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November 1985

Gentamicin vs Cefotaxime for Therapy of Neonatal Sepsis: Relationship to Drug Resistance

Author Affiliations

From the Departments of Medicine (Dr Bryan) and Pediatrics (Drs Pai and Austin), University of South Carolina School of Medicine and Richland Memorial Hospital, Columbia; and the Department of Medicine, Medical University of South Carolina and Veterans Administration Medical Center, Charleston (Dr John).

Am J Dis Child. 1985;139(11):1086-1089. doi:10.1001/archpedi.1985.02140130024022

• An outbreak of serious infections due to gentamicin-resistant Klebsiella pneumoniae occurred in a neonatal intensive care unit in which the combination of gentamicin sulfate and ampicillin sodium had been used for standard initial therapy for suspected sepsis for nearly 11 years. After institution of control measures that included the substitution of cefotaxime sodium for gentamicin in the standard regimen, the outbreak promptly subsided. Nevertheless, a second outbreak of serious infections due to cefotaxime-resistant Enter-obacter cloacae began ten weeks later. Sequential stool cultures from patients in the unit confirmed the disappearance of gentamicin-resistant K pneumoniae and the emergence of cefotaxime-resistant E cloacae after the change in antibiotic policy. These observations suggest that routine use of newer cephalosporins for therapy of suspected sepsis may lead to the emergence of drugresistant microorganisms more rapidly than has occurred with the aminoglycosides.

(AJDC 1985;139:1086-1089)