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Related Experiment Videos

Antibiotic resistance patterns during aminoglycoside restriction.

E J Young, C M Sewell, M A Koza

    The American Journal of the Medical Sciences
    |December 1, 1985
    PubMed
    Summary

    Restricting gentamicin use led to decreased resistance, while amikacin resistance remained stable. However, lifting restrictions increased resistance to both antibiotics, particularly in Pseudomonas aeruginosa, suggesting careful aminoglycoside stewardship is crucial.

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    Area of Science:

    • Microbiology
    • Infectious Diseases
    • Pharmacology

    Background:

    • Aminoglycoside antibiotics like gentamicin and amikacin are critical for treating Gram-negative bacterial infections.
    • Emergence of antibiotic resistance necessitates strategies to preserve the efficacy of these agents.
    • Initial use of amikacin was restricted to prevent resistance development against this new drug.

    Purpose of the Study:

    • To evaluate the impact of restricted versus unrestricted aminoglycoside use on bacterial resistance patterns.
    • To assess changes in resistance to gentamicin and amikacin in Gram-negative bacilli over time.
    • To investigate the mechanisms of amikacin resistance in Pseudomonas aeruginosa.

    Main Methods:

    • Retrospective analysis of bacterial resistance data during three distinct periods of aminoglycoside use.

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  • Monitoring of gentamicin and amikacin resistance incidence in Gram-negative bacilli.
  • Characterization of resistance mechanisms in Pseudomonas aeruginosa strains.

    • Main Results:

    • Restricting gentamicin use led to a significant decrease in gentamicin-resistant bacteria (14% to 9.2%) while amikacin resistance remained low (2.4% to 2.2%).
    • Lifting aminoglycoside restrictions resulted in increased resistance to both gentamicin (15.3%) and amikacin (4.0%), primarily due to resistant Pseudomonas aeruginosa.
    • Escherichia coli remained sensitive to both antibiotics, whereas Pseudomonas aeruginosa showed fluctuating resistance patterns correlating with gentamicin use; impaired uptake was a key resistance mechanism in P. aeruginosa.

    Conclusions:

    • Aminoglycoside stewardship, including restriction of specific agents, can effectively reduce resistance.
    • Unrestricted use of aminoglycosides can lead to increased resistance, particularly in challenging pathogens like P. aeruginosa.
    • Understanding resistance mechanisms is vital for guiding antibiotic therapy and preserving drug effectiveness.