[Failure of new beta-lactam antibiotics in the treatment of severe Enterobacter cloacae infections].
In 12 patients infected with an Enterobacter cloacae (E. cl.) initially susceptible to the 3rd generation cephalosporins, we observed the emergence in vivo of variants resistant to most of the new beta-lactam antibiotics (carboxy-penicillins, ureido-penicillins, 3rd generation cephalosporins and aztreonam). These variants remained susceptible to mecillinam and imipenem. The variant emerged under treatment with cefotaxime in 3 cases, with moxalactam in 3 cases, with aztreonam, carbenicillin, and ticarcillin in 1 case each and without treatment in 1 case. An aminoglycoside was combined with the beta-lactam antibiotic in 6 cases. Therapeutic failure was attributed to emergence of the resistant variant in 6 out of 12 cases (with an aminoglycoside in 3 cases, with the beta-lactam antibiotic alone in 3 cases). These case reports underline the importance of bacteriological monitoring of patients infected with E. cl. treated with a beta-lactam antibiotic. The susceptibility to beta-lactam antibiotics of the E. cl. strains isolated during treatment should be systematically retested.
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D004754:Enterobacter / Q000187:drug effects / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005260:Female; D014644:Genetic Variation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010403:Penicillin Resistance; D047090:beta-Lactams
D000900:Anti-Bacterial Agents; D047090:beta-Lactams
Echecs des nouvelles bêta-lactamines dans le traitement d'infections sévères à Enterobacter cloacae.