Development of Antibiotic Resistance during Conventional and SDD

  • C. A. Hart
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 7)

Abstract

There is little doubt that resistance to antimicrobial agents does develop following therapy with such agents. In intensive care units (ICUs), where a large proportion of the patients are likely to be receiving antibiotics, the likelihood of such an event is greatly increased. Epidemic and endemic spread of infection and/or colonization with a variety of microorganisms resistant to the latest antibiotic have been described both in adult [1, 2, 3] and in neonatal [4, 5] ICUs. In many instances such resistance is plasmid-encoded (see Dr Shears’ chapter), so that resistance may spread to other types of bacteria. In addition, plasmids may encode resistance to many different antimicrobials, and the use of one antibiotic might select for resistance to several others. In this respect it is noteworthy that treatment with ampicillin or cotrimoxazole was shown to be more important in selecting for gentamicin- and multiply-resistant klebsiellae than gentamicin itself [6]. It is clear that development of new antimicrobials is only just keeping ahead of development of resistance.

Keywords

Bacillus Pseudomonad Glycoside Ampicillin Gentamicin 

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References

  1. 1.
    Price DJE, Sleigh JD (1970) Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet ii: 1213–1215Google Scholar
  2. 2.
    Weinstein RA, Nathan C, Gruensfelder R, Kabins SA (1980) Endemic aminoglycoside resistance in Gram-negative bacilli: epidemiology and mechanisms. J Infect Dis 141: 338–345PubMedCrossRefGoogle Scholar
  3. 3.
    Schaberg DR, Rubens CE, Alford RH, Farrar WE, Shaffner W, McGee ZA (1981) Evolution of antimicrobial resistance and nosocomial infection. Am J Med 70: 445–448PubMedCrossRefGoogle Scholar
  4. 4.
    Morgan MEI, Hart CA, Cooke RWI (1984) Klebsiella infection in a neonatal intensive care unit: role of bacteriological surveillance. J Hosp Infect 5: 377–385PubMedCrossRefGoogle Scholar
  5. 5.
    Modi N, Damjanovic V, Cooke RWI (1987) Outbreak of cephalosporin resistant Enterobacter cloacae infection in a neonatal intensive care unit. Arch Dis Child 62: 148–151PubMedCrossRefGoogle Scholar
  6. 6.
    Hart CA (1982) Nosocomial gentamicin-and multiply-resistant enterobacteria at one hospital. 1. Description of an outbreak. J Hosp Infect 3: 15–28PubMedCrossRefGoogle Scholar
  7. 7.
    Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DR (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Int Care Med 10: 185–192CrossRefGoogle Scholar
  8. 8.
    Ledingham IMcA, Alcock SR, Eastaway AT, McDonald JC, McKay IC, Ramsay G (1988) Triple regimen of selective decontamination of the digestive tract, systemic cefòtaxime and microbiological surveillance for prevention of acquired infection in intensive care. Lancet i: 785–790CrossRefGoogle Scholar
  9. 9.
    Brun-Buisson C, Legrand P, Philippon A, Montravers F, Ansqueur M, Duval J (1987) Transferable enzymatic resistance to third-generation cephalospqrins during nosocomial outbreak of multi-resistant Klebsiella pneumoniae. Lancet ii: 302–306Google Scholar
  10. 10.
    van Saene HKF, Stoutenbeek CP, Zandstra DF (1988) Cefotaxime combihed with selective decontamination in long term intensive care unit patients. Virtual absence of emergence of resistance. Drugs 35: (Suppl 2): 29–34PubMedCrossRefGoogle Scholar
  11. 11.
    Hensey OJ, Hart CA, Cooke RWI (1985) Serious infection in a neonatal intensive care unit: a two year survey. J Hyg (Camb) 95: 289–297CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

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  • C. A. Hart

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