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Effect of imipenem-cilastatin therapy on fecal flora
Abstract:
Alteration of fecal flora was prospectively studied in 21 children receiving imipenem-cilastatin therapy under protocol for therapy of infections. Although no profound reduction in facultative or anaerobic flora was observed, qualitative and quantitative increases in organisms which were resistant or less susceptible to imipenem occurred. Of 21 patients, 13 (62%) had increases in counts of Enterococcus spp. of at least 10(3) organisms per g (wet weight) of stool, and 7 (33%) had acquisition of or similar increases in counts of Candida species. No change in susceptibility of isolates to imipenem was demonstrable during therapy. However, the MICs for 50 and 90% of the strains of Enterococcus spp. (2 and 8 micrograms/ml, respectively) were higher than those previously reported.
Insights
Imipenem-cilastatin therapy in children increased resistant Enterococcus and Candida species in fecal flora. Susceptibility to imipenem did not change, but Enterococcus MICs were higher than previously reported.
Area of Science:
- Microbiology
- Pharmacology
- Pediatric Infectious Diseases
Background:
- Antibiotic therapy can disrupt the normal gut microbiota.
- Carbapenem antibiotics like imipenem-cilastatin are broad-spectrum agents used for serious infections.
Purpose of the Study:
- To prospectively investigate the effects of imipenem-cilastatin on fecal flora in pediatric patients.
- To assess changes in the composition and susceptibility of gut microorganisms during treatment.
Main Methods:
- Prospective study of 21 children receiving imipenem-cilastatin.
- Analysis of fecal flora composition and quantitative changes.
- Assessment of microbial susceptibility to imipenem before and during therapy.
Main Results:
- No significant reduction in facultative or anaerobic flora was observed.
- Increased counts of imipenem-resistant or less susceptible organisms, including Enterococcus spp. (62%) and Candida species (33%).
- No change in isolate susceptibility to imipenem during therapy, but higher MICs for Enterococcus spp. were noted.
Conclusions:
- Imipenem-cilastatin therapy can lead to the overgrowth of resistant microorganisms in the pediatric gut flora.
- The observed increase in Enterococcus spp. with higher MICs warrants further investigation regarding clinical implications.