Clinical consequences of development of resistance to third generation cephalosporins

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Abstract
Eighteen patients are described in whom initially sensitive microorganisms were replaced by resistant isolates during administration of ceftriaxone (n=8), cefoperazone (n=5), moxalactam (n=4), cefotaxime (n=2) or ceftazidime (n=1), despite combination with aminoglycosides. All patients had documented gram-negative infections; in 12 patients underlying haemaotological diseases were present. Resistant strains ofEnterobacter cloacae (14),Serratia marcescens (4),Klebsiella oxytoca (3),Pseudomonas aeruginosa (2) andCitrobacter freundii (2) emerged within 2 to 19 (mean 9) days after the beginning of treatment. In 12 patients relapse or secondary infections occurred. Seven of the patients with haematological disorders died. Resistance development was seen in 8 of 29 patients on ceftriaxone and 4 of 10 patients on moxalactam during prospective evaluations; the other drugs were used sporadically. Thus, selection of resistant bacteria is relatively frequent and may have serious clinical consequences in patients with impaired host-defense mechanisms.

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