Gentamicin vs cefotaxime for therapy of neonatal sepsis. Relationship to drug resistance
C. S. Bryan, J. F. John Jr, M. S. Pai and T. L. Austin
An outbreak of serious infections due to gentamicin-resistant Klebsiella
pneumoniae occurred in a neonatal intensive care unit in which the
combination of gentamicin sulfate and ampicillin sodium had been used for
standard initial therapy for suspected sepsis for nearly 11 years. After
institution of control measures that included the substitution of
cefotaxime sodium for gentamicin in the standard regimen, the outbreak
promptly subsided. Nevertheless, a second outbreak of serious infections
due to cefotaxime-resistant Enterobacter cloacae began ten weeks later.
Sequential stool cultures from patients in the unit confirmed the
disappearance of gentamicin-resistant K pneumoniae and the emergence of
cefotaxime-resistant E cloacae after the change in antibiotic policy. These
observations suggest that routine use of newer cephalosporins for therapy
of suspected sepsis may lead to the emergence of drug-resistant
microorganisms more rapidly than has occurred with the aminoglycosides.
