title: Treatment failures of cefotaxime and latamoxef in meningitis caused by Enterobacter and Serratia spp.
abstract: Despite the apparent success of several new cephalosporins in the treatment of Gram-negative bacterial meningitis, four treatment failures with cefotaxime or latamoxef were encountered (two caused by Enterobacter and two by Serratia spp.) In-vitro parameters of susceptibility of these clinical isolates were compared with those of a meningeal Ent. cloacae isolate from a successfully treated patient. The MIC and MBC values, degrees of inoculum effect, and amounts of beta-lactamase produced correlated poorly with the observed clinical outcome. However, the extent to which an isolate was killed by the cephalosporin used for treatment, in a 6-h in-vitro incubation, showed good correlation. We suggest that such a test should be used to predict clinical outcome of therapy because the other parameters such as the MIC and MBC values are not sufficiently discriminatory.
mesh_terms: D000328:Adult; D002439:Cefotaxime / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004754:Enterobacter / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008581:Meningitis / Q000188:drug therapy*; D008875:Middle Aged; D009070:Moxalactam / Q000627:therapeutic use*; D012705:Serratia; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D001618:beta-Lactamases; D002439:Cefotaxime; D009070:Moxalactam