Summary
Newer β-lactam antibiotics, notably the third generation cephalosporins (3 GC) have been designed for providing high intrinsic potency against a large variety of microorganisms. Bacterial resistance can occur however, and nowadays, clinicians are concerned by novel situations where even most recently developed compounds can be ineffective. A first situation is generated by bacteria which produce great amounts of chromosomal cephalosporinase. The resistance emerges during therapy, in hospital isolates which are classified as susceptible with conventional susceptibility testing. The prevalence of 3 GC resistance among these gram-negative rods with inducible β-lactamase seems to increase in some institutions but the significance of susceptibility testing in this regard is doubtful. It is probably more important to note that the prevalence of gram-negative rods with inducible β-lactamases remains stable. A second problem arose with the abrupt development of plasmid mediated β-lactamases markedly active against 3 GC. This resistance is underestimated because some strains fall into susceptibility range of 3 GC as determined by MICs or inhibition zone sizes. These extended spectrum enzymes are now distributed over four continents and represent a growing threat.
Zusammenfassung
Neuere β-Laktamantibiotika, vor allem die Cephalosporine der dritten Generation, wurden im Hinblick auf hohe intrinsische Aktivität gegen ein breites Erregerspektrum konzipiert. Dennoch können Bakterien gegen diese Substanzen resistent werden, und die Ärzte stehen besorgt vor der Situation, daß selbst die neuesten Substanzen wirkungslos sein können. Das eine Problem ist die Produktion chromosomal kodierter Cephalosporinasen in großen Mengen durch bestimmte Bakterien. Die Resistenzentwicklung tritt unter der Therapie auf, betroffen sind Krankenhausstämme, die bei konventioneller Empfindlichkeitstestung sensibel sind. Diese gramnegativen Bakterien mit induzierbarer β-Laktamase scheinen in einigen Kliniken zuzunehmen, die Resistenztestung ist in dieser Hinsicht jedoch von fraglichem Wert. Wichtiger erscheint die Feststellung, daß die Prävalenz von gramnegativen Bakterien mit induzierbarer β-Laktamase stabil bleibt. Ein zweites Problem ergab sich aus dem plötzlichen Auftreten plasmid-kodierter β-Laktamasen, die beträchtliche Wirkung gegen Cephalosporine der dritten Generation haben. Diese Resistenz wird unterschätzt, da einige Stämme noch im Empfindlichkeitsbereich der Cephalosporine der dritten Generation bei MHK-Bestimmung oder im Hemmhoftest liegen. Diese Breitspektrum-Enzyme haben sich inzwischen über vier Kontinente ausgebreitet und stellen eine zunehmende Bedrohung dar.
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Pechère, J.C. Resistance to third generation cephalosporins: the current situation. Infection 17, 333–337 (1989). https://doi.org/10.1007/BF01650724
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DOI: https://doi.org/10.1007/BF01650724