[Cefepim in empiric therapy of ventilator-associated pneumonia].
BACKGROUND
The most common infection following surgical treatment, when mechanical ventilation and tracheal intubation are used, is ventilator-associated pneumonia (VAP) induced by Gram-negative and Gram-positive bacteria. Its treatment is difficult due to increasingly high antimicrobial drug resistance observed recently.


METHODS
A 73-year-old patient was admitted to undergo coronary artery bypass grafting and cardiac aneurysm excision. Additionally, chronic circulatory insufficiency (NYHA 2) with ejection fraction of 30% together with hypertension and type 2 diabetes were diagnosed. After extracorporeal circulation, she was given adrenaline/noradrenaline and intra-aortic balloon pump. Postoperatively, elevated levels of CRP (70 mg L(-1)) and of procalcitonin (22.4 ng mL(-1)) were detected. Empiric therapy with cefepime 1 g x 2 iv was started. X-ray revealed atelectasis in the middle left lung lobe and Enterobacter cloacae was isolated from the bronchial tree. Patient was intubated and mechanically ventilated. Antibiotic therapy with cefepime was continued for 10 days and resulted in improvement of patient's general condition. On postoperative day 7, she was transferred from ITU to the cardiac surgery ward.


CONCLUSIONS
Cefepime applied empirically to a VAP patient can effectively treat the lung infection and improve his/her general condition.
Biernawska
Jowita
J
Oddział Anestezjologii, Reanimacji i Intensywnej Terapii z Pododdziałem Ostrych Zatruć SPSK Nr 2 w Szczecinie. lisienko@wp.pl
Zukowski
Maciej
M
Zegan-Barańska
Małgorzata
M
Zukowska
Agnieszka
A
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000150:complications; D053717:Pneumonia, Ventilator-Associated / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D011859:Radiography; D014689:Venous Insufficiency / Q000150:complications
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime