Adjunctive antimicrobials in surgery of soft tissue infections: evaluation of cephalosporins and carbapenems.
The authors report three trials of B-lactams and carbapenems for soft tissue infections treated on a surgical service: 1) cefmetazole versus cefoperazone, n = 44; 2) cefotetan versus cefoxitin, n = 24; and 3) meropenem versus imipenem, n = 44. A total of 138 hospitalized patients were enrolled with 112 meeting evaluability criteria. Four hundred twenty-three isolates were cultured (mean, three/patient) of which 67 per cent were aerobes and 33 per cent anaerobes. Cure rates for each trial were: 1) 93 per cent; 2) 92 per cent; 3) 100 per cent. Failures were caused by resistant organisms (Streptococcus group D, Bacteroides fragilis and Pseudomonas) appearing in incompletely drained infection sites. Three patients receiving meropenem had adverse effects (headache, nausea) and one receiving cefoxitin (truncal rash). Operative drainage and debridement remain the critical elements in therapy. Agents with longer half lives allowing twice daily dosing (cefmetazole and cefotetan) were as effective and less expensive than multiple doses of short-acting agents. The extended spectrum carbapenems are most useful for severe infections or resistant organisms.
Lami
J L
JL
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Wilson
S E
SE
Hopkins
J A
JA
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000188:drug therapy*; D015780:Carbapenems / Q000008:administration & dosage / Q000627:therapeutic use*; D015311:Cefmetazole / Q000008:administration & dosage / Q000627:therapeutic use; D002438:Cefoperazone / Q000008:administration & dosage / Q000627:therapeutic use; D015313:Cefotetan / Q000008:administration & dosage / Q000627:therapeutic use; D002440:Cefoxitin / Q000008:administration & dosage / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D004352:Drug Resistance, Microbial; D004927:Escherichia coli Infections / Q000188:drug therapy; D005260:Female; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D012874:Skin Diseases, Infectious / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D013845:Thienamycins / Q000008:administration & dosage / Q000627:therapeutic use
D015780:Carbapenems; D002511:Cephalosporins; D004338:Drug Combinations; D013845:Thienamycins; D015311:Cefmetazole; D015313:Cefotetan; D002440:Cefoxitin; D015378:Imipenem; D002438:Cefoperazone; D000077731:Meropenem