The clinical relevance of Enterobacter infections.

An 18-month prospective study of Enterobacter bacteremia was conducted in 129 patients. The results indicated that (1) emergence of resistance was more frequent during treatment with third-generation cephalosporins than with other antibiotics; (2) the addition of an aminoglycoside to the cephalosporin did not prevent emergence of resistance; (3) previous treatment with cephalosporins was associated with bacteremia caused by multiresistant Enterobacter species; and (4) infection with multiresistant Enterobacter species was associated with a higher mortality than infection with susceptible strains. It is concluded that avoidance of third-generation cephalosporins for surgical prophylaxis and therapy in patients in whom Enterobacter infections are suspected or proven should lower the prevalence of Enterobacter bacteremias and mortality and prevent the emergence of multiresistance.