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Long-term amikacin use. Effects on aminoglycoside susceptibility patterns of gram-negative bacilli
Abstract:
Amikacin sulfate was first used sparingly at our cancer center in 1976; since 1979, it has been the only aminoglycoside used for systemic cancer therapy for patients with granulocytopenia. As the development of resistance has been correlated with antibiotic use over time, we wished to determine if prolonged use of amikacin in our patients had led to increased amikacin resistance. A total of 1,129 strains were recovered from 315 patients during a 13-month period. Each species isolated per patient was considered once. Seven percent of the patients had amikacin-resistant strains (2.7% of isolates), and 10% of patients had gentamicin-resistant strains (4% of isolates). Amikacin resistance was significantly less than in an earlier study. Unrestricted use of amikacin has not led to a concomitant increase in amikacin resistance in gram-negative bacilli.
Insights
Prolonged use of amikacin in cancer patients has not increased amikacin resistance. This study found amikacin resistance rates were lower than in previous research, suggesting unrestricted use is safe for gram-negative bacilli.
Area of Science:
- Infectious Diseases
- Oncology
- Microbiology
Background:
- Amikacin sulfate has been the sole systemic aminoglycoside for cancer patients with granulocytopenia since 1979.
- Antibiotic resistance development is often linked to prolonged antibiotic exposure.
Purpose of the Study:
- To investigate if extended amikacin use in a cancer center led to increased amikacin resistance.
- To evaluate current amikacin resistance trends in gram-negative bacilli within this patient population.
Main Methods:
- Analysis of 1,129 bacterial strains from 315 cancer patients over 13 months.
- Tracking amikacin and gentamicin resistance in isolated bacterial species per patient.
Main Results:
- Amikacin resistance was observed in 7% of patients (2.7% of isolates).
- Gentamicin resistance was found in 10% of patients (4% of isolates).
- Amikacin resistance rates were significantly lower compared to an earlier study.
Conclusions:
- Unrestricted amikacin use has not resulted in a concurrent rise in amikacin resistance.
- The findings support the continued use of amikacin in cancer therapy without increased resistance concerns.