Definition KPC
Klebsiella Pneumoniae carbapenemase
Beta-lactams don’t work on atypical bacteria, because: Atypical bacteria lack cell walls and thus are naturally resistant against all beta-lactams & because beta-lactams act by preventing the synthesis of the bacterial cell wall.
Which bacteriaare intrinsically resistant to vancomycin (glycopeptide)
a) Lactobacillus
b) Erysipelothrix
c) a+b
Resistance to ❌. is caused by chromosomal mutation in structural genes of DNA gyrase and topoisomerase IV
Which Bacteria can become resistant to Macrolides
Staphylococcus
Streptococcus
In gentamicin active efflux of drug in bactericides
Chloramphenicol is the enzymatic modifcation of acetyltransferase-
Which resistant bacterias are enzymatic
PRSA
HLAR
MRSA
ESBL
KPC
Resistant bacterias witch are NOT enzymatic but have an altered target site
MLSb
PRSP
MBL
VRE
MRSA ? ❌ ❌ ❌ ❌ resistant against all beta-lactams and inhibitors, excluding 5th generation of cephalosporins
Which Bacteria are resistant against Beta Lactams
MBL - Metallobetalactamases
KPC - Klebisella pneumonia carbapanemase / CPE - Carbapanemase producing Enterobacteriaceae
MRSA (with exception to 5th gen cephalosporin)
Mycoplasma and Chlamydia
Chlamydia + VRE - Vancomyocinr resistant enterococcus
Which of the following phenotypes relate to the enzyme production
ESBL - positive
MBL - positive
NDM - positive
Ch-
❌: Resistant to narrow penicillin & possibly 3rd gen cephalosporin
Which Bacteria are resistant to narrow penicillin
a) E.coli
b) PRSP
c) MRSA
d) b+c
e) All of the mentionend
Which of the following may become resistent (aquired) to tigecycline
1) E.coli 2) P.aeruginosa 3) Acinetobacter baumannii 4) proteus mirabilis 5) K. pneumoniae
a) 1,2,3,5
b) 1,3,5
c) 2,3
d) 3,4
e) 4,5
Modification of an existing PBP´s through recombination indicates
a) MRSA
b) VRE
c) NDM+
d) PRSP
e) PRSA
Which phenotype refers to MSSA
a) resistant to all beta-lactams excluding Vth generation of cephalosporin
b) resistant to all beta lactams including Vth generation of cephalosporin
c) resistant to methicillin, susceptible to oxacillin and carbapenems
d) susceptible to all beta lactams, excluding narrow spectrum penicillins
e) susceptible to all beta lactams including narrow spectrum penicillins
Which of the drugs are pumped out by efflux
a) Tetrayclines
b) Vancomycin
c) Tigecycline
d) a+c
e) all of the mentionend
Choose correct Statement
The class C beta-lactamases are primarily cephalosporinases and are encoded on bacterial chromosomes
Class B carbapenemases are i.A. New Delhi metallo-beta-lactamases
Colistin binds to the membrane instead of penetrating it
Tigecycline may be affected by efflux or enzymatic modification
Active efflux of gentamycin is commonly observed in Bacteroides fragilis
Which of the following phenotypes relate to the enzyme production: 1. VRE 2. ESBL-positive 3. HLAR 4. PRSP 5. MBL-positive 6. NDM-positive
b) 2,4
c) 2,5
d) Only 4
e) 2,3,5,6
What is an “intrinsic resistance”
❌
definition they want us to write: Bacteria is born with such a resistance, “comes into the world”
Explain the abbreviation “NDM”: ❌ ❌
Resistance to this drug results from ❌ which catalyzes its acetylation. This characteristic indicates: Chloramphenicol
Class B ß-Lactamases:
a.) Are Zinc dependent Metalloenzymes
b.) Have Broad spectrum of action
c.) SHV-1 and TEM-1 are Major examples
d.) a+b
e.) None of the above
Tetracycline resistance develops with which of the following mechanisms?
a) Decreased penetration into the bacterial cell
b) Active efflux of the drug
c) Alteration of the ribosomal target site
e) all of the above
Natural resistance is observed in:
a) Pediococcus, Leuconostonc, Erysipelothrix, Lactobacillus
b) E.Coli, Klebsilla
c) Staphylococci
d) a+b
e) none of the above
Pseudomonoas aeruginosa is intrinsically resistant to:
a) Tigecycline
b) Tobramycin
c) Meropenem
d) Ceftazidime
e) Sulphonamides
f) d+e
Resistance through enzymatic modification of the drug is observed in:
a. Clindamycin – Str. Pyogenes
b. ß-Lactams – chlamydia
c. E. coli – glycopeptides
d. Isoniazid – mycobacteria
e. None of the above
Strict anaerobic bacteria have an intrinsic resistance to:
d. Clindamycin
c. Metronidazole
b. Ampicillin
a. Gentamicin
Which of the following phenotypes (resistance) matches the description for MRSA
a. Penicillin G, ureidopenicillin, imipenem, vancomycin – susceptible
b. Vancomycin, imipenem – susceptible; penicillin, 1st and 2nd Generation cephalosporins – resistant
c. Vancomycin – susceptible; penicillin, Cephalosporin, carbapenem – resistant d. Penicillin – susceptible; vancomycin, carbapenem, cephalosporin – resistant
e) none
Partial modification of a PBP through recombination in:
e. All of the above
d. Klebsiella pneumoniae
c. MRSA-acquisition of new pbp
b. Streptococcus pneumoniae
a. Escherichia Coli
Which of the following haven an aquired resistance to ß-Lactams
c) ESBL
e) All of the above
Strict anaerobic bacteria are resistant to:
a) Gentamicin
b) Penicillin
c) Metronidazole
Which of the following resistance phenotypes are associated with PBP modification
a) NDM
b) ESBL
c) PRSP
d) KPC
e) MRSA
f) c+e
Choose true Statement
a) Efflux of aminoglycosides occurs rarely in gram negative bacteria
b) Penicillin G is inactivated with gastric acid
c) Gram negative bacteria rapidly develop resistance against beta lactams by production
d) all of the above
Intrinsic Resistance to sulphonamides
a) Pseudomonas aeruginosa
b) Nocardia
c) Chlamydia
d) B+c
HLAR - ❌ ❌ ❌
MRSA - ❌ ❌ ❌ ❌
Choose true combination of drugs resistance against
a) Rifampin – rna polymerase
b) Levofloxacin – mosaic PBP
c) Erythromycin – enzyme modification
d) Penicillin G- enzyme modification
e) a+c+d
Resistance to this drug with protein production similar to elongation factor that protects 30S ribosomal subunit indicates the resistance to?
a) Penicillin
b) Azithromycin
c) Tetracyclines
d) Rifampin
Acquired resistance to penicillin G is observed in
a) Streptococcus pyogenes
b) E.coli
c) Streptococcus pneumonia
Give two examples of mechanisms of resistance with change of target site?
Give 2 groups of drugs that are elimanted by efflux group
Quinolones
Tetracycline
Resistance to aminoglycosides
Decreased permeability
Enzymatic modification
Erythomyocin is not active against K.Pneumoniae
Which of the following resistant phenotypes are associated with aminoglycosides modyfying enzyme production
Choose True sentence
a) Bacteria can become resistant to β-lactam antibiotics hydrolysis of the antibiotic by bacterial enzymes
b) Exclusion of B-lactamases in treatment of infection caused by non fermented process also due to decreased permeability of membrane
c) Enterobacteriaceae develop resistance to cephalosporins also due to the enzymes production
Intrinsic resistance to Linezolid - Escheria
Resistance to Metronidauole due to
Rescreased uptake of antibiotic
Elimination of cytotoxic compound before they reach DNA
Intrinsic resistance to Penicillin G - S pyogenes
- Chlamydia
Pumped out by efflux pump
Tetracyclines
Aminoglycosides
Which phenotype refers to MRSA?
a.) resistant to all beta lactams including vth generations of cephalosporins
b.) resistant to all beta lactams excluding vth generations of cephalosporins
c.) resistant to methicillin,susceptible to oxacillin and carbapenem
d.) resistant to beta lactams,resistant to vancomycin,susceptible to monobactams
e.) none of the mentioned
Enterococcus gallinarum and casseliflavus are instrinctly resistant
e)all mentioned
d.) a+c
c.) vancomycin contain D-alanine-D-serine terminus
b.)Linezolid
a.) Tigecycline
Correct Examples
A class beta- lactamase = SHV-1 penicillinases found in common gram negative rods (and TEM-1)
B class beta - lactamase= New Delhi metallo-ß-lactamases
Which of the following may become resistant (acquired resistant) to macrolides
S.pyogenes
K.pneumoniae
S.aureus
Acinetobacter baumannii
P.aeruginosa
E.coli
Resistance to Aminoglycosides may result from:-
e.)all mentioned
d.)a+c
c.)increased expulsion of drug from cell
d.)decrease uptake of drug
a.)mutation of ribosomal target site
Resistance to this drug results from acetyltransferase which catalyse to acetylation:-this characteristics indicate
e.)chloramphenicol
d.)imipenem
c.)penicillin G
b.)ceftriaxone
a.)Sulfamethoxazol
Intrinsic resistance to tigecyycline is observed in
a) Morganella
b) Providencia Proteus and P aeruginosa
c) Pseudomonas
e) all mentioned
Which of the following is/are enzyme producers: 1.S.pyogenes 2.ESBL + 3.HLAR + 4.PRSP 5.MBL + 6.chlamydia trachomatis
1,2,3,5
2,5
2,3,5
only 4
2,3,5,6
Becomes resistant to aztreonam
e. faecalis
p.aeruginosa
acinobacter baumanii
s.aureus
s epidermidis
s pygones
1. Complete information regarding the 3 ways how bacteria can become resistant to beta-lactam antibiotics:
Decreased concentration of antibiotic at the cell wall from target site
Decreased binding of antibiotic to the PBP
All
None
a. ESBL - ❌ ❌ ❌ b. VRE - ❌ ❌ ❌ c. KPC - ❌ ❌ ❌
5. Which of the following resistance mechanism phenotypes stem from the enzymatic modification of the drug:
a. PRSA
b. VRE
c. HLAR
d. MBL
e. a+c+d
7. Which of the following phenotype refers to MBL + P.aeruginosa:
a. Susceptible to carbapenems, resistant to beta lactams and its combinations with inhibitors
b. resistant to all beta lactams with exclusion of its combination with inhibitors
c. resistant to all beta lactams with possible exception of aztreonam
d. resistant to all beta lactams with possible exception of monobactams
e. c+d
a. A class beta lactamases: ❌ b. B class beta lactamases: ❌
Which of the following may become resistant to Rifampin?
E.Coli
P. Aeruginosa
Acinebacter Baumanii
S. Auereus
S. Pneumonia
M. Tuberculosis
10. which of the following may become resistant (acquire resistance) to rifampin: (1) E.coli (2) P. aeurigonase (3) acinetobacter baumanii (4) S .aureus (5) K .pneumonia (6) M. tuberculosis
1,2,3,5,6
4,3,5
4,5,6
2,3
4,6
Choose Correct Statement
1. Resistance to amikacin can stem from decreased uptake of drug into bacterial cell
2. Bacteroides fragilis is intrinsically resistant to metronidazole
3. Most of gram (+) bacteria is resistant to macrolides
Which of the follwoing resistance phenotypes refers to MBL P+Aeruginosa
1. Susceptible to carbapenems, resistant to B-lactams and its combinations
2. Resistant to all B-lactams, with exclusion of its combination with inhibitors
3. Resistant to all B-lactams, with possible exception of azteonem
4. Resistant to all B-lactams, with possible exception of macrolides
Complete information regarding the ways how bacteria can become resistant to aminoglycosides:
Target site modification
Decreased membrane permeability
Active efflux
: Enzymatic inactivation of antimicrobial agent
a/ Pseudomonas aeruginosa is intrinsically resistant to trimethoprim.
b/ Overexpression of efflux pumps determines the resistance to ciprofloxacin
c/ Polymyxins are not effective against Gram-positive bacteria due to the lack of outer membrane in these.
Explain the abbreviations:
PRSP: ❌ ❌ HLAR: ❌ ❌ ❌ NDM: ❌ ❌
Intrinsic resistance to glycopeptides is observed in:
a/ Lactobacillus
b/ Streptococcus pneumoniae
c/Enterococci
d/ E coli
e/ a+d
Which of the following resistance phenotype refers to MRSA:
a/ Resistant to beta-lactams with possible exception of its combinations with inhibitors.
b/ Resistant to all beta-lactams, susceptible to Vth generation of cephalosporins
c/ Resistant to narrow spectrum penicillins, resistant to macrolides and lincosamides.
d/ Resistant to all beta-lactams, with possible exception of monobactams.
e/ c+d
Resistance to gentamicin in Bacteroides fragilis is due to...❌
Which of the following may become resistant (acquire resistance) to tigecycline:
1. Proteus mirabilis
2. P. aeruginosa
3. Morganella morganii
4. E. faecalis
5. K. pneumoniae
6. Providencia retgerii
