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Journal of Antimicrobial Chemotherapy (1987) 20, 903-911
© 1987 The British Society for Antimicrobial Chemotherapy

research-article

Treatment failures of cefotaxime and latamoxef in meningitis caused by Enterobacter and Serratia spp.

Robert H.K. Enga,, Charles E. Cherubinb, Jean-Claude Pecherec and Thomas R. Beam, Jr.d

aInfectious Disease Section, Medical Service, Veterans Administration Medical Center East Orange, NJ 07019 New Jersey Medical School, UMDNJ Newark, New Jersey, U.S.A bDepartment of Medicine, Bayley Seton Hospital Staten Island, New York 10304, U.S.A cDépartement de Microbiologie, Centre Médical Universitaire, Université de Genève Genève 4 CH-1211, Switzerland dInfectious Disease Section, Veterans Administration Medical Center Buffalo, NY Department of Medicine SUNY at Buffalo, NY 14215, U.S.A.

accepted 13 July 1987

Correspondence: Dr. Robert Eng, Medical Service (111), VA Medical Center, East Orange, NJ 07019, U.S.A.

Despite the apparent success of several new cephalosporins in the treatment of Gram-negative bacterial meningitis, four treatment failures with cefotaxime or latamoxef were encountered (two caused by Enterobacter and two by Serratia spp.). In-vitro parameters of susceptibility of these clinical isolates were compared with those of a meningeal Ent. cloacae isolate from a successfully treated patient. The MIC and MBC values, degrees of inoculum effect, and amounts of ß-lactamase produced correlated poorly with the observed clinical outcome. However, the extent to which an isolate was killed by the cephalosporin used for treatment, in a 6-h in-vitro incubation, showed good correlation. We suggest that such a test should be used to predict clinical outcome of therapy because the other parameters such as the MIC and MBC values are not sufficiently discriminatory.


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