Widespread resistance to new antimicrobials in a university hospital before clinical use

The activity of cefpirome, cefepitne and piperacillin/tazobactam previously unused in the hospital was evaluated in parallel with five broad-spectrum antibiotics (ceftazidime, ceftriaxone, imipenem, ciprofloxacin and amikacin ) currently being used to treat serious infections in the National Universi ty Hospital, Singapore. Two hundred and two clinically significant, organis ms consecutively isolated during 1998 were included in the study. In vitro efficacy of cefepime, cefpirome and piperacillin/tazobactam was not superio r to imipenem, ciprofloxacin and amikacin which are currently used. More th an 40% of Enterbacteriaceae were found to be ESBL producers. The incidence of nosocomial organisms resistant to drugs used in serious infections had i ncreased since 1995. Imipenem-resistance occurred in 34.4%, of Acinetobacte r spp. and 19.2% Pseudomonas aeruginosa. No single agent appeared to be sui table for empirical monotherapy of serious sepsis. (C) 2001 Elsevier Scienc e B.V. and International Society of Chemotherapy. All rights reserved.