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Piperacillin in surgical infections: a clinical trial
Abstract:
Piperacillin was administered in eighteen patients with mixed infections. Three had osteomyelitis, two had peritonitis, two had gangrenous toes, one had bronchopneumonia, and the other ten had leg ulcers of various types accompanies by cellulitis. In eleven patients one of the infecting organisms was Pseudomonas aeruginosa, and another had Pseudomonas maltophilia. All had appropriate surgical treatment, which in nine patients included skin grafting in the presence of Pseudomonas aeruginosa. All the patients were clinically cured except for one with osteomyelitis who relapsed and was found to have a residual sequestrum. None of the skin grafts failed. In other patient who underwent grafting, cloxacillin was also given because she had a beta-lactamase-producing staphylococcus. The only adverse reaction was thrombophlebitis of the vein used for drug administration in 15 out of 18 patients. One hundred and five other isolates of Pseudomonas aeruginosa were tested in the laboratory against piperacillin and resistance to the drug was found to be rare. It was concluded that piperacillin is a safe drug to use, is effective against a wide range of organisms, and is particularly effective in preventing the destruction of skin grafts by Pseudomonas aeruginosa. It is likely to be ineffective against beta-lactamase-producing staphylococci, and when these are present also, it would be wise to use another drug such as cloxacillin in addition.
Insights
Piperacillin effectively treated mixed infections, including those with Pseudomonas aeruginosa, and prevented skin graft loss. However, it may be less effective against beta-lactamase-producing staphylococci, suggesting combination therapy.
Area of Science:
- Infectious Diseases
- Pharmacology
- Surgical Infections
Background:
- Mixed infections pose significant treatment challenges, often involving challenging pathogens like Pseudomonas aeruginosa.
- Skin grafting is a critical procedure for managing certain types of infections and injuries, but graft survival can be compromised by bacterial contamination.
Purpose of the Study:
- To evaluate the efficacy and safety of piperacillin in treating patients with various mixed infections.
- To assess piperacillin's role in preventing Pseudomonas aeruginosa-related complications, particularly in skin graft procedures.
- To determine the susceptibility of Pseudomonas aeruginosa isolates to piperacillin.
Main Methods:
- Eighteen patients with mixed infections (osteomyelitis, peritonitis, gangrenous toes, bronchopneumonia, leg ulcers with cellulitis) received piperacillin.
- Surgical treatment, including skin grafting in nine patients, was administered concurrently.
- Laboratory testing assessed the susceptibility of 105 Pseudomonas aeruginosa isolates to piperacillin.
Main Results:
- Piperacillin achieved clinical cure in most patients, with one case of osteomyelitis relapse.
- No skin graft failures occurred, even in the presence of Pseudomonas aeruginosa.
- Thrombophlebitis was the most common adverse reaction (15/18 patients); resistance of Pseudomonas aeruginosa to piperacillin was rare.
Conclusions:
- Piperacillin is a safe and effective antibiotic for mixed infections, demonstrating particular efficacy in preserving skin grafts against Pseudomonas aeruginosa.
- Combination therapy with cloxacillin is recommended when beta-lactamase-producing staphylococci are co-present.
- Piperacillin exhibits low resistance rates among Pseudomonas aeruginosa isolates.