The importance of beta-lactamase resistance in surgical infections.
Substantial costs are associated with the treatment of nosocomial infections, 2 million cases of which occur annually in the United States. Hospital-acquired, gram-negative infection has become an increasing problem, particularly in the intensive care unit where up to 40% of the most frequently isolated strains of Enterobacteriaceae are resistant to standard beta-lactam antibiotics. Among several mechanisms of acquisition of resistance, beta-lactamase production accounts for a high percentage of treatment failures and relapses. By the end of the 1980s, some 10-30% of all nosocomial infections were caused by type-1 beta-lactamase-producing gram-negative isolates, and Enterobacter species had emerged as a major resistant pathogen. The beta-lactam/beta-lactamase inhibitor combinations, such as ampicillin/sulbactam, represent an innovative approach to the problem of beta-lactamase-mediated resistance. Clinical use of these agents has been associated with low rates of resistance and new data suggest they may have a specific role in controlling the emergence and spread of nosocomial infections.
Edmiston
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Surgical Microbiology Research Laboratory, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA. edmiston@mcw.edu
Hennen
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Seabrook
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D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D011183:Postoperative Complications / Q000188:drug therapy* / Q000382:microbiology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000494:pharmacology / Q000627:therapeutic use*
D001618:beta-Lactamases