In vivo and in vitro emergence of simultaneous resistance to both beta-lactam and aminoglycoside antibiotics in a strain of Serratia marcescens.

In a patient with Serratia marcescens bacteraemia, a variant resistant to cefotaxime and amikacin was isolated in a blood culture under combined treatment with cefotaxime and amikacin. In addition, in vitro selection on cefotaxime and/or amikacin yielded resistant mutants from the sensitive parent strain. These mutants displayed the same type of cross-resistance as the clinical strain to all beta-lactam and aminoglycoside antibiotics. The mechanism for this resistance was a decrease in the permeability of the cell. To our knowledge, the isolation of such strains from blood cultures and the mechanism responsible for this "broad-spectrum resistance" have not been previously described.