Table 1. Antimicrobial Susceptibility Rates (%) for the Four Most Common Species of Gram-Negative Bacilli, 1994-2000

 

    AA.      E    A. Escherichia coli

(n=4027)

Klebsiella pneumoniae

(n=4877)

B. Enterobacter species (n=4999)
   Pseudomonas aeruginosa

(n=8244)

Amikacin

100

94

98

90

Tobramycin

96

85

92

87

Gentamicin

95

85

92

68

Piperacillin

64

39

60

74

Piperacillin/tazobactam

95

87

73

78

Cefepime

98

90

84

71

Ceftazidime

97

87

63

80

Imipenem

100

99

99

83

Ciprofloxacin

97

88

90

76

 

Table 2   Rates of Cross-Resistance (%) Among Selected Gram-Negative Bacilli, 1994-2000

 

C. Pseudomonas
aeruginosa
Ciprofloxacin
D. Enterobacter
species
Ciprofloxacin
E. Klebsiella pneumoniae Ciprofloxacin

Antimicrobial

         % resistant

(n=1946)

            % susceptible

    (n=6298)

          % resistant

   (n=486)

   % susceptible

(n=4513)

       % resistant

(n=603)

        % susceptible

(n=4274)

Gentamicin

66.0

21.7

48.8

3.9

67.3

7.1

Ceftazidime

39.8

14.0

81.5

31.8

65.2

6.1

Imipenem

37.6

10.9

3.9

1.0

3.2

0.5

Amikacin

26.0

5.6

10.9

0.8

32.6

1.8

 

 Note:  numbers are percentages

 

Table 3. Association of Previously Administered Antibiotics with Multiresistant Enterobacter in the Initial Blood Culture

   Multiresistant Enterobacter

 Antibiotic*    

       Isolate n/N (%)  

 P Value

Any Antibiotic

     Yes

      36/103 (35%)

     No 

      1/26 (4)   

 .002

Third-generation cephalosporin

     Yes 

     22/32 (69)

      No    

     14/71 (20)  

  .001

*Antibiotics received in the 2 weeks before the initial positive blood culture.

  Data from Chow et al (7)

 

Table 4. Emergence of Resistance during Antibiotic Therapy for Enterobacter Bacteremia

Patient 

Antibiotic Used 

Emergence of Resistance to Drug

MIC* before Therapy (mg/mL)

MIC* after Therapy (mg/mL)

Duration of Therapy When Resistance Was Seen (days)

Source of  Second Positive Culture

Enterobacter spp.

Outcome

1

Cefotaxime

 Cefotaxime

 <4 

  >32 

 16 

 Intraabdominal 

abscess

 E. cloacae  

 Survived

2

Ceftazidime,  tobramycin

 Ceftazidime 

 <2 

  >16

 18  

 Blood 

 E. cloacae 

 Survived

3

Ceftazidime

 Ceftazidime 

 <2

  >16 

  5 

 Blood

 E. cloacae 

 Survived

4

Cefotaxime, amikacin

 Cefotaxime

 < 4

  >32 

  6 

 Blood 

 E. aerogenes 

 Died

5

Ceftizoxime 

 Ceftizoxime 

  8  

  32

  4 

 Blood

 E. cloacae 

 Survived

6

Cefotaxime,  gentamicin

 Cefotaxime 

  8

  32

  7

 Blood 

 E. aerogenes 

 Survived

7

Piperacillin, tobramycin

 Tobramycin

  <0.25 

  8

  8

 Two Central venous catheters

 E. cloacae

 Survived