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February 7, 1996

Survival Following Bacteremia With Resistant Organisms-Reply

Author Affiliations

Beilinson Medical Center Petah-Tiqva, Israel

JAMA. 1996;275(5):360-361. doi:10.1001/jama.1996.03530290030026

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In Reply.  —The resistance of pathogens to antibiotic drugs in our hospital is high. In the group of patients described in our article, 35.4% of S aureus were resistant to methicillin; 30.3% of Enterococcus species were resistant to ampicillin; and 40.9%, 19.9%, and 24.9% of Pseudomonas aeruginosa were resistant to gentamicin sulfate, ceftazidime, and piperacillin sodium, respectively.We must not confuse two possible definitions of appropriate empirical antibiotic treatment. One is a normative definition: Was the treatment in accordance with best practiced hospital protocols? The other definition, used in our article, is a factual one: Was the pathogen sensitive to the antibiotics given?The hypothesis implied in Dr Shumate's letter is that resistant bacteria are more virulent than sensitive ones. To the best of my knowledge, there are no data to support such a hypothesis. In our patients, the mortality of patients with multiresistant pathogens was no greater than in