerogenes, or C. freundii infections?\",\n opts: [\"MIC \u22640.5 \u00b5g\/mL\", \"MIC \u22642 \u00b5g\/mL\", \"MIC 4-8 \u00b5g\/mL\", \"Cefepime is always preferred regardless of MIC\", \"MIC is not relevant to this decision\"],\n correct: 2, fb: \"IDSA 2024 guidance suggests a carbapenem is preferred over cefepime when the cefepime MIC is 4-8 \u00b5g\/mL, due to an increased likelihood of co-existing ESBL production in that MIC range.\"},\n\n {q: \"If cefepime is not available for a serious infection caused by a moderate-high-risk AmpC organism, what is the recommended alternative?\",\n opts: [\"A first-generation cephalosporin at a higher dose\", \"Amoxicillin-clavulanate\", \"A carbapenem for serious infection, or a susceptible non-beta-lactam if safe based on local resistance pattern and patient profile\", \"Continue ceftriaxone regardless of susceptibility results\", \"No alternative exists; treatment must be delayed\"],\n correct: 2, fb: \"In the absence of cefepime, a carbapenem is recommended for serious infection, or a non-beta-lactam (e.g. ciprofloxacin, cotrimoxazole, an aminoglycoside) if the isolate is susceptible and this is judged safe for the individual patient.\"}\n];\n\nlet qIndex = 0, xp = 0, answered = false;\nfunction renderQuiz() {\n if (qIndex >= quiz.length) { showQuizResult(); return; }\n const item = quiz[qIndex];\n answered = false;\n document.getElementById('q-progress').textContent = 'Q' + (qIndex + 1) + ' \/ ' + quiz.length;\n let html = '<div class=\"q-text\">' + item.q + '<\/div>';\n item.opts.forEach((opt, i) => {\n html += '<button class=\"q-opt\" onclick=\"answerQ(' + i + ')\">' + opt + '<\/button>';\n });\n html += '<div class=\"q-feedback\" id=\"q-fb\"><\/div>';\n html += '<div style=\"text-align:right; margin-top:8px;\"><button class=\"btn\" id=\"q-next-btn\" style=\"display:none;\" onclick=\"nextQ()\">Next \u2192<\/button><\/div>';\n document.getElementById('quiz-body').innerHTML = html;\n notifyHeightChange();\n}\nfunction answerQ(i) {\n if (answered) return;\n answered = true;\n const item = quiz[qIndex];\n const opts = document.querySelectorAll('.q-opt');\n opts.forEach((b, idx) => {\n b.classList.add('disabled');\n if (idx === item.correct) b.classList.add('correct');\n else if (idx === i) b.classList.add('wrong');\n });\n const fb = document.getElementById('q-fb');\n fb.textContent = item.fb;\n fb.classList.add('show', i === item.correct ? 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This will cover the areas more likely to […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[194,50],"tags":[53,216,52,54],"class_list":["post-1371","post","type-post","status-publish","format-standard","hentry","category-ai","category-frcpath-tips","tag-cice","tag-moodlecloud","tag-part-1-frcpath","tag-part-2-frcpath"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1371","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1371"}],"version-history":[{"count":4,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1371\/revisions"}],"predecessor-version":[{"id":1378,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1371\/revisions\/1378"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1371"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1371"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1371"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

{"id":1371,"date":"2026-07-05T00:48:42","date_gmt":"2026-07-04T23:48:42","guid":{"rendered":"https:\/\/microregistrar.com\/?p=1371"},"modified":"2026-07-05T01:01:58","modified_gmt":"2026-07-05T00:01:58","slug":"interactive-high-yield-notes-module","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=1371","title":{"rendered":"Interactive High Yield Notes Module"},"content":{"rendered":"\n

There will be an interactive High Yield Notes module soon in microregistrar.moodlecloud.com. This will cover the areas more likely to appear in the FRCPath Microbiology examination.<\/p>\n\n\n\n

<\/p>\n\n\n\n

See a sample below (click on the link)<\/strong><\/p>\n\n\n\n

https:\/\/microregistrar.com\/wp-content\/uploads\/2026\/07\/AmpC_Induction_Risk_Trainer-1-1.html<\/a><\/p>\n\n\n\n