Clinical strategies for serious infection : A North American perspective.
Interscience Conference on Antimicrobial Agents and Chemotherapy. Toronto, ON, CAN, 1997/09.
In the United Sates, as in Europe, clinical strategies for serious infection are being incresingly driven by growing numbers of cephalosporin-resistant and multiresistant Gram-negative bacilli.
In a survey of nearly 400 hospital intensive care units in Norht America, resistance rates of Klebsiella to third-generation cephalosporins increased (from 3.6 to 14.4%) between 1990 and 1993.
Resistance rates in Enterobacter are even higher, approaching 40%. Much of this resistance, which is due mainly to production of type-1 and extended spectrum bêta-lactamases, appears to have arisen through overuse of third-generation cephalosporins and from poor hand-washing practices.
In some American cities, a major reservoir of resistant organisms are nursing homes, where there is evidence of over-use of oral antibiotics.
Currently, the most reliable agents available for the treatment of resistant Gram-negative pathogens are the carbapenems, imipenem/cilastatin and meropenem, and the aminoglycoside, amikacin.
A recent clinical study of meropenem monotherapy in patients with nosocomial pneumonia showed statistically significantly better clinical and microbiologic outcome compared with a standard regimen of ceftazidime plus tobramycin.
The enhanced in vitro activity of meropenem against a number of key organisms may have been responsible for the superior results. (...)
Mots-clés Pascal : Bactérie Gram négatif, Résistance multiple, Milieu hospitalier, Antibiotique, Antibactérien, Céfépime, Carbapénème dérivé, bêta-Lactamase, Hydrolases, Enzyme, Cefpirome, Céphalosporine dérivé, Amérique du Nord, Amérique, Article synthèse
Mots-clés Pascal anglais : Gram negative bacteria, Multiple resistance, Hospital environment, Antibiotic, Antibacterial agent, Cefepime, Carbapenem derivatives, bêta-Lactamase, Hydrolases, Enzyme, Cefpirome, Cephalosporin derivatives, North America, America, Review
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0401066
Code Inist : 002B02S02. Création : 25/01/1999.