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. 1978 Feb;13(2):214–220. doi: 10.1128/aac.13.2.214

Gentamicin Use and Pseudomonas and Serratia Resistance: Effect of a Surgical Prophylaxis Regimen

Norbert J Roberts Jr 1, R Gordon Douglas Jr 1
PMCID: PMC352217  PMID: 348094

Abstract

An outbreak of prosthetic valve endocarditis due to methicillin-resistant Staphylococcus epidermidis prompted a change in antimicrobial prophylaxis for open heart surgery in a general hospital from a regimen of aqueous penicillin G, methicillin, and kanamycin to a 5-day regimen of cefazolin and gentamicin. As a result, total gentamicin use in the hospital more than doubled. Increased resistance of pseudomonas and serratia isolates paralleled the increased total use of gentamicin. For pseudomonas species, the incidence of gentamicin resistance increased from 3 to 15%; for serratia species, from 8 to 88%; and for the total of both organisms, from 4 to 28%. Resistance decreased rapidly after removal of gentamicin from the prophylaxis regimen. Review of serratia isolates from the urinary tract showed that gentamicin resistance was associated with prior antibiotic therapy, especially with gentamicin, care on the surgical services, especially the surgical intensive care unit, and presence of indwelling bladder catheters. Gentamicin use in a 5-day antimicrobial prophylaxis regimen for open heart surgery can represent a large proportion of the total hospital use of that antibiotic, with potential adverse effects on hospital flora.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altemeier W. A., Culbertson W. R., Fullen W. D., McDonough J. J. Serratia marcescens septicemia. A new threat in surgery. Arch Surg. 1969 Aug;99(2):232–238. doi: 10.1001/archsurg.1969.01340140104015. [DOI] [PubMed] [Google Scholar]
  2. Baird I. M., Slepack J. M., Kauffman C. A., Phair J. P. Nosocomial infection with gentamicin-carbenicillin-resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1976 Oct;10(4):626–629. doi: 10.1128/aac.10.4.626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bauer A. W., Kirby W. M., Sherris J. C., Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr;45(4):493–496. [PubMed] [Google Scholar]
  4. Bennett J. V. Nosocomial infections due to Pseudomonas. J Infect Dis. 1974 Nov;130 (Suppl)(0):S4–S7. doi: 10.1093/infdis/130.supplement.s4. [DOI] [PubMed] [Google Scholar]
  5. Block P. C., DeSanctis R. W., Weinberg A. N., Austen W. G. Prosthetic valve endocarditis. J Thorac Cardiovasc Surg. 1970 Oct;60(4):540–548. [PubMed] [Google Scholar]
  6. Conte J. E., Jr, Cohen S. N., Roe B. B., Elashoff R. M. Antibiotic prophylaxis and cardiac surgery. A prospective double-blind comparison of single-dose versus multiple-dose regimens. Ann Intern Med. 1972 Jun;76(6):943–949. doi: 10.7326/0003-4819-76-6-943. [DOI] [PubMed] [Google Scholar]
  7. Cooksey R. C., Bannister E. R., Farrar W. E., Jr Antibiotic resistance patterns of clinical isolates of Serratia marcescens. Antimicrob Agents Chemother. 1975 Apr;7(4):396–399. doi: 10.1128/aac.7.4.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cooksey R. C., Thorne G. M., Farrar W. E., Jr R factor-mediated antibiotic resistance in Serratia marcescens. Antimicrob Agents Chemother. 1976 Jul;10(1):123–127. doi: 10.1128/aac.10.1.123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Davis J. T., Foltz E., Blakemore W. S. Serratia marcescens. A pathogen of increasing clinical importance. JAMA. 1970 Dec 21;214(12):2190–2192. doi: 10.1001/jama.214.12.2190. [DOI] [PubMed] [Google Scholar]
  10. Dery P., Marks M. I., Mackay E. Susceptibilities of bacteria to different antibiotic regimens. Study in two nursery populations. Am J Dis Child. 1975 Mar;129(3):328–330. doi: 10.1001/archpedi.1975.02120400038008. [DOI] [PubMed] [Google Scholar]
  11. Dismukes W. E., Karchmer A. W., Buckley M. J., Austen W. G., Swartz M. N. Prosthetic valve endocarditis. Analysis of 38 cases. Circulation. 1973 Aug;48(2):365–377. doi: 10.1161/01.cir.48.2.365. [DOI] [PubMed] [Google Scholar]
  12. Edwards L. D., Cross A., Levin S., Landau W. Outbreak of a nosocomial infection with a strain of Proteus rettgeri resistant to many antimicrobials. Am J Clin Pathol. 1974 Jan;61(1):41–46. doi: 10.1093/ajcp/61.1.41. [DOI] [PubMed] [Google Scholar]
  13. Franco J. A., Eitzman D. V., Baer H. Antibiotic usage and microbial resistance in an intensive care nursery. Am J Dis Child. 1973 Sep;126(3):318–321. doi: 10.1001/archpedi.1973.02110190280006. [DOI] [PubMed] [Google Scholar]
  14. Greene W. H., Moody M., Schimpff S., Young V. M., Wiernik P. H. Pseudomonas aeruginosa resistant to carbenicillin and gentamicin. Epidemiologic and clinical aspects in a cancer center. Ann Intern Med. 1973 Nov;79(5):684–689. doi: 10.7326/0003-4819-79-5-684. [DOI] [PubMed] [Google Scholar]
  15. Iannini P. B., Eickhoff T. C., LaForce F. M. Multidrug-resistant Proteus rettgeri: an emerging problem. Ann Intern Med. 1976 Aug;85(2):161–164. doi: 10.7326/0003-4819-85-2-161. [DOI] [PubMed] [Google Scholar]
  16. Kaslow R. A., Lindsey J. O., Bisno A. L., Price A. Nosocomial infection with highly resistant, Proteus rettgeri. Report of an epidemic. Am J Epidemiol. 1976 Sep;104(3):278–286. doi: 10.1093/oxfordjournals.aje.a112301. [DOI] [PubMed] [Google Scholar]
  17. Killen D. A., Collins H. A., Koenig M. G., Goodman J. S. Prosthetic cardiac valves and bacterial endocarditis. Ann Thorac Surg. 1970 Mar;9(3):238–247. doi: 10.1016/s0003-4975(10)65496-3. [DOI] [PubMed] [Google Scholar]
  18. Kloster F. E. Diagnosis and management of complications of prosthetic heart valves. Am J Cardiol. 1975 Jun;35(6):872–885. doi: 10.1016/0002-9149(75)90124-1. [DOI] [PubMed] [Google Scholar]
  19. Madison J., Wang K., Gobel F. L., Edwards J. E. Prosthetic aortic valvular endocarditis. Circulation. 1975 May;51(5):940–949. doi: 10.1161/01.cir.51.5.940. [DOI] [PubMed] [Google Scholar]
  20. Maki D. G., Hennekens C. G., Phillips C. W., Shaw W. V., Bennett J. V. Nosocomial urinary tract infection with Serratia marcescens: an epidemiologic study. J Infect Dis. 1973 Nov;128(5):579–587. doi: 10.1093/infdis/128.5.579. [DOI] [PubMed] [Google Scholar]
  21. Maki D. G., Hennekens C. H., Bennett J. V. Prevention of catheter-associated urinary tract infection. An additional measure. JAMA. 1972 Sep 11;221(11):1270–1271. [PubMed] [Google Scholar]
  22. Meyer R. D., Lewis R. P., Carmalt E. D., Finegold S. M. Amikacin therapy for serious gram-negative bacillary infections. Ann Intern Med. 1975 Dec;83(6):790–800. doi: 10.7326/0003-4819-83-6-790. [DOI] [PubMed] [Google Scholar]
  23. Meyer R. D., Lewis R. P., Halter J., White M. Gentamicin-resistant Pseudomonas aeruginosa and Serratia marcescens in a general hospital. Lancet. 1976 Mar 13;1(7959):580–583. doi: 10.1016/s0140-6736(76)90370-6. [DOI] [PubMed] [Google Scholar]
  24. Meyers J. A., Sanchez D., Elwell L. P., Falkow S. Simple agarose gel electrophoretic method for the identification and characterization of plasmid deoxyribonucleic acid. J Bacteriol. 1976 Sep;127(3):1529–1537. doi: 10.1128/jb.127.3.1529-1537.1976. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Mulholland S. G., McGarrity G. J., Ross O. A., Greenhalgh P. J., Blakemore W. S. Experience with detailed surveillance of nosocomial infection. Surg Gynecol Obstet. 1975 Jun;140(6):941–945. [PubMed] [Google Scholar]
  26. Phair J. P., Watanakunakorn C., Goldberg L., Carleton J. Ecology of staphylococci in a general medical service. Appl Microbiol. 1972 Dec;24(6):967–971. doi: 10.1128/am.24.6.967-971.1972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Rennie R. P., Duncan I. B. Emergence of gentamicin-resistant Klebsiella in a general hospital. Antimicrob Agents Chemother. 1977 Feb;11(2):179–184. doi: 10.1128/aac.11.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Ringrose R. E., McKown B., Felton F. G., Barclay B. O., Muchmore H. G., Rhoades E. R. A hospital outbreak of Serratia marcescens associated with ultrasonic nebulizers. Ann Intern Med. 1968 Oct;69(4):719–729. doi: 10.7326/0003-4819-69-4-719. [DOI] [PubMed] [Google Scholar]
  29. Sanders C. V., Jr, Luby J. P., Johanson W. G., Jr, Barnett J. A., Sanford J. P. Serratia marcescens infections from inhalation therapy medications: nosocomial outbreak. Ann Intern Med. 1970 Jul;73(1):15–21. doi: 10.7326/0003-4819-73-1-15. [DOI] [PubMed] [Google Scholar]
  30. Schaberg D. R., Alford R. H., Anderson R., Farmer J. J., 3rd, Melly M. A., Schaffner W. An outbreak of nosocomial infection due to multiply resistant Serratia marcescens: evidence of interhospital spread. J Infect Dis. 1976 Aug;134(2):181–188. doi: 10.1093/infdis/134.2.181. [DOI] [PubMed] [Google Scholar]
  31. Shulman J. A., Terry P. M., Hough C. E. Colonization with gentamicin-resistant Pseudomonas aeruginosa, pyocine type 5, in a burn unit. J Infect Dis. 1971 Dec;124 (Suppl):S18–S23. doi: 10.1093/infdis/124.supplement_1.s18. [DOI] [PubMed] [Google Scholar]
  32. Slaughter L., Morris J. E., Starr A. Prosthetic valvular endocarditis. A 12-year review. Circulation. 1973 Jun;47(6):1319–1326. doi: 10.1161/01.cir.47.6.1319. [DOI] [PubMed] [Google Scholar]
  33. Slepack J. M., Korfhagen T., Loper J. C., Tan J. S., Phair J. P. Virulence in rats of gentamicin-carbenicillin-resistant Pseudomonas. Antimicrob Agents Chemother. 1975 Oct;8(4):513–514. doi: 10.1128/aac.8.4.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Thomas F. E., Jr, Leonard J. M., Alford R. H. Sulfamethoxazole-trimethoprim-polymyxin therapy of serious multiply drug-resistant Serratia infections. Antimicrob Agents Chemother. 1976 Feb;9(2):201–207. doi: 10.1128/aac.9.2.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Weinstein M. J., Drube C. G., Moss E. L., Jr, Waitz J. A. Microbiologic studies related to bacterial resistance to gentamicin. J Infect Dis. 1971 Dec;124 (Suppl):S11–S17. doi: 10.1093/infdis/124.supplement_1.s11. [DOI] [PubMed] [Google Scholar]
  36. Williams T. W., Jr, Sailer J. E., Viroslav J., Knight V., Glasgow N., Moreland N. Serratia marcescens as a postoperative pathogen. Am J Surg. 1971 Jul;122(1):64–69. doi: 10.1016/0002-9610(71)90350-3. [DOI] [PubMed] [Google Scholar]
  37. Wilson W. R., Jaumin P. M., Danielson G. K., Giuliani E. R., Washington JA I. I., Geraci J. E. Prosthetic valve endocarditis. Ann Intern Med. 1975 Jun;82(6):751–756. doi: 10.7326/0003-4819-82-6-751. [DOI] [PubMed] [Google Scholar]

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