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[Treatment of septicemia and endocarditis with pefloxacine. 15 cases]
Abstract:
The therapeutic effectiveness of pefloxacin was evaluated in 15 patients admitted to an intensive care unit and suffering from septicaemia or endocarditis. Seven of these patients had a focal infection (acute anterior mediastinitis or epiduritis). Pefloxacin was combined with an aminoglycoside in 13 cases and with rifampicin in 1 case. Blood cultures became or remained negative in all patients. The associated focus of infection was sterilized in 5 patients; a pefloxacin-resistant pathogen was subsequently isolated in 2 other patients. Three patients died some time after the infectious episode. The minimum inhibitory concentration of pefloxacin ranged from 0.25 to 2 mg/l. The bactericidal activity of the serum at peak concentration was greater than or equal to 1/8 in all cases and greater than or equal to 1/32 in 10 cases. No resistant mutants were selected during treatment. However, 8 strains of a species different from that of the initial pathogen were isolated from a site other than the primary focus. Pefloxacin can therefore be used successfully in the treatment of systemic infections, but close monitoring of bacterial ecology is required.
Insights
Pefloxacin effectively treated severe infections like septicaemia and endocarditis in intensive care patients, achieving negative blood cultures. However, careful monitoring of bacterial ecology is crucial due to potential resistant strains.
Area of Science:
- Pharmacology
- Infectious Diseases
- Critical Care Medicine
Context:
- Severe systemic infections, including septicaemia and endocarditis, pose significant challenges in intensive care units.
- Pefloxacin, a fluoroquinolone antibiotic, has been investigated for its efficacy against such infections.
Purpose:
- To evaluate the therapeutic effectiveness of pefloxacin in critically ill patients with severe bacterial infections.
- To assess the impact of pefloxacin on blood culture negativity and the sterilization of focal infection sites.
- To monitor the bactericidal activity and potential development of resistance during pefloxacin treatment.
Summary:
- Pefloxacin, often in combination with other antibiotics, was administered to 15 intensive care unit patients with septicaemia or endocarditis.
- All patients achieved negative blood cultures, and 5 had their focal infections sterilized.
- Despite no resistant mutants developing from the initial pathogens, other resistant species emerged, necessitating careful bacterial ecology monitoring.
Impact:
- Pefloxacin demonstrates successful therapeutic outcomes in treating severe systemic infections.
- The study highlights the importance of vigilant monitoring of bacterial ecology to mitigate the emergence of resistant organisms.
- Findings support the judicious use of pefloxacin in critical care settings while emphasizing the need for ongoing surveillance.