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Immune response in patients with intra-abdominal infections treated with carbapenems
B Brismar1, A E Eklund, C E Nord
1Department of Surgery, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
Abstract:
The immune responses against isolated microorganisms in patients with intraabdominal infections treated with meropenem or imipenem/cilastatin were investigated. Fifty-nine patients received meropenem 500 mg t.i.d. intravenously for 3-21 days (mean 5.4 days) and 50 patients imipenem/cilastatin 500 mg/500 mg t.i.d. intravenously for 3-17 days (mean 5.1 days). Three serum samples were taken from each patient, the first sample at admission, the second sample between three and seven days after start of antibiotic treatment, and the third sample between 14 and 28 days later. Ninety-eight per cent of the patients in the meropenem group and 95% of the patients in the imipenem/cilastatin group were cured. There was no difference in the clinical outcome between the two treatment groups. Escherichia coli, Bacteroides fragilis group, anaerobic cocci, Staphylococcus epidermidis, and Klebsiella spp. predominated among the isolated microorganisms. Thirty-nine patients in the meropenem group had significant immune responses against one or more of the isolated microorganisms while 31 patients in the imipenem/group had significant responses. E. coli and B. fragilis gave rise in antibody titres in most patients indicating that these species are the most important pathogens in intraabdominal infections.
Insights
Meropenem and imipenem/cilastatin showed similar clinical outcomes for intraabdominal infections. Both antibiotics effectively treated patients, with Escherichia coli and Bacteroides fragilis identified as key pathogens triggering immune responses.
Area of Science:
- Infectious Diseases
- Immunology
- Pharmacology
Background:
- Intraabdominal infections (IAIs) are serious conditions requiring effective antibiotic treatment.
- Meropenem and imipenem/cilastatin are broad-spectrum carbapenem antibiotics used for IAIs.
- Understanding immune responses during treatment is crucial for patient outcomes.
Purpose of the Study:
- To compare the immune responses to isolated microorganisms in patients with IAIs treated with meropenem versus imipenem/cilastatin.
- To evaluate the clinical efficacy and outcomes of meropenem and imipenem/cilastatin in IAI patients.
- To identify key pathogens responsible for IAIs and their role in eliciting immune responses.
Main Methods:
- Prospective study involving 109 patients with IAIs.
- Patients received either meropenem (59 patients) or imipenem/cilastatin (50 patients) intravenously.
- Serum samples were collected at admission, during treatment, and post-treatment to assess immune responses (antibody titers).
Main Results:
- Clinical cure rates were high and similar for both groups: 98% for meropenem and 95% for imipenem/cilastatin.
- No significant difference in clinical outcomes was observed between the two treatment groups.
- Significant immune responses were detected in a majority of patients, particularly against Escherichia coli and Bacteroides fragilis group.
- E. coli and B. fragilis were the predominant microorganisms isolated and elicited the strongest antibody responses.
Conclusions:
- Meropenem and imipenem/cilastatin are equally effective in treating intraabdominal infections.
- Both antibiotics demonstrate high clinical efficacy and similar patient outcomes.
- Immune responses, especially against E. coli and B. fragilis, are significant in IAIs, highlighting their role as primary pathogens.