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European Journal of Clinical Microbiology

, Volume 6, Issue 4, pp 446–450 | Cite as

Clinical consequences of development of resistance to third generation cephalosporins

  • F. Follath
  • E. Costa
  • A. Thommen
  • R. Frei
  • A. Burdeska
  • J. Meyer
Articles Current Topic Inducible Beta-Lactamases: Enzymes of Increasing Clinical Importance

Abstract

Eighteen patients are described in whom initially sensitive microorganisms were replaced by resistant isolates during administration of ceftriaxone (n=8), cefoperazone (n=5), moxalactam (n=4), cefotaxime (n=2) or ceftazidime (n=1), despite combination with aminoglycosides. All patients had documented gram-negative infections; in 12 patients underlying haemaotological diseases were present. Resistant strains ofEnterobacter cloacae (14),Serratia marcescens (4),Klebsiella oxytoca (3),Pseudomonas aeruginosa (2) andCitrobacter freundii (2) emerged within 2 to 19 (mean 9) days after the beginning of treatment. In 12 patients relapse or secondary infections occurred. Seven of the patients with haematological disorders died. Resistance development was seen in 8 of 29 patients on ceftriaxone and 4 of 10 patients on moxalactam during prospective evaluations; the other drugs were used sporadically. Thus, selection of resistant bacteria is relatively frequent and may have serious clinical consequences in patients with impaired host-defense mechanisms.

Keywords

Pseudomonas Aeruginosa Cephalosporin Ceftriaxone Cefotaxime Aminoglycosides 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Franke, E. L., Neu, H. C.: Use of cefotaxime, aβ-lactamase stable cephalosporin, in the therapy of serious infections, including those due to multiresistant organisms. American Journal of Medicine 1981, 71: 435–442.PubMedGoogle Scholar
  2. 2.
    Bailey, R. R., Peddie, B., Blake, E., Bishop, V., Reddy, J.: Cefoperazone in the treatment of severe or complicated infections. Drugs 1981, 22, Supplement: 76–86.PubMedGoogle Scholar
  3. 3.
    Winston, D. J., Busuttil, R. W., Kurtz, T. O., Young, L. S.: Moxalactam therapy for bacterial infections. Archives of Internal Medicine 1981, 141: 1607–1612.PubMedGoogle Scholar
  4. 4.
    Richards, D. M., Heel, R. C., Brogden, R. N., Speight, T. M., Avery, G. S.: Ceftriaxone: a review of its antibacterial activity, pharmacological properties and therapeutic use. Drugs 1984, 27: 469–527.PubMedGoogle Scholar
  5. 5.
    Francioli, P., Clément, M., Geroulanos, S., Von Gtaevenitz, A., Lüthy, R., Régamey, C., Stalder, H., Vogt, M., Waldvogel, F. A.: Ceftazidime in severe infections: a Swiss multicentre study. Journal of Antimicrobial Chemotherapy 1983, 12, Supplement A: 139–146.PubMedGoogle Scholar
  6. 6.
    Then, R. L., Angehrn, P.: Trapping of nonhydrolyzable cephalosporins by cephalosporinases inEnterobacter cloacae andPseudomonas aeruginosa as a possible resistance mechanism. Antimicrobial Agents and Chemotherapy 1982, 21: 711–717.PubMedGoogle Scholar
  7. 7.
    Sanders, C. C., Sanders, W. E.: Emergence of resistance during therapy with the newerβ-lactam antibiotics: role of inducibleβ-lactamases and implications to the future. Reviews of Infectious Diseases 1983, 5: 639–648.PubMedGoogle Scholar
  8. 8.
    Seeberg, A. H., Tolxdorff-Neutzling, R. M., Wiedemann, B.: Chromosomalβ-lactamases ofEnterobacter cloacae are responsible for resistance to third-generation cephalosporins. Antimicrobial Agents and Chemotherapy 1983, 23: 918–925.PubMedGoogle Scholar
  9. 9.
    Prehem, L. C., Penn, R. G., Sanders, C. C., Goering, R. V., Giger, K.: Emergence of resistance toβ-lactam and aminoglycoside antibiotics during moxalactam therapy ofPseudomonas aeruginosa infections. Antimicrobial Agents and Chemotherapy 1982, 22: 1037–1041.PubMedGoogle Scholar
  10. 10.
    Mathisen, G. E., Meyer, F. D., Thompson, J. M., Finegold, S. M.: Clinical evaluation of moxalactam. Antimicrobial Agents and Chemotherapy 1982, 21: 780–786.PubMedGoogle Scholar
  11. 11.
    Blaser, J., Bauernfeind, A., Vogt, M., Lüthy, R.: Monotherapie von systemischenPseudomonas aeruginosa Infektionen mit Ceftazidim. Deutsche Medizinische Wochenschrift 1983, 108: 1312–1317.PubMedGoogle Scholar
  12. 12.
    Bryan, C. S., John, J. F., Sharada Pai, M., Austin, T. L.: Gentamicin vs. cefotaxime for therapy of neonatal sepsis. American Journal of Diseases of Children 1985, 139: 1086–1089.PubMedGoogle Scholar
  13. 13.
    Guggenbichler, J. P., Kofler, J.: Influence of third-generation cephalosporins on aerobic intestinal flora. Journal of Antimicrobial Chemotherapy 1984, 14, Supplement B: 67–70.Google Scholar
  14. 14.
    Sanders, C. C.: Failure to detect resistance in antimicrobial susceptibility tests. A “very major” error of increasing concern. Antimicrobic Newsletter 1984, 1: 27–34.Google Scholar
  15. 15.
    Bush, K., Tanaka, S. K., Bonner, D. P., Sykes, R. B.: Resistance caused by decreased penetration ofβ-lactam antibiotics intoEnterobacter cloacae. Antimicrobial Agents and Chemotherapy 1985, 27: 555–560.PubMedGoogle Scholar
  16. 16.
    DiPiro, J. T., Bowden, T. A., Hooks, V. H.: Prophylactic parenteral cephalosporins in surgery. Are the new agents better? Journal of the American Medical Association 1984, 252: 3277–3279.PubMedGoogle Scholar
  17. 17.
    Nichols, L., Maki, D. G.: The emergence of resistance toβ-lactam antibiotics during treatment ofPseudomonas aeruginosa lower respiratory tract infections: is combination therapy the solution? Chemioterapia 1985, 4: 102–109.PubMedGoogle Scholar
  18. 18.
    Kunin, C. M.: Evaluation of antibiotic usage: a comprehensive look at alternative approaches. Reviews of Infectious Diseases 1981, 3: 745–753.PubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1987

Authors and Affiliations

  • F. Follath
    • 1
  • E. Costa
    • 1
  • A. Thommen
    • 1
  • R. Frei
    • 1
  • A. Burdeska
    • 2
  • J. Meyer
    • 2
  1. 1.Department of MedicineUniversity Hospital (Kantonspital)BaselSwitzerland
  2. 2.Department of Microbiology, BiozentrumUniversity of BaselSwitzerland

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