Antibiotic resistance patterns in nosocomial gram-negative bacterial infections in units with heavy antibiotic usage.
The pattern of antibiotic resistance amongst gram-negative bacteria (GNB) in paediatric units, which have heavy empirical usage of broad-spectrum antibiotics, was studied prospectively over a 6-month period. A total of 200 consecutive, non-duplicate gram-negative isolates were obtained from 109 patients admitted to intensive care and oncology units in two hospitals. The commonest isolates were Klebsiella spp (36.5 per cent) and Pseudomonas (20.0 per cent). The isolates showed lower susceptibility rates to the third-generation cephalosporins (47-62 per cent) compared with cefepime (91 per cent), imipenem (90 per cent) and ciprofloxacin (99 per cent). Fifty-four (52.8 per cent) Klebsiella and Escherichia coli isolates were determined to be extended-spectrum beta-lactamase (ESBL) producing strains. Antibiotics found to be effective against ESBL-producers were imipenem and ciprofloxacin. The high resistance rate amongst GNB to third-generation cephalosporins is a likely consequence of heavy empirical usage of this group of antibiotics. The carbapenems and quinolones remain useful agents in the management of patients admitted to these units.
Department of Paediatrics, University of Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia. hany@um.edu.my
Hany
H
Ariffin
Parasakthi
P
Navaratnam
Tan Kah
TK
Kee
Ganeswarie
G
Balan
D000150:Acinetobacter / Q000187:drug effects / Q000302:isolation & purification; D002648:Child; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006757:Hospital Units; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D007709:Klebsiella / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification; D008296:Malaysia; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000276:immunology; D001618:beta-Lactamases / Q000096:biosynthesis
D001618:beta-Lactamases