Related Experiment Videos
[Value of an imipenem-cilastatin combination in surgery and surgical care units]
1Département d'Anesthésie-Réanimation, Hôtel-Dieu, Lyon.
Abstract:
One-hundred and ninety-nine patients with severe infection caused by susceptible organisms were treated with imipenem-cilastatin administered intravenously in doses of 31 mg/kg/day on average. The drug was given alone in 71 per cent of the cases and with another antibiotic (usually an aminoglycoside) in 13 per cent. In 57.4 per cent of the patients several micro-organisms were involved. Clinical success was achieved in 169 patients (84.9 per cent), 129 of whom (64.8 per cent) were cured and 40 (20.1 per cent) were improved. Failure was observed in 30 patients (15.0 per cent). Fifteen patients died during treatment; death was directly related to the infection in 5 and occurred while the infection had clinically regressed in 5; in the remaining 5 patients persistence of the infection played a determinant role in the fatal outcome. In 15 patients the lack of clinical improvement under imipenem-cilastatin required by 5/65 Pseudomonas strains and 2/56 Anaerobes strains initially isolated, or to superinfection, or to persistence of the initial strain in the focus of infection. Treatment was discontinued in 8 cases due to adverse events (skin intolerance 4, thrombocytopenia 4). There was no statistically significant difference in the outcome of patients treated with imipenem-cilastatin alone or combined with another antibiotic.
Insights
Imipenem-cilastatin effectively treated severe infections in 84.9% of patients. This broad-spectrum antibiotic showed similar outcomes whether used alone or in combination therapy for susceptible bacterial infections.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Severe bacterial infections pose significant clinical challenges.
- Broad-spectrum antibiotics are crucial for managing complex infections.
- Imipenem-cilastatin is a widely used combination antibiotic.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of imipenem-cilastatin in patients with severe infections.
- To compare outcomes of imipenem-cilastatin monotherapy versus combination therapy.
Main Methods:
- Prospective study involving 199 patients with severe infections.
- Intravenous administration of imipenem-cilastatin (average dose 31 mg/kg/day).
- Analysis of clinical success, cure rates, improvement, failure, and adverse events.
Main Results:
- Clinical success was achieved in 84.9% of patients (169/199).
- Cure rates were 64.8% (129/199), with 20.1% showing improvement (40/199).
- No significant difference in outcomes between monotherapy and combination therapy groups.
Conclusions:
- Imipenem-cilastatin demonstrates high efficacy in treating severe infections caused by susceptible organisms.
- The drug is generally well-tolerated, with adverse events leading to discontinuation in a small percentage of patients.
- Combination therapy with other antibiotics did not show a statistically significant advantage over imipenem-cilastatin monotherapy in this study population.