Evaluation of imipenem/cilastatin against nosocomial infections and multiresistant pathogens
Abstract:
Thirty-five patients suffering from soft tissue infections (12), upper UTIs (6), bronchopneumonia (6), septicaemia (2), chronic osteomyelitis (2), intra-abdominal abscess (2), liver abscess (1), lung abscess (1), acute cholangitis (1), thoracic empyema (1) and chronic prostatitis (1) were given imipenem/cilastatin for 6-21 days. In 22 patients several aggravating factors coexisted, while infection in 16 patients was polymicrobial. The following pathogens were implicated: Pseudomonas aeruginosa (21), Escherichia coli (15), Enterobacter cloacae (6), Proteus spp. (3), Klebsiella pneumoniae(3), Citrobacter freundii (1), Salmonella enteritidis (1), Acinetobacter spp. (4), Haemophilus influenzae (2), Bacteroides fragilis (1) and Peptococcus saccharolyticus (1) with MICs to imipenem ranging between 0.5 and 8 mg/l. A successful clinical response was observed in 91.4% of the patients, while pathogens were eradicated in 75.9%, persisted in 24.2% and recurred, in 9.1% of patients, with development of resistance to imipenem in two Ps. aeruginosa strains. Against 150 multiresistant strains of Ps. aeruginosa, 40% of which were resistant to amikacin, 86.4% and 88.9% were found sensitive to ceftazidime and imipenem respectively. It is concluded that imipenem provides the possibility of treating successfully multiresistant and polymicrobial infections with a single antimicrobial.
Insights
Imipenem/cilastatin effectively treated various infections, including polymicrobial and multiresistant cases, achieving a 91.4% clinical success rate. This broad-spectrum antibiotic demonstrated significant efficacy against challenging pathogens like Pseudomonas aeruginosa.
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Soft tissue infections, UTIs, and pneumonia are common, often caused by polymicrobial or multiresistant pathogens.
- Imipenem/cilastatin is a broad-spectrum antibiotic used for serious infections.
- Assessing its efficacy in complex cases is crucial for treatment guidelines.
Purpose of the Study:
- To evaluate the clinical efficacy and microbiological outcomes of imipenem/cilastatin in patients with diverse infections.
- To assess the activity of imipenem/cilastatin against multiresistant bacterial strains, particularly Pseudomonas aeruginosa.
Main Methods:
- A prospective study involving 35 patients with various infections treated with imipenem/cilastatin for 6-21 days.
- Pathogen identification and susceptibility testing, including Minimum Inhibitory Concentrations (MICs) for imipenem.
- Evaluation of clinical response and pathogen eradication rates. Testing against 150 multiresistant Pseudomonas aeruginosa strains.
Main Results:
- A 91.4% successful clinical response rate was observed across infections including soft tissue infections, UTIs, and pneumonia.
- Pathogen eradication occurred in 75.9% of patients; resistance to imipenem developed in two Pseudomonas aeruginosa strains.
- Imipenem showed high sensitivity rates (88.9%) against multiresistant Pseudomonas aeruginosa, compared to ceftazidime (86.4%).
Conclusions:
- Imipenem/cilastatin is a highly effective antimicrobial for treating a wide range of complex infections, including polymicrobial and multiresistant cases.
- It offers a valuable therapeutic option, particularly against challenging Gram-negative pathogens like Pseudomonas aeruginosa.
- The study supports the use of imipenem/cilastatin as a single agent for difficult-to-treat infections.
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