Resistant pathogens:Emergence and Control

Emergence and Control
  • Patricia Winokur
  • Carol E. Chenoweth
  • Louis Rice
  • Borna Mehrad
  • Joseph P. Lynch
Part of the Perspectives on Critical Care Infectious Diseases book series (CCID, volume 4)


Antibiotic resistance is one of the most prominent and vexing problems in intensive care medicine. Physicians are now encountering resistant strains in hospitals.


Antimicrobial Resistance Clin Infect Antimicrob Agent Nosocomial Pneumonia Acinetobacter Baumannii 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Cohen ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 1992; 257(5073):1050–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Flaherty J, Weinstein R. Nosocomial infection caused by antibiotic-resistant organisms in the intensive-care unit. Infect Control Hosp Epidemiol 1996; 17(4):236–248.PubMedCrossRefGoogle Scholar
  3. 3.
    Itokazu G, Quinn J, Bell-Dixon C, Kahan F, Weinstein R. Antimicrobial resistance rates among aerobic gram-negative bacilli recovered from patients in intensive care units: evaluation of a national postmarketing surveillance program. Clin Infect Dis 1996; 23(4):779–784.PubMedCrossRefGoogle Scholar
  4. 4.
    Archibald L, Phillips L, Monnet D, et al. Antimicrobial resistance in isolates from inpatients and outpatients in the United States: Increasing importance of the intensive care unit. Clinical Infectious Diseases 1997; 24:211–215.PubMedCrossRefGoogle Scholar
  5. 5.
    Coronado V, Edwards J, Culver D, Gaynes R, System TNNIS. Ciprofloxacin resistance among Pseudomonas aeruginosa and Staphylococcus aureus in the United States. Infect Control Hosp Epid 1995; 16:71–75.CrossRefGoogle Scholar
  6. 6.
    Trouillet JL, Chastre J, Vuagnat A, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998; 157(2):531–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115(2):462–74.PubMedCrossRefGoogle Scholar
  8. 8.
    Chen HY, Yuan M, Livermore DM. Mechanisms of resistance to beta-lactam antibiotics amongst Pseudomonas aeruginosa isolates collected in the UK in 1993. J Med Microbiol 1995; 43(4):300–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Senda K, Arakawa Y, Nakashima K, Ito H. Multifocal outbreaks of metallo-b-lactamaseproducing Pseudomonas aeruginosa resistant to broad-spectrum b-lactams, including carbapenems. Antimicrob Agents Chemother 1996; 40:349–353.PubMedGoogle Scholar
  10. 10.
    Gold H, Moellering RJ. Antimicrobial-drug resistance. N Eng J Med 1996; 335(19):1445–1453.CrossRefGoogle Scholar
  11. 11.
    Acar J, Goldstein F. Trends in bacterial resistance to fluoroquinolones. Clin Infect Dis 1997; 24, Suppl. 1:S67–73.CrossRefGoogle Scholar
  12. 12.
    Rice LB, Carias LL, Bonomo RA, Shlaes DM. Molecular genetics of resistance to both ceftazidime and ß-lactam-ß-lactamase inhibitor combinations in Klebsiella pneumoniae and in vivo response to ß-lactam therapy. Journal of Infectious Diseases 1996; 173: 151–158.PubMedCrossRefGoogle Scholar
  13. 13.
    Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for ß-lactamases and its correlation with molecular structure. Antimicrobial Agents and Chemotherapy 1995; 39:1211–1233.PubMedCrossRefGoogle Scholar
  14. 14.
    Livermore DM. ß-lactamases in laboratory and clinical resistance. Clinical Microbiology Reviews 1995; 8:557–584.PubMedGoogle Scholar
  15. 15.
    Ambler RP, Coulson AFW, Frère JM, et al. A standard numbering scheme for the class A ß-lactamases. Biochemistry Journal 1991; 276:269–272.Google Scholar
  16. 16.
    Jacobs C, Frere J-M, Normark S. Cytosolic intermediates for cell wall biosynthesis and degradation control inducible ß-lactam resistance in gram-negative bacteria. Cell 1997; 88:823–832.PubMedCrossRefGoogle Scholar
  17. 17.
    Pitout J, Sanders C, Sanders WJ. Antimicrobial resistance with focus on beta-lactam resistance in gram-negative bacilli. Am J Med 1997; 103(1):51–59.PubMedCrossRefGoogle Scholar
  18. 18.
    Jacoby GA. Epidemiology of extended-spectrum ß-lactamases. Clinical Infectious Diseases 1998; 27:81–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Leung M, Shannon K, French G. Rarity of transferable ß-lactamase production by Klebsiella species. Journal of Antimicrobial Chemotherapy 1997; 39:737–745.PubMedCrossRefGoogle Scholar
  20. 20.
    Jacoby GA. Genetics of extended-spectrum beta-lactamases. Eur J Clin Microbiol Infect Dis 1994; 13(Suppl 1):S2–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Rahal JJ, Urban C, Horn D, et al. Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. Journal of the American Medical Association 1998; 280:1233–1237.PubMedCrossRefGoogle Scholar
  22. 22.
    Doern G, Pfaller M, Kugler K, Freeman J, Jones R. Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: 1997 results from the SENTRY antimicrobial surveillance program. Clin Inf Dis 1998; 27:764–70.CrossRefGoogle Scholar
  23. 23.
    Archer G. Staphylococcus aureus: a well-armed pathogen. Clin Infect Dis 1998; 26(5):1179–1181.PubMedCrossRefGoogle Scholar
  24. 24.
    Murray BE. Vancomycin-resistant enterococci. American Journal of Medicine 1997; 101:284–293.CrossRefGoogle Scholar
  25. 25.
    Boswell FJ, Wise R. Advances in the macrolides and quinolones. Infect Dis Clin North Am 1998; 12(3):647–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Jorgensen JH, Weigel LM, Ferraro MJ, Swenson JM, Tenover FC. Activities of newer fluoroquinolones against Streptococcus pneumoniae clinical isolates including those with mutations in the gyrA, parC, and parE loci. Antimicrob Agents Chemother 1999; 43(2):329–34.PubMedGoogle Scholar
  27. 27.
    Nikaido H. Multiple antibiotic resistance and efflux. Curr Opin Microbiol 1998; 1(5):516–523.PubMedCrossRefGoogle Scholar
  28. 28.
    Perez FJ, Gimeno C, Navarro D, Garcia-de-Lomas J. Meropenem permeation through the outer membrane of Pseudomonas aeruginosa can involve pathways other than the OprD porin channel. Chemotherapy 1996; 42(3):210–14.PubMedCrossRefGoogle Scholar
  29. 29.
    Ewig S, Ruiz M, Torres A, et al. Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med 1999; 159:1835–42.PubMedCrossRefGoogle Scholar
  30. 30.
    George DL, Falk PS, Wunderink RG, et al. Epidemiology of ventilator-acquired pneumonia based on protected bronchoscopic sampling. Am J Respir Crit Care Med 1998; 158(6):1839–47.PubMedCrossRefGoogle Scholar
  31. 31.
    Fink M, Snydman D, Niederman M, et al. Treatment of severe pneumonia in hospitalized patients: results of a multicenter, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin. Antimicrobial Agents Chemother 1994; 38(3):547–557.CrossRefGoogle Scholar
  32. 32.
    Brewer S, RG W, CB J, Leeper KJ. Ventilator-associated pneumonia due to Pseudomonas aeruginosa. Chest 1996; 109(4):1019–1029.CrossRefGoogle Scholar
  33. 33.
    Bergogne-Berezin E, Towner K. Acinetobacter spp. as nosocomial pathogens: Microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996; 9:148–165.PubMedGoogle Scholar
  34. 34.
    NNIS. National Nosocomial Infections Surveillance (NNiS) Report, data summary from October 1986-April 1996, issued May 1996. Am J Infect Control 1996; 24:380–388.CrossRefGoogle Scholar
  35. 35.
    Schaberg D, Culver D, Gaynes R. Major trends in the microbial etiology of nosocomial infections. Am J Med 1991; 91(Suppl 3B):72S–75S.PubMedCrossRefGoogle Scholar
  36. 36.
    NNIS. Hospital Infections Program for Disease Control and Prevention: National nosocomial infections surveillance (NNIS) report, Data Summary from October 1986-April 1996. Am J Infect Control 1997; 24:380–388.Google Scholar
  37. 37.
    Fridkin SK, Steward CD, Edwards JR, et al. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: project ICARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals. Clin Infect Dis 1999; 29(2):245–52.PubMedCrossRefGoogle Scholar
  38. 38.
    Pfaller MA, Jones RN, Doern GV, Kugler K. Bacterial pathogens isolated from patients with bloodstream infection: frequencies of occurrence and antimicrobial susceptibility patterns from the SENTRY antimicrobial surveillance program (United States and Canada, 1997). Antimicrob Agents Chemother 1998; 42(7):1762–70.PubMedGoogle Scholar
  39. 39.
    Burwen DR, Banerjee SN, Gaynes RP. Ceftazidime resistance among selected nosocomial gram-negative bacilli in the United States. National Nosocomial Infections Surveillance System. J Infect Dis 1994; 170(6):1622–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Edmond MB, Wallace, S.E., McClish, D.K., et al. Nosocomial Bloodstream Infections in U.S. Hospitals: A Three-Year Analysis. Clin. Inf. Dis In press.Google Scholar
  41. 41.
    Sader HS, Jones RN, Gales AC, et al. Antimicrobial susceptibility patterns for pathogens isolated from patients in Latin American medical centers with a diagnosis of pneumonia: analysis of results from the SENTRY Antimicrobial Surveillance Program (1997). SENTRY Latin America Study Group. Diagn Microbiol Infect Dis 1998; 32:289–301.PubMedCrossRefGoogle Scholar
  42. 42.
    Rello J, Torres, A., Ricard, M., et al. Ventilator-associated Pneumonia by Staphylococcus aureus. Comparison of Methicillin-resistant and Methicillin-sensisitive Episodes. Am. J. Respir. Crit. Care Med. 1994; 150:1545–1549.PubMedCrossRefGoogle Scholar
  43. 43.
    Heyland DK, Cook. D.J., Griffith, L., Keenan, S.P., Brun-Buisson, C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am. J. Respir. Crit. Care Med. 1999; 159:1249–1256.PubMedCrossRefGoogle Scholar
  44. 44.
    Chenoweth C, Lynch JP, 3rd. Antimicrobial resistance: implications for managing respiratory failure. Curr Opin Pulm Med 1997; 3:159–69.PubMedCrossRefGoogle Scholar
  45. 45.
    Maranan M, Moreira B, Boyle-Vavfa S, Daum R. Antimicrobial resistance in staphylococci. Epidemiology, molecular mechanisms, and clinical relevance. Infect Dis Clin North Am 1997; 11:813–849.PubMedCrossRefGoogle Scholar
  46. 46.
    NNIS. Intensive care antimicrobial resistance epidemiology (ICARE) surveillance report, data summary from January 1996 through December 1997. Am J Infect Control 1999; 27:279–284.CrossRefGoogle Scholar
  47. 47.
    Huebner J, Goldmann D. Coagulase-negative staphylococci: Role as pathogens. Annu Rev Med 1999; 50:223–236.PubMedCrossRefGoogle Scholar
  48. 48.
    Moellering Jr R. The specter of glycopeptide resistance: current trends and future considerations. Am J Med 1998; 104:3S–6S.PubMedCrossRefGoogle Scholar
  49. 49.
    Thornsberry C, Ogilvie PT, Holley HP, Jr., Sahm DF. Survey of susceptibilities of Streptococcus pneumoniae,Haemophilus influenzae, and Morazella catarrhalis isolates to 26 antimicrobial agents: a prospective U.S. study. Antimicrob Agents Chemother 1999; 43:2612–23.PubMedGoogle Scholar
  50. 50.
    Lowy F. Staphylococcus aureus infections. N Engl J Med 1998; 339:520–532.PubMedCrossRefGoogle Scholar
  51. 51.
    Richards M, Edwards J, Culver D, Gaynes R, NNISS. Nosocomial infections in medical intensive care units in the United States. Crit Care Med 1999; 27:887–854.PubMedCrossRefGoogle Scholar
  52. 52.
    Steinberg J, Clark C, Hackman B. Nosocomial and community-acquired Staphylococcus aureus bacteremias from 1980 to 1993: impact of intravascular devices and methicillin resistance. Clin Infect Dis 1996; 23:255–259.PubMedCrossRefGoogle Scholar
  53. 53.
    Pujol M, Pena C, Pallares R, et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996; 100:509–516.PubMedCrossRefGoogle Scholar
  54. 54.
    Gonzalez C, Rubio M, Romero-Vivas J, Gonzalez M, Picazo JJ. Bacteremic pneumonia due to Staphylococcus aureus: A comparisonof disease caused by methicillinresistant and methicillin-susceptible organisms. Clin Infect Dis 1999; 29:1171–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Michel M, Gutmann L. Methicillin-resistant Staphylococcus aureus and vancomycinresistant enterococci: therapeutic realities and possibilities. Lancet 1997; 349(9069): 1901–1906.PubMedCrossRefGoogle Scholar
  56. 56.
    Corbella X, Dominguez M, Pujol M, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997; 16:351–357.PubMedCrossRefGoogle Scholar
  57. 57.
    Bradley S. Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med 1999; 106(Suppl 5A):25–10S.PubMedCrossRefGoogle Scholar
  58. 58.
    Onorato M, Borucki M, Baillargeon G, et al. Risk factors for colonization or infection due to methicillin-resistant Staphylococcus aureus in HIV-positive patients: a retrospective case-control study. Infect Control Hosp Epideliol 1999; 20:26–30.CrossRefGoogle Scholar
  59. 59.
    Nguyen M, Kauffman C, Goodman R, et al. Nasal carriage of and infection with Staphylococcus aureus in HIV-infected patients. Ann Intern Med 1999; 130:221–225.PubMedGoogle Scholar
  60. 60.
    Monnet D. Methicillin-resistant Staphylococcus aureus and its relationship to antimicrobial use: possible implications for control. Infect Control Hosp Epid 1998; 19:552–559.CrossRefGoogle Scholar
  61. 61.
    Wenzel R, Reagan D, Bertino.JJ, Baron E, Arias K. Methicillin-resistant Staphylococcus aureus outbreak: a consensus panel’s definition and management guidelines. Am J Infect Control 1998; 26:102–110.PubMedCrossRefGoogle Scholar
  62. 62.
    Jones R. Impact of changing pathogens and antimicrobial susceptibility patterns in the treatment of serious infections in hospitalized patients. Am J Med 1996; 100:3S–12S.PubMedCrossRefGoogle Scholar
  63. 63.
    Adcock P, Pastor P, Medley F, Patterson J, Murphy T. Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis 1998; 178:577–580.PubMedCrossRefGoogle Scholar
  64. 64.
    O’Brien F, Pearman J, Gracey M, Riley T, Grubb W. Community strain of methicillinresistant Staphylococcus aureus involved in a hospital outbreak. J Clin Microbiol 1999; 37:2858–2862.PubMedGoogle Scholar
  65. 65.
    Landman D, Choklingam M, Quale J. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumonia following chnages in a hospital antibiotic formulary. Clin Infect Dis 1999; 28:1062–1066.PubMedCrossRefGoogle Scholar
  66. 66.
    Conterno LO, Wey SB, Castelo A. Risk factors for mortality in Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 1998; 19:32–7.PubMedCrossRefGoogle Scholar
  67. 67.
    McClelland R, Fowler VJ, Sanders L, et al. Staphylococcus aureus bacteremia among elderly vs younger adult patients. Arch Intern Med 1999; 159:1244–1247.PubMedCrossRefGoogle Scholar
  68. 68.
    Harbarth S, Rutschmann O, Sudre P, Pittet D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998; 158:182–189.PubMedCrossRefGoogle Scholar
  69. 69.
    Yzerman E, Boelens H, Tjhie J, et al. Delta APACHE II for predicting course and outcome of nosocomial Staphylococcus aureus bacteremia and its relation to host defense. J Infect Dis 1996; 173:914–919.PubMedCrossRefGoogle Scholar
  70. 70.
    Abramson M, Sexton D. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: At what costs? Infect Control Hosp Epidemiol 1999; 20:408–411.PubMedCrossRefGoogle Scholar
  71. 71.
    Georges H, Leroy O, Alfandari S, et al. Pulmonary disposition of vancomycin in critically ill patients. Eur.1 Clin Microbiol Infect Dis 1997; 16:385–8.CrossRefGoogle Scholar
  72. 72.
    Chambers H. Methicillin resistance in staphylococci: molecular and biochemical basis and clinical implications. Clin Microbiol Rev 1997; 10:781–791.PubMedGoogle Scholar
  73. 73.
    Aubry-Damon H, Legrand P, Brun-Buisson C, et al. Reemergence of gentamicinsusceptible strains of methicillin-resistant Staphylococcus aureus: roles of an infection control program and changes in aminoglycoside use. Clin Infect Dis 1997; 25:647–653.PubMedCrossRefGoogle Scholar
  74. 74.
    Bonilla H, Zarins L, Bradley S, Kauffman C. Susceptibility of ciprofloxacin-resistant staphylococci and enterococci to trovafloxacin. Diagn Microbiol Infect Dis 1996; 26:17–21.PubMedCrossRefGoogle Scholar
  75. 75.
    Sieradzki K, Roberts R, Haber S, Tomasz A. The development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med 1999;340:517–523.PubMedCrossRefGoogle Scholar
  76. 76.
    Smith T, Pearson M, Wilcox K, et al. Emergence of vancomycin resistance in Staphylococcus aureus. N Engl J Med 1999; 340:493–501.PubMedCrossRefGoogle Scholar
  77. 77.
    Martone W. Spread of vancomycin-resistant enterococci: why did it happen in the United States? Infect Control Hosp Epidemiol 1998; 19:539–545.PubMedCrossRefGoogle Scholar
  78. 78.
    Goldman D, Huskins W. Control of nosocomial antimicrobial-resistant bacteria: a strategic priority for hospitals worldwide. Clin Infect Dis 1997; 24 (suppl 1):S139–145.CrossRefGoogle Scholar
  79. 79.
    CDC. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995; 44:1–12.Google Scholar
  80. 80.
    Herold BC, Immergluck LC, Maranan MC, et al. Community-acquired methicillinresistant Staphylococcus aureus in children with no identified risk. JAMA 1998; 279:593–598.PubMedCrossRefGoogle Scholar
  81. 81.
    Veenstra D, Saint S, Saha S, Lumley T, Sullivan S. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA 1999; 281:261–267.PubMedCrossRefGoogle Scholar
  82. 82.
    Raad 1, Darouiche R, Dupuis J, et al. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections. A randomized, double-blind trial. Ann Intern Med 1997; 127:267–274.PubMedGoogle Scholar
  83. 83.
    Maki D, Stolz S, Wheeler S, Mermel L. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann Intern Med 1997; 127:257–266.PubMedGoogle Scholar
  84. 84.
    Darouiche R, Raad I, Heard S, et al. A comparison of two antimicrobial-impregnated central venous catheters. N Engl J Med 1999; 340:1–8.PubMedCrossRefGoogle Scholar
  85. 85.
    Pegues D, Colby C, Hibberd P, et al. The epidemiology of resistance to ofloxacin and oxacillin among clinical coagulase-negative staphylococcal isolates: analysis of risk factors and strain types. Clin Infect Dis 1998; 26:72–79.PubMedCrossRefGoogle Scholar
  86. 86.
    Pagano L, Tacconelli E, Tumbarello M, et al. Teicoplanin-resistant coagulase-negative staphylococcal bacteraemia in patients with haematological malignancies: a problem of increasing importance. J Antimicrob Chemother 1997; 40:738–740.PubMedCrossRefGoogle Scholar
  87. 87.
    Raad I, Alrahwan A, Rolston K. Staphylococcus epidermidis: emerging resistance and need for alternative agents. Clin Infect Dis 1998; 26:1182–1187.PubMedCrossRefGoogle Scholar
  88. 88.
    Thylefors J, Harbarth S, Pittet D. Increasing bacteremia due to coagulase-negative staphylococci: fiction or reality? Infect Control Hosp Epidemiol 1998; 19:581–589.PubMedCrossRefGoogle Scholar
  89. 89.
    Stosor V, Peterson L, Postelnick M, Noskin G. Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998; 158:522–527.PubMedCrossRefGoogle Scholar
  90. 90.
    Jones R, Marshall S, Pfaller M, et al. Nosocomial enterococcal blood stream infections in the SCOPE program; antimicrobial resistance, species occurrence, moleuclar testing results and laboratory testing accuracy. Diagn Microbiol Infect Dis 1997; 29:95–102.PubMedCrossRefGoogle Scholar
  91. 91.
    Boyce J. Vancomycin-resistant enterococcus. Detection, epidemiology,and control measures. Infect Dis Clin North Am 1997; 11:367–384.PubMedCrossRefGoogle Scholar
  92. 92.
    Bonten M, Hayden M, Nathan C, Rice T, Weinstein R. Stability of vancomycin-resistant enterococcal genotypes isolated from long-term-colonized patients. J Infect Dis 1998; 177:378–382.PubMedCrossRefGoogle Scholar
  93. 93.
    Newell K, Millis J, Arnow P, et al. Incidence and outcome of infection by vancomycinresistant Enterococcus following orthotopic liver transplantation. Transplantation 1998; 65:439–442.PubMedCrossRefGoogle Scholar
  94. 94.
    Silverman J, Thal L, Perri M, Bostic G, Zervos M. Epidemiologic evaluation of antimicrobial resistance in community-acquired enterococci. J Clin Microbiol 1998; 36:830–832.PubMedGoogle Scholar
  95. 95.
    Moellering RC, Linden PK, Reinhardt J, et al. The efficacy and safety of quinupristin/dalfopristin for the treatment of infections caused by vancomycinresistant Enterococcus faecium. Synercid Emergency-Use Study Group. J Antimicrob Chemother 1999; 44:251–61.PubMedCrossRefGoogle Scholar
  96. 96.
    Slaughter S, Hayden MK, Nathan C, et al. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996; 125:448–456.PubMedGoogle Scholar
  97. 97.
    Monteca1vo M, Jarvis W, Uman J, et al. Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med 1999; 131:269–272.PubMedGoogle Scholar
  98. 98.
    Anglim A, Klym B, Byers K, Scheid W, Farr B. Effect of a vancomycin restriction policy on ordering practices during an outbreak of vancomycin-resistant Enterococcus faecium. Arch Intern Med 1997; 157:1132–1136.PubMedCrossRefGoogle Scholar
  99. 99.
    Quale J, Landman D, Saurina G, et al. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clinical Infectious Diseases 1996; 23:1020–1025.PubMedCrossRefGoogle Scholar
  100. 100.
    Reilo J, Torres A. Microbial causes of ventilator-associated pneumonia. Semin Resp Infect 1996; 11:24–31.Google Scholar
  101. 101.
    Barry A. Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in North America. Am J Med 1999; 107:38S–33S.CrossRefGoogle Scholar
  102. 102.
    Corso A, Severina E, Petruk V, Mauriz Y, Tomasz A. Molecular characterization of penicillin-resistant Streptococcus pneumoniae isolates causing respiratory disease in the United States. Microbiol Drug Resist 1998; 4:325–37.CrossRefGoogle Scholar
  103. 103.
    Jones R, Low D, Pfaller M. Epidemiologic trends in nosocomial and community-acquired infections due to antibiotic-resistant gram-positive bacteria: the role of streptogramins and other newer compounds. Diagn Microbiol Infect Dis 1999; 33:101–112.PubMedCrossRefGoogle Scholar
  104. 104.
    Blondeau J. A review of the comparative in-vitro activities of 12 antimicrobial agents, with a focus on five new ‘respiratory quinolones.’. J Antimicrob Chemother 1999; 43 (Suppl B):1–11.PubMedCrossRefGoogle Scholar
  105. 105.
    Chen D, McGeer A, DeAzavedo J, Low D, Network. TCBS. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med 1999; 341:233–9.PubMedCrossRefGoogle Scholar
  106. 106.
    Nuorti J, Butler J, Crutcher J, et al. An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. N Engl J Med 1998; 338:1861–8.PubMedCrossRefGoogle Scholar
  107. 107.
    Medeiros AA. Evolution and dissemination of ß-lactamases accelerated by generations of ß-lactam antibiotics. Clinical Infectious Diseases 1997; 24(suppl 1):S19–S45.PubMedCrossRefGoogle Scholar
  108. 108.
    Jacobson KL, Cohen SH, Inciardi JF, et al. The relationship between antecedent antibiotic use and resistance to extended-spectrum cephalosporins in group I beta-lactamaseproducing organisms. Clin Infect Dis 1995; 21:1107–13.PubMedCrossRefGoogle Scholar
  109. 109.
    Chow 1W, Shlaes DM. Imipenem resistance associated with the loss of a 40 kDa outer membrane protein in Enterobacter aerogenes. J Antimicrob Chemo 1991; 28:499–504.CrossRefGoogle Scholar
  110. 110.
    Pfaller MA, Jones RN, Marshall SA, et al. Inducible amp C beta-lactamase producing gram-negative bacilli from blood stream infections: frequency, antimicrobial susceptibility, and molecular epidemiology in a national surveillance program (SCOPE). Diagn Microbiol Infect Dis 1997; 28:211–9.PubMedCrossRefGoogle Scholar
  111. 111.
    Sandersir. WE, Tenney JH, Kessler RE. Efficacy of cefepime in the treatment of infections due to multiply resistant Enterobacter species. Clin Infect Dis 1996; 23:454–461.CrossRefGoogle Scholar
  112. 112.
    Bradford PA, Urban C, Mariano N, et al. Imipenem resistance in Klebsiella pneumoniae is associated with the combination of ACT-1, a plasmid-mediated AmpC betalactamase, and the loss of an outer membrane protein. Antimicrob Agents Chemother 1997; 41:563–9.PubMedGoogle Scholar
  113. 113.
    Limaye AP, Gautom RK, Black D, Fritsche TR. Rapid emergence of resistance to cefepime during treatment. Clin Infect Dis 1997; 25:339–40.PubMedCrossRefGoogle Scholar
  114. 114.
    Bradford PA, Cherubin CE, Idemyor V, Rasmussen BA, Bush K. Multiply-resistant Klebsiella pneumoniae strains from two Chicago Hospitals: identification of the extended-spectrum TEM-12 and TEM10 ceftazidime-hydrolyzing ß-lactamases in a single isolate. Antimicrob Agents Chemother 1994; 38:761–766.PubMedCrossRefGoogle Scholar
  115. 115.
    Piroth L, Aube H, Doise J-M, Vincent-Martin M. Spread of extended-spectrum ßlactamase-producing Klebsiella pneumoniae: are ß-lactamase inhibitors of therapeutic value? Clin Infect Dis 1998; 27:76–80.PubMedCrossRefGoogle Scholar
  116. 116.
    Rice LB, Carias LL, Shlaes DM. In vivo efficacies of ß-lactam-ß-lactamase inhibitor combinations against a TEM-26-producing strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 1994; 38:2663–2664.PubMedCrossRefGoogle Scholar
  117. 117.
    Peña C, Pujol M, Ardanuy C, et al. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum ß-lactamases. Antimicrob Agents Chemother 1998; 42:53–58.PubMedGoogle Scholar
  118. 118.
    Meyer KS, Urban C, Eagan JA, Berger BJ, Rahal JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993; 119:35–38.Google Scholar
  119. 119.
    Jacoby GA, Medeiros AA. More extended-spectrum ß-lactamases. Antimicrob Agents Chemother 1991; 35:1697–1704.PubMedCrossRefGoogle Scholar
  120. 120.
    Urban C, Meyer KS, Mariano N, et al. Identification of TEM-26 ß-lactamase responsible for a major outbreak of ceftazidime-resistant Klebsiella pneumoniae. Antimicrob Agents Chemother 1994; 38:392–395.PubMedCrossRefGoogle Scholar
  121. 121.
    Soilleux MJ, Morand AM, Arlet GJ, Scavizzi MR, Labia R. Survey of Klebsiella pneumoniae producing extended-spectrum beta-lactamases: prevalence of TEM-3 and first identification of TEM-26 in France. Antimicrob Agents Chemother 1996; 40:1027–9.PubMedGoogle Scholar
  122. 122.
    Rahal J, Urban C. Acinetobacter. Seminars In Respir Infect In Press.Google Scholar
  123. 123.
    Rice LB, Yao JDC, Klimm K, Eliopoulos GM, Moellering Jr. RC. Efficacy of different ßlactams against an extended spectrum ß-lactamase-producing Klebsiella pneumoniae strain in the rat intra-abdominal abscess model. Antimicrob Agents Chemother 1991; 35:1243–1244.PubMedCrossRefGoogle Scholar
  124. 124.
    Schiappa DA, Hayden MK, Matushek MG, et al. Ceftazidime-resistant Klebsiella pneumoniae and Escherichia colt bloodstream infection: A case-control and molecular epidemiologic investigation. J Infect Dis 1996; 174:529–536.PubMedCrossRefGoogle Scholar
  125. 125.
    Peña C, Pujol M, Ricart A, et al. Risk factors for faecal carriage of Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL-KP) in the intensive care unit. J Hosp Infect 1997; 35:9–16.PubMedCrossRefGoogle Scholar
  126. 126.
    Lucet J-C, Chevret S, Decre D, et al. Outbreak of multiply resistant Enterobacteriaceae in an intensive care unit: Epidemiology and risk factors for acquisition. Clin Infect Dis 1996; 22:430–436.PubMedCrossRefGoogle Scholar
  127. 127.
    Go ES, Urban C, Burns J, et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymixin B and sulbactam. Lancet 1994; 344(8933):1329–1332.PubMedCrossRefGoogle Scholar
  128. 128.
    Ahmad M, Urban C, Mariano N, et al. Clinical characteristics and molecular epidemiology associated with imipenem-resistant Klebsiella pneumoniae. Clin Infect Dis 1999; 29:352–355.PubMedCrossRefGoogle Scholar
  129. 129.
    Villers D, Espaze E, Coste-Burel M, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998; 129:182–9.PubMedGoogle Scholar
  130. 130.
    Husni RN, Goldstein LS, Arroliga AC, et al. Risk factors for an outbreak of multi-drugresistant Acinetobacter nosocomial pneumonia among intubated patients. Chest 1999; 115:1378–82.PubMedCrossRefGoogle Scholar
  131. 131.
    Cisneros JM,.Reyes MJ, Pachon J, et al. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996; 22:1026–32.CrossRefGoogle Scholar
  132. 132.
    Baraibar J, Correa H, Mariscal D, et al. Risk factors for infection by Acinetobacter baumannii in intubated patients with nosocomial pneumonia. Chest 1997; 112:1050–4.PubMedCrossRefGoogle Scholar
  133. 133.
    Koljalg S, Sults I, Raukas E, Truu J, Ustav M, Mikelsaar M. Distribution of Acinetobacter baumannii in a neurointensive care unit. Scand J Infect Dis 1999; 31:145–50.PubMedCrossRefGoogle Scholar
  134. 134.
    Wisplinghoff H, Perbix W, Seifert H. Risk factors for nosocomial bloodstream infections due to Acinetobacter baumannii: a case-control study of adult bum patients. Clin Infect Dis 1999; 28:59–66.PubMedCrossRefGoogle Scholar
  135. 135.
    Lortholary O, Fagon JY, Buu Hoi A, Mahieu G, Gutmann L. Colonization by Acinetobacter baumanii in intensive-care-unit patients. Infect Control Hosp Epidemiol 1998; 19:188–90.PubMedCrossRefGoogle Scholar
  136. 136.
    Jawad A, Seifert H, Snelling AM, Heritage J, Hawkey PM. Survival of Acinetobacter baumannii on dry surfaces: comparison of outbreak and sporadic isolates. J Clin Microbiol 1998; 36:1938–41.PubMedGoogle Scholar
  137. 137.
    Catalano M, Quelle LS, Jeric PE, Di Martino A, Maimone SM. Survival of Acinetobacter baumannii on bed rails during an outbreak and during sporadic cases. J Hosp Infect 1999; 42:27–35.PubMedCrossRefGoogle Scholar
  138. 138.
    McDonald LC, Walker M, Carson L, et al. Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners. Pediatr Infect Dis J 1998; 17:716–22.PubMedCrossRefGoogle Scholar
  139. 139.
    Perilli M, Felici A, Oratore A, et al. Characterization of the chromosomal cephalosporinases produced by Acinetobacter [woffii and Acinetobacter baumannii clinical isolates. Antimicrob Agents Chemother 1996; 40:715–9.PubMedGoogle Scholar
  140. 140.
    Poirel L, Karim A, Mercat A, et al. Extended-spectrum beta-lactamase-producing strain of Acinetobacter baumannii isolated from a patient in France. J Antimicrob Chemother 1999; 43:157–8.PubMedCrossRefGoogle Scholar
  141. 141.
    Vahaboglu H, Ozturk R, Aygun G, et al. Widespread detection of PER-1-type extended-spectrum beta-lactamases among nosocomial Acinetobacter and Pseudomonas aeruginosa isolates in Turkey: a nationwide multicenter study. Antimicrob Agents Chemother 1997; 41:2265–9.PubMedGoogle Scholar
  142. 142.
    Brown S, Bantar C, Young HK, Amyes SG. Limitation of Acinetobacter baumannii treatment by plasmid-mediated carbapenemase ARI-2 [letter]. Lancet 1998; 351(9097):186–7.PubMedCrossRefGoogle Scholar
  143. 143.
    Vila J, Ruiz J, Navia M, et al. Spread of amikacin resistance in Acinetobacter baumannii strains isolated in Spain due to an epidemic strain. J Clin Microbiol 1999; 37:758–61.PubMedGoogle Scholar
  144. 144.
    Pascual A, Lopez-Hernandez I, Martinez-Martinez L, Perea EJ. In-vitro susceptibilities of multiresistant strains of Acinetobacter baumannii to eight quinolones [letter]. J Antimicrob Chemother 1997; 40:140–2.PubMedCrossRefGoogle Scholar
  145. 145.
    Martinez JL, Alonso A, Gomez-Gomez JM, Baquero F. Quinolone resistance by mutations in chromosomal gyrase genes. Just the tip of the iceberg? J Antimicrob Chemother 1998; 42:683–688.PubMedCrossRefGoogle Scholar
  146. 146.
    Jimenez-Mejias ME, Pachon J, Becerril B, et al. Treatment of multidrug-resistant Acinetobacter baumannii meningitis with ampicillin/sulbactam. Clin Infect Dis 1997; 24:932–5.PubMedCrossRefGoogle Scholar
  147. 147.
    Corbella X, Ariza J, Ardanuy C, et al. Efficacy of sulbactam alone and in combination with ampicillin in nosocomial infections caused by multiresistant Acinetobacter baumannii. J Antimicrob Chemother 1998; 42:793–802.CrossRefGoogle Scholar
  148. 148.
    Levin AS, Barone AA, Penco J, et al. Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis 1999; 28:1008–11.PubMedCrossRefGoogle Scholar
  149. 149.
    Hogg GM, Barr JG, Webb CH. In-vitro activity of the combination of colistin and rifampicin against multidrug-resistant strains of Acinetobacter baumannii. J Antimicrob Chemother 1998; 41:494–5.PubMedCrossRefGoogle Scholar
  150. 150.
    Tascini C, Menichetti F, Bozza S, Del Favero A, Bistoni F. Evaluation of the activities of two-drug combinations of rifampicin, polymyxin B and ampicillin/sulbactam against Acinetobacter baumannii. J Antimicrob Chemother 1998; 42:270–1.CrossRefGoogle Scholar
  151. 151.
    Seifert H, Baginski R, Schulze A, Pulverer G. Antimicrobial susceptibility of Acinetobacter species. Antimicrob Agents Chemother 1993; 37:750–3.PubMedCrossRefGoogle Scholar
  152. 152.
    Kollef MH, Vlasnik J, Sharpless L, et al. Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 1997; 156:1040–8.PubMedCrossRefGoogle Scholar
  153. 153.
    Rello J, Mariscal D, March F, et al. Recurrent Pseudomonas aeruginosa pneumonia in ventilated patients. Relapse or infection? Am J Respir Crit Med 1998; 157:912–916.CrossRefGoogle Scholar
  154. 154.
    Meduri G, Reddy R, Stanley T, El-Zeky F. Pneumonia in acute respiratory distress syndrome: A prospective evaluation of bilateral bronchoscopie sampling. Am J Respir Crit Care Med 1998:870–875.Google Scholar
  155. 155.
    Chastre J, Trouillet J, Vuagnat A, et al. Nosocomial pneumonia in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 1998; 157:1165–1172.PubMedCrossRefGoogle Scholar
  156. 156.
    Delclaux C, Roupie E, Blot F, et al. Lower respiratory tract colonization and infection during severe adult respiratory distress syndrome. Am J Respir Crit Care Med 1997; 156:1092–1098.PubMedCrossRefGoogle Scholar
  157. 157.
    Rello J. Acinetobacter baumannii infections in the ICU: customization is the key. Chest 1999; 115:1226–9.Google Scholar
  158. 158.
    Quinn J. Clinical problems posed by multiresistant nonfermenting gram-negative pathogens. Clin Infect Dis 1998; 27 (Suppl 1):S117–S124.PubMedCrossRefGoogle Scholar
  159. 159.
    Talon D, Mulini B, Rouget C, et al. Risks and routes for ventilator-associated pneumonia with Pseudomonas aeruginosa. Am J Respir Crit Care Med 1998; 157:978–984.PubMedCrossRefGoogle Scholar
  160. 160.
    Bergmans D, Bonten M, van Tiel F, et al. Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit. Thorax 1998; 53:1053–1058.PubMedCrossRefGoogle Scholar
  161. 161.
    Iaconis J, Pitkin D, Sheikh W, Nadleer H. Comparison of antibacterial activities of meropenem and six other antimicrobials against Pseudomonas aeruginosa isolates from North American studies and clinical trials. Clin Infect Dis 1997; 24(suppl 2):S191–S196.PubMedCrossRefGoogle Scholar
  162. 162.
    Jones R, Pfaller M, Doern G, Erwin M, Hollis R. Antimicrobial activity and spectrum investigation of eight broad-spectrum ß-lactam drugs: a 1997 surveillance trial in 102 medical centers in the United States. Diagn Microbiol Infect Dis 1998; 30:215–228.PubMedCrossRefGoogle Scholar
  163. 163.
    Troillet N, Samore M, Carmeli Y. Imipenem-resistant Pseudomonas aeruginosa: risk factors and antibiotic susceptibility patterns. Clin Infect Dis 1997; 25:1094–1098.PubMedCrossRefGoogle Scholar
  164. 164.
    Carmeli Y, Troillet N, Eliopoulos G, Samore M. Emergence of antibiotic-resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother 1999; 43:1379–1382.PubMedGoogle Scholar
  165. 165.
    Harris A, Torres-Viera C, Venkatarmana L, et al. Epidemiology and clinical outcomes of patients with multiresistant Pseudomonas aeruginosa. Clin Infect Dis 1999; 28:1128–1134.PubMedCrossRefGoogle Scholar
  166. 166.
    Hancock R. Resistance mechanisms in Pseudomonas aeruginosa and other nonfermentative gram-negative bacteria. Clin Infect Dis 1998; 27(Suppl. 1):S93–99.PubMedCrossRefGoogle Scholar
  167. 167.
    Livermore DM, Corkill JE. Effects of CO2 and pH on inhibition of TEM-1 and other ßlactamases by penicillanic acid sulfones. Antimicrob Agents Chemother 1992; 36:1870–1876.PubMedCrossRefGoogle Scholar
  168. 168.
    Jaccard C, Troillet N, Harbarth S, et al. Prospective randomized comparison of imipenemcilastatin and piperacillin-tazobactam in nosocomial pneumonia or peritonitis. Antimicrob Agents Chemother 1998; 42:2966–2972.PubMedGoogle Scholar
  169. 169.
    Friedrich LV, White RL, Bosso JA. Impact of use of multiple antimicrobials on changes in susceptibility of gram-negative aerobes. Clin Infect Dis 1999; 28:1017–24.PubMedCrossRefGoogle Scholar
  170. 170.
    Joshi M, Bernstein.J, Solomkin J, Wester B, Kuye O. Piperacillin/Tazobactam plus tobramycin versus ceftazadime plus tobramycin for the treatment of patients with nosocomial lower respiratory tract infection. Piperacillin/tazobactam Nosocomial Pneumonia Study Group. J Antimicrob Chemother 1999; 43:389–397.PubMedCrossRefGoogle Scholar
  171. 171.
    Brun-Buisson C, Sollet.J, Schweich H, Briere S, Petit C. Treatment of ventilator-associated pneumonia with piperacillin-tazobactam/amikacin versus ceftazidime/amikacin: a multicenter, randomized controlled trial. VAP Study Group. Clin Infect Dis 1998; 26:346–354.PubMedCrossRefGoogle Scholar
  172. 172.
    Lynch JD. Combination antibiotic therapy is appropriate for nosocomial pneumonia in the intensive care unit. Semin Resp Infect 1993; 8:268–284.Google Scholar
  173. 173.
    Kashuba A, Nafziger A, Drusano G, Bertino J. Optimizing aminoglycoside therapy for nosocomial pneumonia cuased by gram-negative bacteria. Antimicrob Agents Chemother 1999; 43:623–629.PubMedGoogle Scholar
  174. 174.
    Ramsey B, Pepe M, Quan J, et al. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. N Engl J Med 1999; 340:23–30.PubMedCrossRefGoogle Scholar
  175. 175.
    Hyatt J, Nix D, Stratton C, Schentag J. In vitro pharmacodynamics of piperacillin, piperacillin-tazobactam, and ciprofloxacin alone and in combination against Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa. Antimicrob Agents Chemother 1995; 39:1711–1716.PubMedCrossRefGoogle Scholar
  176. 176.
    Piddock L, Johnson M, Ricci V, Hill S. Activities of new fluoroquinolones against fluoroquinolone-resistant pathogens of the lower respiratory tract. Antimicrob Agents Chemother 1998; 42:2956–60.PubMedGoogle Scholar
  177. 177.
    MacGowan A, Wootton M, Holt H. The antibacterial efficacy of levofloxacin and ciprofloxacin against Pseudomonas aeruginosa assessed by combining antibiotic exposure and bacterial susceptibility. J Antimicrobial Chemotherapy 1999; 43:345349.Google Scholar
  178. 178.
    Segatore B, Setacci D, Perilli M, et al. Bacterial activity of levofloxacin and ciprofloxacin on clinical isolates of different phenotypes of Pseudomonas aeruginosa. Antimicrob Agents Chemother 1999; 13:223–226.Google Scholar
  179. 179.
    Geddes A, Thaler M, Schonwald S, et al. Levofloxacin in the empirical treatment of patients with suspected bacteraemia/sepsis: comparison with imipenem/cilastatin in an open, randomized trial. J Antimicrob Chemother 1999; 44:799–810.PubMedCrossRefGoogle Scholar
  180. 180.
    Spencer RC. The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia. J Hosp Infect 1995; 30 Suppl:453–64.CrossRefGoogle Scholar
  181. 181.
    Muder RR, Harris AP, Muller S, et al. Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clin Infect Dis 1996; 22:508–12.PubMedCrossRefGoogle Scholar
  182. 182.
    Gopalakrishnan R, Hawley HB, Czachor JS, Markert RJ, Bernstein JM. Stenotrophomonas maltophilia infection and colonization in the intensive care units of two community hospitals: A study of 143 patients. Heart Lung 1999; 28:134–41.PubMedCrossRefGoogle Scholar
  183. 183.
    Weber DJ, Rutala WA, Blanchet CN, Jordan M, Gergen MF. Faucet aerators: A source of patient colonization with Stenotrophomonas maltophilia. Am J Infect Control 1999; 27:59–63.PubMedCrossRefGoogle Scholar
  184. 184.
    Alfieri N, Ramotar K, Armstrong P, et al. Two consecutive outbreaks of Stenotrophomonas maltophilia (Xanthomonas maltophilia) in an intensive-care unit defined by restriction fragment-length polymorphism typing. Infect Control Hosp Epidemiol 1999; 20:553–6.PubMedCrossRefGoogle Scholar
  185. 185.
    Vartivarian S, Anaissie E, Bodey G, Sprigg H, Rolston K. A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy. Antimicrob Agents Chemother 1994; 38:624–7.PubMedCrossRefGoogle Scholar
  186. 186.
    Pankuch GA, Jacobs MR, Appelbaum PC. MIC and time-kill study of antipneumococcal activities of RPR 106972 (a new oral streptogramin), RP 59500 (quinupristindalfopristin), pyostacine (RP 7293), penicillin G, cefotaxime, erythromycin, and clarithromycin against 10 penicillin-susceptible and -resistant pneumococci. Antimicrob Agents Chemother 1996; 40:2071–4.PubMedGoogle Scholar
  187. 187.
    Biedenbach DJ, Croco MA, Barrett TJ, Jones RN. Comparative in vitro activity of gatifloxacin against Stenotrophomonas maltophilia and Burkholderia species isolates including evaluation of disk diffusion and E test methods. Eur J Clin Microbiol Infect Dis 1999; 18:428–31.CrossRefGoogle Scholar
  188. 188.
    Sanyal SC, Mokaddas EM. The increase in carbapenem use and emergence of Stenotrophomonas maltophilia as an important nosocomial pathogen. J Chemother 1999; 11:28–33.PubMedGoogle Scholar
  189. 189.
    Walsh TR, MacGowan AP, Bennett PM. Sequence analysis and enzyme kinetics of the L2 serine beta-lactamase from Stenotrophomonas maltophilia. Antimicrob Agents Chemother 1997; 41:1460–4.PubMedGoogle Scholar
  190. 190.
    Isenberg HD, Alperstein P, France K. In vitro activity of ciprofloxacin, levofloxacin, and trovafloxacin, alone and in combination with beta-lactams, against clinical isolates of Pseudomonas aeruginosa,Stenotrophomonas maltophilia, and Burkholderia cepacia. Diagn Microbiol Infect Dis 1999; 33:81–6.PubMedCrossRefGoogle Scholar
  191. 191.
    Holmes A, Nolan R, Taylor R, et al. An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis. J Infect Dis 1999; 179:1197–205.PubMedCrossRefGoogle Scholar
  192. 192.
    Goldmann DA, Weinstein RA, Wenzel RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. JAMA 1996; 275:234–40.PubMedCrossRefGoogle Scholar
  193. 193.
    Shlaes DM, Gerding DN, John JF, Jr., et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 1997; 25:584–99.PubMedCrossRefGoogle Scholar
  194. 194.
    Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998; 338:232–8.PubMedCrossRefGoogle Scholar
  195. 195.
    Jones R, Pfaller M. Bacterial Resistance: a worldwide problem. Diagn Microbiol Infect Dis 1998; 31:379–388.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Patricia Winokur
    • 1
  • Carol E. Chenoweth
    • 2
  • Louis Rice
    • 3
  • Borna Mehrad
    • 4
  • Joseph P. Lynch
    • 4
  1. 1.Infectious Disease and PathologyUniversity of Iowa College of MedicineIowaUSA
  2. 2.Infectious Disease Department of Internal MedicineUniversity of Michigan Medical CenterAnn ArborUSA
  3. 3.Department of Medicine Section of Infectious DiseaseVA Medical Center Case Western Reserve University School of MedicineClevelandUSA
  4. 4.Pulmonary and Critical Care Medicine Department of Internal MedicineUniversity of Michigan Medical CenterAnn ArborUSA

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