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Pneumonia treated with imipenem/cilastatin
Abstract:
In an open, prospective, multicenter trial the efficacy and tolerance of imipenem/cilastatin for the treatment of bacterial pneumonia was investigated. Forty-three adults were studied: 29 with nosocomial and 14 with community-acquired infections. Significant underlying disease was present in 91 percent of patients. Nosocomial infection was frequently associated with endotracheal intubation (48 percent), prior antibiotic therapy (48 percent), and recent surgery (31 percent). Most frequent sputum isolates included Pseudomonas aeruginosa (10, all nosocomial), Hemophilus influenzae (10), Escherichia coli (eight), Staphylococcus aureus (seven), and Streptococcus pneumoniae (six). Treatment with imipenem/cilastatin was associated with clinical cure in 93 percent of patients. Two of three failures and one superinfection occurred in association with isolates of Pseudomonas aeruginosa resistant to imipenem. Overall, six of 10 strains of Pseudomonas aeruginosa isolated prior to therapy developed resistance to imipenem after an average of 10 days of therapy. Adverse effects occurred in nine patients (21 percent) and included one case of pseudomembranous colitis. Monotherapy with imipenem/cilastatin of serious lower respiratory tract infections was relatively safe and highly effective with the exception of disease associated with P. aeruginosa.
Insights
Imipenem/cilastatin effectively treated bacterial pneumonia in 93% of patients. However, treatment failures and resistance occurred with Pseudomonas aeruginosa infections.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Bacterial pneumonia, particularly nosocomial infections, presents a significant treatment challenge.
- Patients often have severe underlying conditions and risk factors like intubation and prior antibiotic use.
- Pseudomonas aeruginosa is a common and often resistant pathogen in severe pneumonia.
Purpose of the Study:
- To evaluate the efficacy and tolerance of imipenem/cilastatin for bacterial pneumonia.
- To assess treatment outcomes in patients with both nosocomial and community-acquired pneumonia.
- To identify any limitations or specific pathogen-related challenges with imipenem/cilastatin therapy.
Main Methods:
- An open, prospective, multicenter clinical trial was conducted.
- Forty-three adult patients with bacterial pneumonia were enrolled.
- Clinical outcomes and microbiological data, including pathogen resistance, were analyzed.
Main Results:
- Imipenem/cilastatin achieved a clinical cure rate of 93% in treated patients.
- Treatment failures and superinfections were linked to imipenem-resistant Pseudomonas aeruginosa.
- Six out of ten P. aeruginosa strains developed resistance during therapy.
- Adverse effects were observed in 21% of patients, including one case of pseudomembranous colitis.
Conclusions:
- Imipenem/cilastatin is a safe and highly effective monotherapy for serious lower respiratory tract infections.
- Efficacy is compromised in cases involving Pseudomonas aeruginosa, particularly resistant strains.
- Careful monitoring for resistance is crucial, especially with P. aeruginosa infections.