title: High rates of antimicrobial co-resistance among Enterobacteriaceae: comparative analysis between clinical isolates resistant and susceptible to third-generation cephalosporins.
abstract: We compared the antimicrobial co-resistance of 3,402 clinical isolates of Enterobacteriaceae resistant to third-generation cephalosporins (2,569 ESBL-producing and 833 AmpC overproducing) with that of 16,220 susceptible isolates, in order to determine the impact of resistance to third-generation cephalosporins on the likelihood of resistance to other antimicrobial classes. Enterobacteriaceae resistant to third-generation cephalosporins, independently of their mechanism of resistance, were significantly more resistant to other classes of antimicrobials than susceptible isolates (p <0.001). Percentages of co-resistance to ciprofloxacin, gentamicin, tobramycin and trimethoprim-sulfamethoxazole of resistant isolates were: 51%, 39%, 53% and 51%, respectively. However, among the susceptible isolates, percentages were 17%, 7%, 6% and 19%, respectively. Fosfomycin exhibited excellent in vitro activity against urinary isolates (92%), mainly against ESBL-producing organisms (90%), and is a good alternative treatment of infections caused by multidrug resistant Enterobacteriaceae. Amikacin and imipenem were the most active antimicrobials against all species tested.
authors: Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Madrid.
authors: M J
authors: MJ
authors: Goyanes
authors: E
authors: E
authors: Cercenado
authors: R
authors: R
authors: Insa
authors: A
authors: A
authors: Morente
authors: L
authors: L
authors: Alcalá
authors: E
authors: E
authors: Bouza
mesh_terms: D000900:Anti-Bacterial Agents / Q000145:classification / Q000494:pharmacology; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000145:classification / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology; D006785:Hospitals, University; D006801:Humans; D013030:Spain
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins