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Neonatal Klebsiella pneumonia sepsis and imipenem/cilastatin
1Ege University Medical Faculty, Department of Pediatrics, Izmir, Turkey.
Abstract:
Efficacy and safety of imipenem/cilastatin in neonatal Klebsiella pneumonia sepsis was investigated in 45 infants compared to 39 control infants on conventional antibiotic regimen. Sensitivity to imipenem was 94% followed by cephoxitin (88%), quinolons (80%), and amikacin (52%) according to susceptibility results in the study group. Treatment duration of surviving infants was 16.5 +/- 4.6 and 20.3 +/- 6.4 days in the study and control groups respectively (p < 0.05). Five infants (11%) vs 27 (69%) were unresponsive (septic deaths) to treatment in the study and control groups respectively (p < 0.001). The cure rates were 73% and 28% respectively (p < 0.001). Sequelae free discharge rates were 67% and 23% respectively (p < 0.001). The most frequent adverse effects of imipenem/cilastatin were Candida albicans superinfection (20%); Candida albicans colonisation (10%); impairment of liver and renal functions (19% and 10% respectively); seizures (5%); thrombocytosis (3%); thrombophlebitis (3%); urine discoloration (3%); and Staphylococcus epidermidis colonisation (2%). Imipenem is considered a good alternative for neonatal Klebsiella pneumonia sepsis with these results, however, one must be aware of the increased risk of Candida albicans superinfection.
Insights
Imipenem/cilastatin shows high efficacy in treating neonatal Klebsiella pneumonia sepsis, significantly improving cure and discharge rates. However, increased risk of Candida albicans superinfection requires careful monitoring.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonatal sepsis caused by Klebsiella pneumoniae presents a significant challenge.
- Conventional antibiotic regimens have limitations in treating severe neonatal infections.
Purpose of the Study:
- To investigate the efficacy and safety of imipenem/cilastatin for neonatal Klebsiella pneumonia sepsis.
- To compare outcomes with conventional antibiotic treatment.
Main Methods:
- A comparative study involving 45 infants treated with imipenem/cilastatin and 39 control infants on conventional antibiotics.
- Antimicrobial susceptibility testing was performed.
Main Results:
- Imipenem demonstrated high susceptibility (94%) in the study group.
- Imipenem/cilastatin significantly reduced mortality (11% vs 69%), increased cure rates (73% vs 28%), and improved sequelae-free discharge (67% vs 23%).
- Adverse effects included Candida albicans superinfection (20%) and transient liver/renal function impairment (19%/10%).
Conclusions:
- Imipenem/cilastatin is an effective alternative for neonatal Klebsiella pneumonia sepsis.
- Awareness of potential Candida albicans superinfection is crucial when using imipenem/cilastatin.