[Enterobacter cloacae and E. aerogenes septicemia: emergence of resistant variants (derepressed cephalosporinase) during treatment with third-generation cephalosporins]. / Septicémies à Enterobacter cloacae et E. aerogenes: émergence de variants résistants (céphalosporinase déréprimée) en cours de traitement par des céphalosporines de troisième génération.

From three patients hospitalised in intensive care units with Enterobacter septicaemia (two cases with E. cloacae, and one with E. aerogenes), cefotaxime therapy, alone or in combination with an aminoglycoside, selected variants (R) with increased resistance to beta-lactam antibiotics. The cross-resistance extended to all the beta-lactam antibiotics tested, penicillins and cephalosporins, including third-generation cephalosporins. The crude extracts of uninduced cultures of R variants showed high beta-lactamase activity and of the cephalosporinase type. These variants were selected in vitro with a frequency of 10(-6) to 10(-7) and may result from a mutation involving the regulation of Enterobacter cephalosporinases, usually inducible. Data from the literature indicated that this new type of resistance is actually emerging and observed not only in Enterobacter sp. The problem of emergence of R variants exhibiting cross-resistance to beta-lactam antibiotics should be considered when third-generation cephalosporins are used.

[Comparative in vitro antistaphylococcal effect of norfloxacin and pefloxacin on 312 hospital strains]. / Activité antistaphylococcique comparée in vitro de la norfloxacine et de la péfloxacine sur 312 souches hospitaliéres.

Antistaphylococcal activity of two new quinolones, norfloxacin and pefloxacin, was studied. Minimal inhibitory concentrations (MICs) were determined by the agar dilution technique for 312 staphylococcal strains, all of which were resistant to nalidixic acid. 50% and 90% MICs were respectively 1 and 4 micrograms/ml for norfloxacin and 0.5 and 1 micrograms/ml for pefloxacin. Activities of these two new quinolones proved similar on Staphylococcus aureus and non-coagulase-producing staphylococci, regardless of their response to methicillin. Cross resistance between the two drugs was demonstrated.

[Treatment of Gram-negative septicaemia with cefotaxime: 16 cases (author's transl)]. / Traitement des septicémies à bacilles à Gram négatif par le céfotaxime. 16 observations.

Sixteen patients, 9 to 81 years old, with Gram-negative septicaemia have been treated with cefotaxime. In all cases, the patients were hospitalised in an intensive care unit for a severe infection distinct from septicaemia. Cefotaxime was given alone to 11 patients and was administered by infusion over 20 to 30 minutes, every 4 or 6 hours, in a daily dose of 67 to 94 mg/kg to patients with normal of subnormal renal function. Gram-negative pathogens were sensitive to cefotaxime (MIC less than 1 mcg/ml in most cases). A clinical cure was obtained in 14 patients. In all the cases, tolerance was good. The very low MIC's of cefotaxime and the results in severe Gram-negative septicaemia justify the use of cefotaxime in monotherapy, in patients with severe life-threatening infections, when blood cultures appear to be positive for Gram-negative pathogens, even without awaiting antibiograms.

[Acute primary infection due to slow-growing anaerobes after total hip arthroplasty (author's transl)]. / Infection aiguë précoce primitive à germes anaérobies à croissance lente après chirurgie prothétique de la hanche. Trois observations.

Most early post-operative infections in total hip arthroplasty are due to aerobic bacteria. Anaerobes infections are less common and less easy to diagnose since the organisms are growing slowly. In the three patients reported the responsible organisms were detected by a strict bacteriological technique including cultures lasting more than 48 hours. Treatment consisted of re-operation and appropriate antibiotic therapy. The slow development of anaerobic bacteria makes antibiotic sensitivity tests particularly difficult to read. The need for cultures prolonged beyond 48 hours partly explains the frequency of overt suppuration in cases where standard bacteriological methods had given negative results.