[Azlocillin plus amikacin: an alternative therapy for sepsis caused by resistant staphylococci?].
OBJECTIVE
To assess the effectiveness of combined therapy with azlocillin and amikacin in a group of neonates with sepsis caused by multiresistant staphylococci who were hospitalized in the neonatal intensive care unit of Hospital Ginecobstétrico "America Arias" in Havana, Cuba, from 1998 to 2000.


METHODS
A retrospective study was carried out of the clinical and laboratory results obtained in 15 patients with sepsis caused by multiresistant staphylococci who received combined therapy with azlocillin and amikacin, according to hospital guidelines on the use of antibiotics. We used a broth microdilution method to study the patterns of resistance shown by isolated strains to 10 of the antibiotics in use. In vitro synergy tests, specifically the checkerboard technique with microtitration plates, were used to observe the effects of treatment in 8 patients.


RESULTS
Twelve coagulase-negative staphylococci and three Staphylococcus aureus isolates showed five different patterns of resistance on the basis of their sensitivity to oxacillin, three aminoglycosides, and vancomycin. Six of the synergy tests showed a considerable synergistic effect, with an average three-fold reduction in the minimum inhibitory concentrations (MIC) of the two antibiotics used to treat the patients. No antagonistic effects were noted, and the combined antibiotics showed an overall clinical effectiveness of 91.7%.


CONCLUSIONS
The test showed that the therapeutic combination used was effective, but further studies are needed before conclusive results are obtained.
Hernández
María Espino
ME
Departamento de Agentes Biológicos, Escuela Latinoamericana de Medicina, Ciudad de La Habana, Cuba. mespino@elacm.sld.cu
Ramos
María Julia Couto
MJ
Ferrer
Niurka Fiol
NF
D000583:Amikacin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001390:Azlocillin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D004357:Drug Synergism; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008826:Microbial Sensitivity Tests; D008962:Models, Theoretical; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013210:Staphylococcus / Q000187:drug effects*; D013211:Staphylococcus aureus / Q000187:drug effects
D000900:Anti-Bacterial Agents; D000583:Amikacin; D001390:Azlocillin