Clinical consequences of development of resistance to third generation cephalosporins
Articles Current Topic Inducible Beta-Lactamases: Enzymes of Increasing Clinical Importance
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.
KeywordsPseudomonas 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.
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
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
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
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
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
Then, R. L., Angehrn, P.
: Trapping of nonhydrolyzable cephalosporins by cephalosporinases inEnterobacter cloacae
as a possible resistance mechanism. Antimicrobial Agents and Chemotherapy 1982, 21: 711–717.PubMedGoogle Scholar
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
Seeberg, A. H., Tolxdorff-Neutzling, R. M., Wiedemann, B.
-lactamases ofEnterobacter cloacae
are responsible for resistance to third-generation cephalosporins. Antimicrobial Agents and Chemotherapy 1983, 23: 918–925.PubMedGoogle Scholar
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
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
Blaser, J., Bauernfeind, A., Vogt, M., Lüthy, R.
: Monotherapie von systemischenPseudomonas aeruginosa
Infektionen mit Ceftazidim. Deutsche Medizinische Wochenschrift 1983, 108: 1312–1317.PubMedGoogle Scholar
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
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
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
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
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
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
Kunin, C. M.
: Evaluation of antibiotic usage: a comprehensive look at alternative approaches. Reviews of Infectious Diseases 1981, 3: 745–753.PubMedGoogle Scholar
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