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Patterns and mechanisms of emergence of resistance to amikacin
Abstract:
Emergence of gram-negative bacilli resistant to amikacin occurred in five of 96 patients treated. Three of the five instances were associated with clinical failure and arose during therapy for an infection caused by a pathogen also susceptible to gentamicin. The other two episodes were associated with colonization. The enzyme aminoglycoside-6'-acetyltransferase, which inactivates amikacin, was found in Serratia marcescens. Decreased permeability to amikacin was shown in four isolates of Pseudomonas aeruginosa. The emergence and existence of these organisms is of great epidemiologic importance. Judicious use of amikacin and adherence to general principles of infection control are advised.
Insights
Emergence of amikacin-resistant gram-negative bacilli was observed in patients, with some cases linked to clinical failure. This highlights the need for careful antibiotic use and infection control to combat emerging resistance.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Amikacin is a critical antibiotic for treating serious gram-negative bacterial infections.
- Monitoring the emergence of antimicrobial resistance is essential for effective patient care.
Observation:
- Five of 96 patients developed gram-negative bacilli resistant to amikacin during treatment.
- Three instances of resistance correlated with clinical treatment failure.
Findings:
- Mechanisms of resistance included the enzyme aminoglycoside-6'-acetyltransferase in Serratia marcescens and decreased amikacin permeability in Pseudomonas aeruginosa.
- Two cases of resistance were associated with colonization rather than active infection.
Implications:
- The emergence of amikacin resistance has significant epidemiologic implications.
- Judicious use of amikacin and strict adherence to infection control protocols are recommended to mitigate resistance spread.