title: Utility of serial rectal swab cultures for detection of ceftazidime- and imipenem-resistant gram-negative bacilli from patients in the intensive care unit.
abstract: Forty-four patients receiving intensive care were studied prospectively to assess the utility of serial rectal swab cultures and clinical correlates of resistance for Pseudomonas aeruginosa, Enterobacter spp., Citrobacter spp., Morganella morganii, and Serratia marcescens strains resistant to ceftazidime or imipenem. Strains of Pseudomonas aeruginosa, Enterobacter spp., Citrobacter spp., or Morganella morganii were found in 26 of 44 (59%) patients: 17 (65%) in clinical sites (11 with concomitant rectal isolates) and nine (35%) in a rectal site only. Of 49 total isolates, 13 (26.5%) were resistant: 10 (20.4%) to ceftazidime and three (6.1%) to imipenem. Surveillance rectal swabs from 27 patients without a clinical isolate identified two patients with resistant organisms (15% of all resistant isolates). The majority of resistance to ceftazidime or imipenem among Pseudomonas or Enterobacter can be detected by the use of clinical specimens alone.
authors.affiliation: Department of Medicine, New England Medical Center, Boston, Massachusetts 02111, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Arbo
authors.forename: R
authors.initials: R
authors.lastname: Hariharan
authors.forename: C
authors.initials: C
authors.lastname: Nathan
authors.forename: L
authors.initials: L
authors.lastname: Barefoot
authors.forename: R A
authors.initials: RA
authors.lastname: Weinstein
authors.forename: D R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D000328:Adult; D000368:Aged; D002442:Ceftazidime / Q000494:pharmacology*; D002511:Cephalosporins / Q000494:pharmacology*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D015378:Imipenem / Q000494:pharmacology*; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology*; D013845:Thienamycins / Q000494:pharmacology*; D018440:beta-Lactam Resistance
chemical_list: D002511:Cephalosporins; D013845:Thienamycins; D015378:Imipenem; D002442:Ceftazidime