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Experience with imipenem/cilastatin in the intensive care unit
The Journal of Antimicrobial Chemotherapy
|December 1, 1986
Summary
Imipenem-cilastatin effectively treated severe hospital infections from multi-resistant Gram-negative bacilli, achieving a 77% cure rate. This antibiotic combination showed rapid efficacy in meningitis and ventriculitis cases.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Severe nosocomial infections pose significant challenges due to multi-resistant Gram-negative bacilli.
- Treatment options for these infections are often limited, necessitating effective antimicrobial strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of imipenem combined with cilastatin in treating severe nosocomial infections.
- To assess the effectiveness of this combination against specific Gram-negative pathogens, including Acinetobacter spp. and Pseudomonas aeruginosa.
Main Methods:
- A cohort of 22 ICU patients with severe nosocomial infections were treated with intravenous imipenem-cilastatin.
- Infections included meningo-ventriculitis, septicaemia, mediastinitis, and pneumonia.
- Bacteriological monitoring was performed, with combination therapy including aminoglycosides in most cases.
Main Results:
- A cure was achieved in 17 out of 22 patients (77% cure rate).
- Rapid cerebrospinal fluid sterilization was observed in meningitis and ventriculitis cases.
- Emergence of resistant mutants was noted in three Pseudomonas aeruginosa infections, leading to treatment failures.
Conclusions:
- Imipenem-cilastatin is a highly effective antibiotic for severe nosocomial infections, particularly those caused by Acinetobacter spp. and Pseudomonas aeruginosa.
- The combination demonstrates broad-spectrum activity, including against Gram-negative bacilli and streptococci.
- Close bacteriological monitoring is crucial during treatment to detect emerging resistance.