Occurrence of cefotaxime-resistant Enterobacter during therapy of cardiac surgery patients

During 1981-1984, nine patients were treated with second or third generation cephalosporins for deep post-operative wound, respiratory, and blood infections with Enterobacter. In at least 50-60% of cases, therapy failed due to emergence of broad-spectrum cephalosporin resistance. Laboratory testing of two strains that became resistant showed that they were more likely to develop high level resistant mutants, which had greater ability to bind cefotaxime. Although these surgery patients represent an extreme case, spread of their resistant strains to other patients in hospital could lead to wide-spread nosocomial resistance.