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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Published on: August 30, 2018

Widespread resistance to new antimicrobials in a university hospital before clinical use

G Kumarasinghe1, C Chow, P A Tambyah

  • 1Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. gaminik@nuh.com.sg

International Journal of Antimicrobial Agents
|November 3, 2001
PubMed

Insights

New antibiotics like cefpirome and cefepime showed no superior efficacy over existing broad-spectrum antibiotics for serious infections. High rates of antibiotic resistance, including ESBL producers, were observed in hospital-acquired infections.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Pharmacology

Background:

  • Rising antimicrobial resistance poses a significant threat to treating serious hospital-acquired infections.
  • The National University Hospital, Singapore, sought to evaluate new antibiotic options against prevalent pathogens.

Purpose of the Study:

  • To assess the in vitro activity of cefpirome, cefepime, and piperacillin/tazobactam against clinically significant organisms.
  • To compare the efficacy of these novel agents with currently used broad-spectrum antibiotics.

Main Methods:

  • In vitro susceptibility testing of 202 clinically significant bacterial isolates collected in 1998.
  • Evaluation of cefpirome, cefepime, piperacillin/tazobactam, ceftazidime, ceftriaxone, imipenem, ciprofloxacin, and amikacin.

Main Results:

  • Cefepime, cefpirome, and piperacillin/tazobactam demonstrated in vitro efficacy not superior to imipenem, ciprofloxacin, and amikacin.
  • Over 40% of Enterobacteriaceae isolates were extended-spectrum beta-lactamase (ESBL) producers.
  • Increased incidence of resistance to drugs used for serious infections noted since 1995, with high imipenem resistance in Acinetobacter spp. and Pseudomonas aeruginosa.

Conclusions:

  • Current broad-spectrum antibiotics remain essential, but resistance is a growing concern.
  • The evaluated new agents did not offer a significant advantage over existing therapies.
  • No single agent was found suitable for empirical monotherapy for serious sepsis due to resistance patterns.

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