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Septicaemia caused by an enterobacter cloacae strain varying in resistance against cephalosporins

Septikämie durch einen Enterobacter cloacae-Stamm mit variabler Resistenz gegen Cephalosporine

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Summary

Enterobacter cloacae, sensitive to third-generation cephalosporins (cefotaxime and ceftazidime), was isolated from the stoma of a patient with leukaemia. One month later, he developed a fatal septicaemia, caused by an identical strain isolated from blood cultures. He had been treated with several antibacterial agents, including cefotaxime. The blood culture strain seemed to be a mixture of four variants with different resistance patterns to cefotaxime and ceftazidime. One variant was extremely sensitive to third-generation cephalosporins, one was completely resistant, and two showed variations in zone diameter within sensitivity group 2, both for cefotaxime and ceftazidime. Minimal inhibitory concentration (MIC) studies also showed different resistance patterns between the four variants. Similar variants were found when the stoma isolate was further investigated.

Zusammenfassung

Bei einem Leukämiepatienten wurde aus dem Stoma des Anus praeter ein gegen Cephalosporine der dritten Generation (Cefotaxim, Ceftazidim) empfindlicherEnterobacter cloacae-Stamm isoliert. Nach einem Monat trat eine tödliche Septikämie auf, bei der aus Blutkulturen ein identischer Stamm isoliert wurde. Vorausgegangen war eine Antibiotikatherapie mit verschiedenen Substanzen einschließlich Cefotaxim. Der aus Blut isolierte Stamm hatte offensichtlich vier Varianten mit unterschiedlichem Resistenzmuster gegen Cefotaxim und Ceftazidim. Eine Variante wies sehr hohe Empfindlichkeit gegen Cephalosporine der dritten Generation auf, eine war vollkommen resistent, zwei zeigten sowohl für Cefotaxim wie für Ceftazidim Unterschiede im Hemmhofdurchmesser im Empfindlichkeitsbereich Gruppe 2. Die Bestimmung der minimalen Hemmkonzentrationen ergab ebenfalls unterschiedliche Resistenzmuster bei den vier Varianten. Ähnliche Varianten wurden auch bei weiterer Untersuchung des Stoma gefunden.

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Authors and Affiliations

  1. Department of Microbiology, University Hospital, N-9000, Tromsø

    Bjørg Marit Andersen M.D.

  2. Department of Internal Medicine, University Hospital, N-9000, Tromsø

    Inger Marie S. Dahl M.D.

  3. Central Public Health Laboratory, Division of Hospital Infection, London, England

    R. C. George M.D. & Anette Gilfillian

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  1. Bjørg Marit Andersen M.D.
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  2. Inger Marie S. Dahl M.D.
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  3. R. C. George M.D.
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  4. Anette Gilfillian
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Andersen, B.M., Dahl, I.M.S., George, R.C. et al. Septicaemia caused by an enterobacter cloacae strain varying in resistance against cephalosporins. Infection 17, 156–159 (1989). https://doi.org/10.1007/BF01644017

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  • DOI: https://doi.org/10.1007/BF01644017

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