NEW BETA-LACTAMS - NEW PROBLEMS FOR THE INTERNIST

Newer beta-lactam antibiotics pose new problems, especially in the area of microbial drug resistance. The use of these agents has been associated with increased prevalence of infections caused by multiply resistant organisms such as Enterobacter spp. and Pseudomonas aeruginosa. Mortality in patients infected with such organisms is substantially elevated. The appearance and apparent spread of these resistant organisms within the hospital environment can be quite rapid because of the unusual genetic system responsible for the resistance. Resistance arises from the activation of a gene already extant in the population rather than by the acquisition of new genetic material. Because there are few new agents being developed that will be effective against these resistant organisms, the major approach to limiting resistance must be the judicious use of these new beta-lactam antibiotics.