32 Chapter 2 Conclusion The presence of plasmid AmpC in Enterobacterales may affect the patient’s treatment options. Although the prevalence of plasmid AmpC producing Enterobacterales in the Netherlands is lower than the prevalence of ESBL-producing Enterobacterales, it is important to be aware of this resistance mechanism. Since empirical treatment of infections in the Netherlands is currently based on the 2nd and 3rd generation cephalosporins, detection of AmpC- beta-lactamase producing Enterobacterales is critical, so that any increase in this resistance mechanism can be halted at an early stage. Attention to the detection of AmpC producing Enterobacterales and limiting the spread of this resistance mechanism can ensure that antibiotic resistance within the Netherlands remains limited in the future. Directions for practice • The presence of plasmid AmpC- producing Enterobacterales may affect a patient’s treatment due to related resistance to commonly used beta-lactam antibiotics. • Diagnostics for the presence of plasmid AmpC deviates from the diagnosis for the presence of ESBL in Enterobacterales, but can be confirmed with specific phenotypic and genotypic tests in most laboratories • Although plasmid AmpC- producing Enterobacterales are currently still limited in the Netherlands, attention to prevalence and transmission is desirable to prevent further spread
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