Clinical and bacteriological study of nosocomial infections due to Enterobacter aerogenes resistant to imipenem.
Enterobacter aerogenes strains resistant to imipenem were isolated in 10 patients, 7 of whom had received imipenem-cilastatin. The strains were differentiated by biotype, antibiotype, and plasmid content. All of the strains overproduced a chromosomal cephalosporinase and lost a major outer membrane protein with a size of about 40 kDa. In 5 of the 10 patients, E. aerogenes strains resistant to extended-spectrum cephalosporin were isolated during the same stay. In three patients, the similarity between the imipenem-susceptible and -resistant strains suggests the occurrence of mutation and reversion in vivo. The combination imipenem-cilastatin has been critically important for use with multiresistant strains of Enterobacter spp., but its use increases the risk of selection of imipenem-resistant strains.
de Champs
C
C
Service d'Hygiène Hospitalière, Faculté de Médecine, Clermont-Ferrand, France.
Henquell
C
C
Guelon
D
D
Sirot
D
D
Gazuy
N
N
Sirot
J
J
D001425:Bacterial Outer Membrane Proteins / Q000032:analysis; D015373:Bacterial Typing Techniques; D002510:Cephalosporinase / Q000378:metabolism; D015377:Cilastatin / Q000494:pharmacology / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D004338:Drug Combinations; D004352:Drug Resistance, Microbial / Q000235:genetics; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D015378:Imipenem / Q000494:pharmacology* / Q000627:therapeutic use; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D010957:Plasmids; D001618:beta-Lactamases / Q000378:metabolism
D001425:Bacterial Outer Membrane Proteins; D004338:Drug Combinations; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; D002510:Cephalosporinase; D001618:beta-Lactamases