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Endemic Emergence of Cephalosporin-Resistant Enterobacter: Relation to Prior Therapy

Published online by Cambridge University Press:  02 January 2015

Robert A. Weinstein
Robert A. Weinstein*
Affiliation:
Infection Control Program and Division of Infectious Diseases, Department of Medicine, Michael Reese Hospital and Medical Center and the University of Chicago, Pritzker School of Medicine, Chicago, Illinois
*
Department of Medicine, Michael Reese Hospital and Medical Center, Lake Shore Drive at 31st Street, Chicago, IL 60616
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Extract

The “second” and “third” generation cephalosporins offer striking antimicrobial activity against a wide spectrum of Enterobacteriaceae. Nevertheless, mutants resistant to these drugs have emerged in both laboratory and clinical settings. For example, before the commercial availability of the third-generation agents, we treated three cardiac surgery patients for Enterobacter mediastinitis with aminoglycosides and high doses of cefamandole. In two, initial treatment failed due to emergence of strains that were not only resistant to cefamandole, but also to then experimental third-generation drugs. Despite such reports and in vitro studies of the mechanisms of resistance, the frequency with which broad-spectrum cephalosporin resistance develops in clinical practice is not clear. To help delineate this problem, we have reviewed our hospital's experience with Enterobacter strains resistant to newer cephalosporins (using cefamandole and cefotaxime as prototypes) and the relation of resistant strains to cephalosporin use, with special attention to our cardiac surgery patients.

Type
Research Article
Information
Infection Control & Hospital Epidemiology , Volume 7 , supplement S2: Proceedings of the Second ICI/Stuart Workshop , February 1986 , pp. 120 - 123
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1986

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References

1.Cullmann, W, Dalhoff, A, Dick, W: Nonspecific induction of Beta-lactamase in Enterobacter cloacae. J Gen Microbiol 1984; 130:1781–1786.Google Scholar
2.Findell, CM, Sherris, JC: Susceptibility of Enterobacter to cefamandole: Evidence for a high mutation rate to resistance. Antimicrob Agents Chemother 1976; 9:970–974.Google Scholar
3.Levin, MH, Weinstein, RA, Kabins, SA: Cefoxitin disc induction of latamoxef (moxalactam) resistance. J Antimicrob Chemother 1983; 12:524–525.CrossRefGoogle ScholarPubMed
4.Murray, PR, Granich, GG, Krogstad, DJ, et al: In vivo selection of resistance to multiple cephalosporins by Enterobacter cloacae. J Infect Dis 1983; 147:590.Google Scholar
5.Olson, B, Weinstein, RA, Nathan, C, et al: Broad-spectrum beta-lactam resistance in Enterobacter: Emergence during treatment and mechanisms of resistance. J Antimicrob Chemother 1983; 11:299–310.CrossRefGoogle ScholarPubMed
6.Sanders, CC, Sanders, WE: Emergence of resistance to cefamandole: Possible role of cefoxitin-inducible beta-lactatnases. Antimicrob Agents Chemother 1979; 15:792–797.CrossRefGoogle Scholar
7.Sanders, CC, Moellering, RC, Martin, RR, et al: Resistance to cefamandole: A collaborative study of emerging clinical problems. J Infect Dis 1982; 145:118–125.Google Scholar
8.Weinstein, RA: Occurrence of cefolaxime-resistant Enterobacter during therapy of cardiac surgery patients. Chemioterapia 1985; 4:110–112.Google Scholar
9.Weinstein, RA, Nathan, C, Gruensfelder, R, et al: Epidemie aminoglycoside resistance in gram-negative bacilli: Epidemiology and mechanisms. J Infect Dis 1980; 141:338–345.CrossRefGoogle Scholar