Antimicrobial Resistance Patterns

The emergence of extended-spectrum beta-lactamases in E. coli, Klebsiella, and other organisms has limited the utility of penicillins and traditional cephalosporins at some centers.7 Although imipenem, meropenem, and cefepime have extremely broad spectrums of activity, organisms resistant to these agents have also been described.4,5 Methicillin resistance in coagulase-nega-tive staphylococci and Staphylococcus aureus (MRSA) has become increasingly common, as has vancomycin-resistant Enterococcus (VRE).

Organisms such as Stenotrophomonas, Leukonostoc, and Corynebacterium jekeium are now appearing,5 some of which are not covered by standard antibiotics. For example, Stenotrophomonas is often resistant to all but sulfa-based agents.4,5

Frequent reconsideration of antibiotic regimens is important. If a patient is deteriorating on therapy, consideration should be given to expanding antibiotic coverage to include the multiresistant bacteria that may be specific to that hospital. Updates from the hospital microbiology laboratory and infection control committee can provide valuable information about changing susceptibility patterns.

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