Use of Third-Generation Cephalosporins for Treatment of Neonatal Infections

McCracken, George H.

doi:10.1001/archpedi.1985.02140130017019

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…The mutants of E. cloacae with elevated production of chromosomal p-lactamase are resistant to many 0-lactams (Curtis et al 1986). To avoid the dissemination of these organisms in the hospital flora, the use of the newer cephalosporins should be restricted (Sanders 1983, McCracken 1985.…”

Section: Soguardmentioning

confidence: 99%

COMPARISON OF RESISTANCE TYPES IN ENTEROBACTER CLOACAE 1977 AND 1985

Søgaard

Togsverd

Mansa

1987

Acta Pathologica Microbiologica Scandinavica Series B: Microbio

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A collection of Enterobacter cloacae strains from Odense University Hospital from 1977 were compared with a collection from 1985 as regards acquired resistance traits. Among the strains with carbenicillin (Ca) resistance, the number of multiresistant strains decreased while the number with sole Ca‐resistance increased. In 1977, a high proportion of the Ca‐resistant (Ca‐r) strains had plasmid‐mediated β‐lactam resistance, but in 1985 the Ca‐r strains were completely dominated by organisms with elevated amounts of chromosomally‐mediated β‐lactamase. The latter, but not the former, strains were resistant to the newer cephalosporins (e.g. cefotaxime (Ctax)). The consumption of Ctax and cefuroxime increased from 0 kg in 1977 to 7.0 kg in 1985. It is therefore probable that this increase was the cause of the change in occurrence of the resistance types. Ninety‐one % of the Ca‐r strains were isolated from urinary samples in 1977. The percentage was only 31 in 1985. This change, concomitant with the increase in Ctax‐r strains, can probably be explained by the better conditions for selection of Ctax‐r mutants, producing greater amounts of chromosomal β‐lactamase, in wounds and respiratory tract than in urine.

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Section: Soguardmentioning

confidence: 99%

COMPARISON OF RESISTANCE TYPES IN ENTEROBACTER CLOACAE 1977 AND 1985

Søgaard

Togsverd

Mansa

1987

Acta Pathologica Microbiologica Scandinavica Series B: Microbio

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“…These bac te ria with in duci ble ex pres sion also have a sig nificant number (10 -6 to 10 -7 wild-type cells) of mu tant 'stable dere pressed' cells that pro duce con sti tu tively large amounts of beta-lactamase (1,2). These re sis tant vari ants can be quickly se lected as the pre domi nant bac te ria by la bile weak in ducer an ti bi ot ics both in vi tro (3,4) and in vivo (1,2, [5][6][7][8][9][10][11][12]. The emer gence of re sis tance by this mecha nism dur ing ther apy has been well de scribed and has re sulted in a high rate of treat ment fail ures (1).…”

mentioning

confidence: 99%

Transient in Vivo Selection of a Constitutively Cephalosporin Resistant Enterobacter Cloacae Causing Ventriculitis

Joffe¹,

Kabani²,

Ramotar³

et al. 1994

Canadian Journal of Infectious Diseases and Medical Microbiolog

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A case of neonatal ventriculitis complicating a ventriculoperitoneal shunt and caused by one strain of Enterobacter cloacae (as shown on pulsed field gel electrophoresis) is presented. Daily ventricular fluid cultures from day 1 to 9 revealed inducible cephalosporin resistance in all isolates except on days 3, 4 and 5 of therapy when isolates were constitutively resistant. This emergence of resistance due to constitutive Bush class 1 beta-lactamase production is an excellent example of the rapid emergence of a predominant strain of bacteria depending on antibiotic selection pressures in vivo. The transient nature of the predominant resistant phenotype may have been due to missing a dose of cefotaxime on day 5 or in vivo factors allowing persistence of sensitive organisms in antibiotic protected sites. Caution is advised in the use of cephalosporins alone for serious Enterobacter species infections. Repeat culture and sensitivity should be done in severe infections that are slow to respond to cephalosporin therapy.

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Antibiotics in Neonatal Infections

Fanos

Dall’Agnola

1999

Drugs

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The bacteria most commonly responsible for early-onset (materno-fetal) infections in neonates are group B streptococci, enterococci, Enterobacteriaceae and Listeria monocytogenes. Coagulase-negative staphylococci, particularly Staphylococcus epidermidis, are the main pathogens in late-onset (nosocomial) infections, especially in high-risk patients such as those with very low birthweight, umbilical or central venous catheters or undergoing prolonged ventilation. The primary objective of the paediatrician is to identity all potential cases of bacterial disease quickly and begin antibacterial treatment immediately after the appropriate cultures have been obtained. Combination therapy is recommended for initial empirical treatment in the neonate. In early-onset infections, an effective first-line empirical therapy is ampicillin plus an aminoglycoside (duration of treatment 10 days). An alternative is ampicillin plus a third-generation cephalosporin such as cefotaxime, a combination particularly useful in neonatal meningitis (mean duration of treatment 14 to 21 days), in patients at risk of nephrotoxicity and/or when therapeutic monitoring of aminoglycosides is not possible. Another potential substitute for the aminoglycoside is aztreonam. Triple combination therapy (such as amoxicillin plus cefotaxime and an aminoglycoside) could also be used for the first 2 to 3 days of life, followed by dual therapy after the microbiological results. In late-onset infections the combination oxacillin plus an aminoglycoside is widely recommended. However, vancomycin plus ceftazidime (+/- an aminoglycoside for the first 2 to 3 days) may be a better choice. Teicoplanin may be a substitute for vancomycin. However, the initial approach should always be modified by knowledge of the local bacterial epidemiology. After the microbiological results, treatment should be switched to narrower spectrum agents if a specific organism has been identified, and should be discontinued if cultures are negative and the neonate is in good clinical condition. Penicillins and third-generation cephalosporins are generally well tolerated in neonates. There is controversy regarding whether therapeutic drug monitoring of aminoglycosides will decrease toxicity (particularly renal damage) in neonates, and on the efficacy and safety of a single daily dose versus multiple daily doses of these drugs. Toxic effects caused by vancomycin are uncommon, but debate still exists over the need for therapeutic drug monitoring of this agent. When antibacterials are used in neonates, accurate determination of dosage is required, particularly for compounds with a low therapeutic index and in patients with renal failure. Very low birthweight infants are also particularly prone to antibacterial-induced toxicity.

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Use of Third-Generation Cephalosporins for Treatment of Neonatal Infections

Cited by 3 publications

References 19 publications

COMPARISON OF RESISTANCE TYPES IN ENTEROBACTER CLOACAE 1977 AND 1985

COMPARISON OF RESISTANCE TYPES IN ENTEROBACTER CLOACAE 1977 AND 1985

Transient in Vivo Selection of a Constitutively Cephalosporin Resistant Enterobacter Cloacae Causing Ventriculitis

Antibiotics in Neonatal Infections

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