Dr. Becca Bruning, Infectious Diseases Pharmacy Specialist at the Moffitt Cancer and Research Institute in Tampa, FL, takes a deep dive into the subject of resistance mechanisms for specific gram negative bacteria. Dr. Bruning begins her talk by discussing the primary resistance mechanisms, including porin channels, efflux pumps, and other target sites. Extended spectrum beta-lactamases (ESBLs) are next covered, including typical bacterial species, identification techniques, ESBL testing, and the use of Piperacillin-tazobactam and carbapenems. Next, Dr. Bruning mentions AmpC-type resistance, and identifies the “HECKYES” bacteria. Pharmacokinetic and phamacdynamic considerations are explored, and specific antimicrobial agents are discussed. Lastly, Dr. Bruning covers the use of carbapenemase testing including the modified hodge test and the Carba-R test.