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Imipenem therapy of Pseudomonas aeruginosa and other serious bacterial infections
Abstract:
Imipenem is the first of a new class of beta-lactam antimicrobial agents with remarkable and extremely potent in vitro activity against most commonly isolated bacterial pathogens, including Staphylococcus aureus, enterococcus, members of the family Enterobacteriaceae, Pseudomonas aeruginosa, Bacteroides fragilis, and Hemophilus influenzae. The clinical efficacy and toxicity of imipenem were evaluated in 35 patients with 38 different infections. The overall clinical response was favorable (infections cured or improved) in 89% of the infections (34 of 38). Of the 17 infections with P. aeruginosa, 15 were cured or improved. However, P. aeruginosa isolates resistant to imipenem emerged during the therapy of six infections, and two cases of P. aeruginosa septicemia later relapsed after imipenem therapy. Gastrointestinal toxicity (nausea with or without emesis) occurred in 17% of the patients (6 of 35) but was ameliorated by slowing the rate of intravenous infusion or lowering the dose of imipenem. Except for certain severe P. aeruginosa infections, imipenem is effective and relatively safe therapy for infections caused by susceptible organisms.
Insights
Imipenem, a novel beta-lactam antibiotic, shows high efficacy against common bacterial pathogens. While generally safe and effective, careful monitoring is needed due to potential resistance development in Pseudomonas aeruginosa infections.
Area of Science:
- Microbiology
- Pharmacology
- Infectious Diseases
Background:
- Imipenem represents a new class of potent beta-lactam antimicrobial agents.
- It exhibits broad-spectrum in vitro activity against key bacterial pathogens like Staphylococcus aureus, Enterococcus, Enterobacteriaceae, Pseudomonas aeruginosa, Bacteroides fragilis, and Hemophilus influenzae.
Purpose of the Study:
- To evaluate the clinical efficacy and toxicity of imipenem in patients with various infections.
- To assess the effectiveness of imipenem against Pseudomonas aeruginosa infections.
Main Methods:
- Clinical evaluation of imipenem in 35 patients with 38 infections.
- Monitoring treatment response, including cure rates and adverse events.
- Analysis of bacterial isolate susceptibility and emergence of resistance during therapy.
Main Results:
- An overall favorable clinical response (cure or improvement) was observed in 89% of infections (34/38).
- Imipenem was effective against 15 out of 17 Pseudomonas aeruginosa infections.
- Emergence of imipenem resistance in P. aeruginosa occurred in six infections, with two relapses after therapy. Gastrointestinal toxicity (nausea/emesis) was noted in 17% of patients.
Conclusions:
- Imipenem demonstrates significant clinical efficacy and a favorable safety profile for treating infections caused by susceptible bacteria.
- While effective against P. aeruginosa, the potential for resistance development necessitates careful consideration, particularly in severe infections.