title: [Clinical experience with the treatment of severe nosocomial infections by inhibitor-protected 3rd generation cephalosporin cefoperazone/sulbactam].
abstract: A retrospective analysis of the clinical and microbiological efficacy and safety of cefoperazone/sulbactam in the treatment of 39 cardiosurgical patients operated under the conditions of artificial circulation is presented. The age of the adult patients (n = 28) varied from 44 to 58 years and that of the pediatric patients varied from 4 months to 6 years. Antibacterial therapy of 26 patients was needed because of postoperative infectious complications, such as nosocomial pneumonia in 22 patients and sepsis in 4 patients. The antibacterial therapy with cefoperazone/sulbactam in 9 patients was performed during the operation because of active infectious endocarditis. In 4 patients there were observed clinical and laboratory signs of infection without the infection foci. The initial empirical therapy with cefoperazone/sulbactam was applied to 14 patients (group 1) and the target-aimed therapy based on the data of the pathogen susceptibility to cefoperazone/sulbactam was used in 6 patients (group 2). 19 patients (group 3) were treated with cefoperazone/sulbactam because of the fail of the previous antibacterial therapy, including the 4th generation cephalosporins and carbapenems as well. Cefoperazone/sulbactam was used in the monotherapy of 15 cases (38%). Cefoperazone/sulbactam showed high efficacy in the treatment of severe nosocomial infections and infectious endocarditis (in combination with vancomycin or linezolid). It amounted to 93, 100 and 79% in groups 1, 2 and 3 respectively, the total of 94%. The results of the microbiological assay were evident of the cefoperazone/sulbactam high activity against the problem gram nagative isolates of Klebsiella pneumoniae (n = 12), Acinetobacter baumanii (n = 4), Pseudomonas aeruginosa (n = 4) and Stenotrophomonas maltophilia (n = 5). Adverse reactions were stated in 2 patients (5%), 1 case of urticaria requiring discontinuation of the drug use. Many of the patients proved to be colonized by MRS before the therapy with cefoperazone/sulbactam. The high probability of staphylococcal superinfection required combination of cefoperazone/sulbactam with antistaphylococcal agents, such as rifampicin, fusidin, vancomycin, linezolid. The best results were provided by the target-aimed therapy based on the microbiological monitoring.
authors.forename: N V
authors.initials: NV
authors.lastname: Beloborodova
authors.forename: S T
authors.initials: ST
authors.lastname: Kuznetsova
authors.forename: D A
authors.initials: DA
authors.lastname: Popov
authors.forename: E N
authors.initials: EN
authors.lastname: Bachinskaia
authors.forename: T Iu
authors.initials: TIu
authors.lastname: Vostrikov
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002438:Cefoperazone / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D004338:Drug Combinations; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000382:microbiology; D013407:Sulbactam / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D002438:Cefoperazone; C057923:sulperazone; D013407:Sulbactam