{"id":163,"date":"2023-06-25T09:32:40","date_gmt":"2023-06-25T08:32:40","guid":{"rendered":"https:\/\/microregistrar.com\/?p=163"},"modified":"2023-06-25T09:32:40","modified_gmt":"2023-06-25T08:32:40","slug":"antibiotic-intrinsic-resistance","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=163","title":{"rendered":"Antibiotic \u2013 intrinsic resistance"},"content":{"rendered":"\n<p class=\"has-luminous-vivid-amber-background-color has-background\">Microorganisms are only listed as \u201cintrinsically resistant\u201d to an agent (or group of agents) when a vast majority of wild-type isolates exhibit MIC values that are so high that the agent should not be considered for either therapy or clinical susceptibility testing (EUCAST).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Enterobacterales &amp; Aeromonas<\/h2>\n\n\n\n<p>Enterobacterales and Aeromonas are intrinsically resistant to benzylpenicillin, glycopeptides, lipoglycopeptides, fusidic acid, macrolides (Except Azithromycin, effective for typhoid\/paratyphoid fever and erythromycin for travellers\u2019 diarrhoea), lincosamides, streptogramins, rifampicin, and oxazolidinones.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Bacteria<\/strong><\/td><td><strong>Beta-lactams<\/strong><\/td><td><strong>Non-beta-lactams<\/strong><\/td><\/tr><tr><td>Klebsiella pneumonia complex,<br>Klebsiella oxytoca<br>Roultella sp.<br>Citrobacter koseri,<br>Citrobacter amalonaticus<\/td><td>Amoxicillin, Ticarcillin<\/td><td><\/td><\/tr><tr><td>Klebsiella aerogenes,<br>Enterobacter cloacae complex<br>Citrobacter freundii<br>Hafnia alvei<\/td><td>Amoxicillin, Coamoxiclav,<br>1st generation cephalosporins<br>Cefoxitin<\/td><td><\/td><\/tr><tr><td>Serratia marcescens<\/td><td>Amoxicillin, Coamoxiclav,<br>1st and 2nd generation cephalosporin<\/td><td>Tetracycline, doxycycline<br>(not minocycline or tigecycline)<br>Colistin, Nitrofurantoin<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Bacteria<\/strong><\/td><td><strong>Beta-lactams<\/strong><\/td><td><strong>Non beta-lactams<\/strong><\/td><\/tr><tr><td>Proteus mirabilis<\/td><td><\/td><td>Tetracycline, Tigecycline<br>Colistin, Nitrofurantoin<\/td><\/tr><tr><td>Proteus vulgaris<\/td><td>Amoxicillin<br>1st generation cephalosporins, cefuroxime<\/td><td>Tetracycline, Tigecycline<br>Colistin, Nitrofurantoin<\/td><\/tr><tr><td>Providencia stuartii, P rettgeri<\/td><td>Amoxicillin, Coamoxiclav<br>1st generation cephalosporin<\/td><td>Tetracycline<br>Colistin, Nitrofurantoin<\/td><\/tr><tr><td>Morganella morganii<\/td><td>Amoxicillin, Coamoxiclav<br>1st generation cephalosporin<\/td><td>Tetracycline<br>Colistin, Nitrofurantoin<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Bacteria<\/strong><\/td><td><strong>Beta-lactams<\/strong><\/td><td><strong>Non-beta-lactams<\/strong><\/td><\/tr><tr><td>Yersinia enterocolitica<\/td><td>Amoxicillin, Coamoxiclav,<br>1st generation cephalosporins<br>2nd generation \u2013 cefoxitin (but not cefuroxime)<\/td><td><\/td><\/tr><tr><td>Yersinia pseudotuberculosis<\/td><td><\/td><td>Colistin<\/td><\/tr><tr><td>Aeromonas hydrophila<br>Aeromonas caviae<\/td><td>Amoxicillin, coamoxiclav,<br>Cefoxitin<\/td><td><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-21-1024x394.png\" alt=\"\" class=\"wp-image-6604\"\/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Non-fermentative gram-negative bacteria<\/h2>\n\n\n\n<p>Generally intrinsically resistant to benzylpenicillin, first- and second-generation cephalosporins, glycopeptides, lipoglycopeptides, fusidic acid, macrolides, lincosamides, streptogramins, rifampicin and oxazolidinones.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Bacteria<\/strong><\/td><td><strong>Beta-lactam<\/strong><\/td><td><strong>Non-beta-lactam<\/strong><\/td><\/tr><tr><td>Acinetobacter baumannii,<br>Acinetobacter pittii,<br>Acinetobacter nosocomialis<\/td><td>Amoxicillin, Coamoxiclav<br>Ceftriaxone, Cefotaxime,<br>Ertapenem, Aztreonam<\/td><td>Trimethoprim,<br>Fosfomycin,<br>Tetracycline, Doxycycline<br>(Not Minocycline\/Tigecycline)<\/td><\/tr><tr><td>Pseudomonas aeruginosa<\/td><td>Amoxicillin, Coamoxiclav<br>Ceftriaxone, Cefotaxime,<br>Ertapenem<\/td><td>Trimethoprim<br>Chloramphenicol<br>Tetracycline group, Tigecycline<br>Kanamycin, Neomycin<\/td><\/tr><tr><td>Burkholderia cepacia complex<\/td><td>Amoxicillin, Coamoxiclav<br>Ticar-clavulinic acid,<br>Pip-tazobactam,<br>Ceftriaxone, Cefotaxime,<br>Ertapenem, Aztreonam<\/td><td>Trimethoprim,<br>Chloramphenicol,<br>Ciprofloxacin,<br>Fosfomycin,<br>Colistin<br>Aminoglycoside<\/td><\/tr><tr><td>Stenotrophomonas maltophilia<\/td><td>Amoxicillin, Coamoxiclav<br>Pip-tazobactam,<br>Ceftriaxone, Cefotaxime,<br>Ertapenem, Meropenem,<br>Aztreonam<\/td><td>Aminoglycoside,<br>Trimethoprim (cotrimoxazole),<br>Fosfomycin,<br>Tetracycline (Not doxycycline, minocycline, tigecycline)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Bacteria<\/strong><\/td><td><strong>Beta-lactams<\/strong><\/td><td><strong>Non-beta-lactams<\/strong><\/td><\/tr><tr><td>Achromobacter xylosoxidans<\/td><td>Amoxicillin,<br>Ceftriaxone, Cefotaxime,<br>Ertapenem<\/td><td><\/td><\/tr><tr><td>Ochrobactrum anthropi<\/td><td>Amoxicillin, Coamoxiclav<br>Ticar-clavulinic acid,<br>Pip-tazobactam,<br>Ceftriaxone, Cefotaxime,<br>Ceftazidime, Cefepime<br>Ertapenem , Aztreonam<\/td><td><\/td><\/tr><tr><td>Elizabethkingia meningoseptica<\/td><td>Amoxicillin, Coamoxiclav<br>Ticar-clavulinic acid,<br><br>Ceftriaxone, Cefotaxime,<br>Ceftazidime, Cefepime<br>Ertapenem , Aztreonam<br>Meropenem<\/td><td>Colistin<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-17-1024x498.png\" alt=\"\" class=\"wp-image-6573\"\/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Other gram negatives<\/h2>\n\n\n\n<p>All of them are intrinsically resistant to glycopeptides, lipoglycopeptides, lincosamides, and oxazolidinones. Additionally\u2026<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Bacteria<\/strong><\/td><td><strong>Antibiotic<\/strong><\/td><\/tr><tr><td>Haemophilus influenzae<\/td><td>Fusidic acid, Streptogramins<\/td><\/tr><tr><td>Moraxella catarrhalis<\/td><td>Trimethoprim<\/td><\/tr><tr><td>Neisseria spp<\/td><td>Trimethoprim<\/td><\/tr><tr><td>Campylobacter jejuni, Campylobacter coli<\/td><td>Fusidic acid, Streptogramins, Trimethoprim<\/td><\/tr><tr><td>Campylobacter fetus<\/td><td>Fusidic acid, Streptogramins, Trimethoprim, nalidixic acid<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Gram-positive bacteria<\/h2>\n\n\n\n<p>Gram-positive bacteria are also intrinsically resistant to aztreonam, temocillin, polymyxin B\/colistin and nalidixic acid.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Bacteria<\/strong><\/td><td><strong>Beta-lactams<\/strong><\/td><td><strong>Aminoglycoside, MLSB<\/strong><\/td><td><strong>Others<\/strong><\/td><\/tr><tr><td>Staphylococcus saprophyticus<\/td><td>Ceftazidime<\/td><td><\/td><td>Fosfomycin<br>Novobiocin<\/td><\/tr><tr><td>Staph cohnii, Staph xylosus<\/td><td>Ceftazidime<\/td><td><\/td><td>Novobiocin<\/td><\/tr><tr><td>Staph capitis<\/td><td>Ceftazidime<\/td><td><\/td><td>Fosfomycin<\/td><\/tr><tr><td>Staph aureus, other CoNs<\/td><td>Ceftazidime<\/td><td><\/td><td><\/td><\/tr><tr><td>Streptococcus<\/td><td>Ceftazidime<\/td><td>Aminoglycoside<br>(low-level resistance*)<\/td><td><\/td><\/tr><tr><td>Enterococcus faecalis<\/td><td>Cephalosporins<\/td><td>Aminoglycoside<br>(low-level resistance*)<br>Macrolides, clindamycin<br>Quinupristin-dalfopristin<\/td><td>Fusidic acid,<br>Sulfonamide<\/td><\/tr><tr><td>Enterococcus gallinarum,<br>Enterococcus casseliflavus<\/td><td>Cephalosporins<\/td><td>Aminoglycoside<br>(low-level resistance*)<br>Macrolides, clindamycin<br>Quinupristin-dalfopristin<\/td><td>Fusidic acid,<br>Sulfonamide,<br><strong>Vancomycin<\/strong><\/td><\/tr><tr><td>Enterococcus faecium<\/td><td>Cephalosporins<\/td><td>Aminoglycosides<br>(low-level resistance+AAC(6\u2019)-I**)<br>Macrolide<\/td><td>Fusidic acid<br>Sulfonamide<\/td><\/tr><tr><td>Corynebacterium spp.<\/td><td><\/td><td><\/td><td>Fosfomycin<\/td><\/tr><tr><td>Listeria<\/td><td>Cephalosporins<\/td><td><\/td><td><\/td><\/tr><tr><td>Leuconostoc spp., Pediococcus spp.<br>Lactobacillus spp.<br>(L. casei, L. casei var. rhamnosus)<\/td><td><\/td><td><\/td><td><strong>Vancomycin<br>Teicoplanin<\/strong><\/td><\/tr><\/tbody><\/table><figcaption class=\"wp-element-caption\">* Low-level resistance \u2013 Synergy can be achieved with penicillin or vancomycin unless high-level resistance is present (need testing)<br>** Low-level resistance + AAC(6\u2019)-I enzyme \u2013 the synergy is only seen in gent, amikacin and streptomycin.<\/figcaption><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2021\/07\/image-22-1024x353.png\" alt=\"\" class=\"wp-image-6611\"\/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Anaerobes<\/h2>\n\n\n\n<p>Anaerobes are intrinsically resistant to aztreonam, aminoglycosides, polymyxin B\/colistin and nalidixic acid.<\/p>\n\n\n\n<p>Additionally,<\/p>\n\n\n\n<p>Clostridium ramosum &amp; Clostridium innocuum are resistant to vancomycin.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Reference:<\/h2>\n\n\n\n<p><a href=\"https:\/\/www.eucast.org\/expert_rules_and_intrinsic_resistance\/\">https:\/\/www.eucast.org\/expert_rules_and_intrinsic_resistance\/<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Expert_Rules\/2020\/Intrinsic_Resistance_and_Unusual_Phenotypes_Tables_v3.2_20200225.pdf\">https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Expert_Rules\/2020\/Intrinsic_Resistance_and_Unusual_Phenotypes_Tables_v3.2_20200225.pdf<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Microorganisms are only listed as \u201cintrinsically resistant\u201d to an agent (or group of agents) when a vast majority of wild-type [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":164,"comment_status":"open","ping_status":"open","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 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