[Value of an imipenem-cilastatin combination in surgery and surgical care units].
One-hundred and ninety-nine patients with severe infection caused by susceptible organisms were treated with imipenem-cilastatin administered intravenously in doses of 31 mg/kg/day on average. The drug was given alone in 71 per cent of the cases and with another antibiotic (usually an aminoglycoside) in 13 per cent. In 57.4 per cent of the patients several micro-organisms were involved. Clinical success was achieved in 169 patients (84.9 per cent), 129 of whom (64.8 per cent) were cured and 40 (20.1 per cent) were improved. Failure was observed in 30 patients (15.0 per cent). Fifteen patients died during treatment; death was directly related to the infection in 5 and occurred while the infection had clinically regressed in 5; in the remaining 5 patients persistence of the infection played a determinant role in the fatal outcome. In 15 patients the lack of clinical improvement under imipenem-cilastatin required by 5/65 Pseudomonas strains and 2/56 Anaerobes strains initially isolated, or to superinfection, or to persistence of the initial strain in the focus of infection. Treatment was discontinued in 8 cases due to adverse events (skin intolerance 4, thrombocytopenia 4). There was no statistically significant difference in the outcome of patients treated with imipenem-cilastatin alone or combined with another antibiotic.
Bouletreau
P
P
Département d'Anesthésie-Réanimation, Hôtel-Dieu, Lyon.
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D015377:Cilastatin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011182:Postoperative Care
D000900:Anti-Bacterial Agents; D015377:Cilastatin; D015378:Imipenem
Intérêt de l'association imipénème-cilastatine en chirurgie et en réanimation chirurgicale.