Hello everybody! 

There has been some debate at our facility regarding treatment of enterobacteriacea species known to be carriers of chromosomal ampC. The presence of ampC in these species (represented by the acronym SPICE; serratia, pseudomonas, Indole positive proteae including proteus, morganella, and providencia, citrobacter, and enterobacter) harbors the possibility of inducible resistance, resulting from the hyper-production of cephalosporinases while on antimicrobial therapy. In other words, these bugs test sensitive to cephs/some pen-BLI combos but will become resistance during treatment. At Sanford, it seems most providers prefer to treat these bacteria with a carbapenem, fluoroquinolone, or cefepime regardless of sensitivities. The avoidance of 3rd gen cephs and penicillin/BL-I combos seems entirely appropriate, however I have spoken with several ID physicians and intensivists who each seem to have their own opinion on which of the previous options (carbs, FQ, cefepime) is preferred or even appropriate. I was wondering what others have seen used at their facilities for these organisms - Are carbapenems the go-to, or do FQ's and cefepime have a larger role?