Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-30T20:12:15.286Z Has data issue: false hasContentIssue false
  • English
  • Français

Role of Aminoglycosides in Face of Introduction of New Beta-Lactam Antibiotics in Treatment of Nosocomial Infection

Published online by Cambridge University Press:  02 January 2015

John E. McGowan Jr. ,
David B. McClellan  and
Paula S. Irwin
John E. McGowan Jr.*
Affiliation:
Departments of Pathology and Laboratory Medicine and Medicine (Infectious Diseases), Emory University School of Medicine and the Clinical Microbiology Laboratory, Grady Memorial Hospital, Atlanta, Georgia
David B. McClellan
Affiliation:
Departments of Pathology and Laboratory Medicine and Medicine (Infectious Diseases), Emory University School of Medicine and the Clinical Microbiology Laboratory, Grady Memorial Hospital, Atlanta, Georgia
Paula S. Irwin
Affiliation:
Departments of Pathology and Laboratory Medicine and Medicine (Infectious Diseases), Emory University School of Medicine and the Clinical Microbiology Laboratory, Grady Memorial Hospital, Atlanta, Georgia
*
Clinical Microbiology (Box 248), Grady Memorial Hospital, 80 Butler Street, Atlanta, GA30335
Get access Rights & Permissions [Opens in a new window]

Abstract

Aminoglycosides often are employed for empiric therapy of nosocomial infection because of their activity against a wide spectrum of gram-negative aerobic bacilli (GNAB). New beta-lactam antimicrobials also are active against many GNAB. As toxicity appears less likely for the beta-lactams than for aminoglycosides, their use might be preferable if susceptibility profiles were equivalent.

We studied susceptibility of 90 GNAB recovered from blood culture during a three-month period. All were susceptible to aminoglycosides; 93% were susceptible to at least one of the following: ampicillin, carbenicillin, ticarcillin, cephalothin, chloramphenicol or trimethoprim-sulfamethoxazole. All were susceptible to at least one of our newer beta-lactams (cefamandole, cefoxitin, cefotaxime, moxalactam, piperacillin), but the percentage susceptible to any single beta-lactam was lower than that for any of the aminoglycosides tested. All of the isolates were susceptible to combinations of two beta-lactam drugs.

In our hospital, beta-lactams may be reasonable alternatives to aminoglycosides in selected cases where susceptibility has been demonstrated. However, aminoglycosides continue to provide the broadest single-drug coverage for empiric therapy of known or suspected sepsis with GNAB. The utility of combinations of beta-lactam drugs for empiric therapy requires further assessment by clinical trials.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 4 , Issue 6 , December 1983 , pp. 440 - 443
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1983

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Phillips, I: Aminoglycosides. Lancet 1982;2:311–315.CrossRefGoogle ScholarPubMed
2.Wilkowske, CJ, Hermans, PE: General principles of antimicrobial therapy. Mayo Clin Proc 1983;58:6–13.Google ScholarPubMed
3.Platt, R: Diagnosis and empiric therapy of urinary tract infection in the seriously ill patient. Rev Infect Dis 1983; 5(suppl 1):S65–S71.CrossRefGoogle ScholarPubMed
4.Neu, HC: The new beta-lactamase-stable cephalosporins. Ann Intern Med 1982;97:408–419.CrossRefGoogle ScholarPubMed
5.Brooks, GF, Barriere, SL: Clinical use of the new beta-lactam antimicrobial drugs. Practical considerations for physicians, microbiology laboratories, pharmacists, and formulary committees. Ann Intern Med 1983;98:530–535.CrossRefGoogle ScholarPubMed
6.Haley, RW, Schaberg, DR, McClish, DK, et al: The accuracy of retrospective chart review in measuring nosocomial infection rates: Results of validation studies in pilot hospitals. Am J Epidemiol 1980;111:516–523.CrossRefGoogle ScholarPubMed
7.National Committee for Clinical Laboratory Standards: Performance Standards for Antimicrobic Disk Susceptibility Tests, ed 2, NCCLS Standard M2-A2. Villanova, Pennsylvania, NCCLS, 1982.Google Scholar
8.Finland, M: Empiric therapy for bacterial infections: The historical perspective. Rev Infect Dis 1983; 5(suppl 1):S2–S8.CrossRefGoogle ScholarPubMed
9.McGowan, JE Jr: Antimicrobial resistance in hospital organisms and its relationship to antibiotic use. Rev Infect Dis 1983;5:1033–1048.CrossRefGoogle ScholarPubMed
10.Klastersky, J: Empiric treatment of infections in neutropenic patients with cancer. Rev Infect Dis 1983; 5(suppl 1):S21–S31.CrossRefGoogle ScholarPubMed
11.Sanders, CC: Novel resistance selected by the new expanded spectrum cephalosporins: A concern. J Infect Dis 1983;147:585–589.CrossRefGoogle ScholarPubMed