DECREASING ANTIBIOTIC-RESISTANCE OF ENTEROBACTERIACEAE BY INTRODUCINGA NEW ANTIBIOTIC COMBINATION THERAPY FOR NEUTROPENIC FEVER PATIENTS

Prompt empiric antibiotic therapy is of critical importance for patien ts with neutropenic fever. However, a major concern with important cli nical consequences is the emergence of bacterial resistance to antibio tics. After using ceftazidime with a glycopeptide as initial empiric t herapy for neutropenic fever, we were confronted with a 75% reduced su sceptibility rate to ceftazidime of inducible Enterobacteriaceae colle cted in 1994. The initial empiric therapy was therefore replaced in Ma y 1995 by a combination of cefepime with amikacin, with addition of a glycopeptide after 48 h if necessary. After this change, we observed a significant decrease in reduced susceptibility of inducible Enterobac teriaceae, not only to ceftazidime, but also to amikacin, cotrimoxazol e and ciprofloxacin. There was also a decrease in reduced susceptibili ty of non-inducible Enterobacteriaceae, such as Klebsiella spp, to cef tazidime. The reduction of resistance may be related at least in part to the combined use of cefepime together with an aminoglycoside. This study shows that it is possible to reverse bacterial resistance by mod ifying the antibiotic regimen used.