cefsulodin and Cross-Infection

Nosocomial infections by Pseudomonas aeruginosa seen in a general intensive care unit from January 1987 through December 1989 were studied. Use of piperacillin, ticarcillin, cefsulodine, ceftazidime, and imipenem over the same period were recorded. Rate of infection by P. aeruginosa among the 1,844 patients admitted during the study period was 3.2%; 32% of all nosocomial infections during this period were due to P. aeruginosa. The proportion of P. aeruginosa strains exhibiting in vitro susceptibility to ticarcillin rose from 45.5% in 1987 to 59% in 1988 and 86% in 1989. Concomitantly, the proportion of P. aeruginosa strains simultaneously resistant to ticarcillin, piperacillin, cefsulodine and ceftazidime fell from 32% to 18.5% then 0%. A statistically significant correlation was found between the decrease in piperacillin use and the fall in penicillinase-producing ticarcillin-resistant strains of P. aeruginosa. Because piperacillin has undesirable effects on the intestinal flora and promotes the emergence of resistant strains of P. aeruginosa, the authors now use narrow spectrum antimicrobial agents as first line treatment of nocosomial infections.

Topics: Cefsulodin; Ceftazidime; Cross Infection; Drug Resistance, Microbial; Female; Humans; Imipenem; Intensive Care Units; Male; Middle Aged; Piperacillin; Pseudomonas aeruginosa; Pseudomonas Infections; Ticarcillin

The activities of cefsulodin and gentamicin against Pseudomonas aeruginosa isolated from clinical specimens from five hospitals in different geographical areas of Japan, from 1980 to 1983, were compared in vitro. The incidence of resistant strains was higher for gentamicin. In 1982 the sensitivity to both drugs decreased from 1980 and 1981 levels, largely because of the isolation of numbers of cefsulodin-gentamicin cross-resistant bacteria from three of the five hospitals. In 1983, the incidence of resistant strains was similar to that in 1982. This linked cefsulodin-gentamicin resistance may have been selected by the use of the cephalosporins, cefmenoxime, cefoperazone, cefotaxime, ceftizoxime and latamoxef, which had been prescribed extensively in the hospitals where cross-resistance was encountered. Although cefsulodin-resistant strains of P. aeruginosa have increased since 1982, the in-vitro activity of cefsulodin in 1983 remained greater than that of these third-generation cephalosporins.

Topics: Cefsulodin; Cross Infection; Drug Resistance, Microbial; Drug Utilization; Gentamicins; Humans; Japan; Pseudomonas aeruginosa

The in-vitro antibacterial activity of ceftazidime was compared with that of cefsulodin and ticarcillin against 140 strains of Pseudomonas aeruginosa. Against 123 clinical isolates, geometric mean MICs were 1499mg/l for ticarcillin, 15 mg/l for cefsulodin and 2.1 mg/l for ceftazidime. Against constitutive beta-lactamase producers (93 strains), and according to the type of enzyme (TEM-1, carbenicillinases, oxacillinases), ceftazidime had similar activity but MICs of cefsulodin were particularly affected by highly ticarcillin-resistant (carbenicillinase pIs 53, 5.7 and 575) strains. Against ticarcillin-resistant (constitutive beta-lactamase non-producers) and ticarcillin-susceptible strains, the MICs of ceftazidime were slightly lower than those of cefsulodin.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefsulodin; Ceftazidime; Cross Infection; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Ticarcillin