cilastatin--imipenem-drug-combination and Respiratory-Insufficiency

The paper discusses a case of 50-year-old male admitted to the hospital with symptoms of respiratory failure. The patient had previously been treated for pneumonia. After the admission, control-assisted ventilation was introduced and a swab from endotracheal tube was taken for microbiological examination, as well as pefloxacin, dexamethasone, Ambroxol and heparin treatment was administered. Patients condition improved. After several days respiratory failure intensified, requiring repeated artificial ventilation. According to the obtained antibiogram, Tienam was administered with favourable results. During the therapy with Tienam no side-effects were observed. Based on chest X-ray examination and data from interview, infection of multiple congenital bronchogenic cysts was diagnosed.

Topics: Bronchogenic Cyst; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Imipenem; Male; Middle Aged; Respiration, Artificial; Respiratory Insufficiency; Trachea

In an open prospective study the efficacy and tolerance of imipenem/cilastatin was investigated in 24 critically ill patients on mechanical ventilation with nosocomial respiratory tract infection. Nine patients had previously received antibiotic therapy, eight of them with various other beta-lactam antibiotics which had failed. Imipenem was given in a dose of 1-3 g/24 h over 5-37 (mean 11) days. Seven patients were additionally treated with aminoglycosides, one patient with erythromycin. Pseudomonas aeruginosa (n = 14), Staphylococcus aureus (n = 4), Haemophilus influenzae (n = 4) and Escherichia coli (n = 3) were the potential pathogens most frequently isolated from tracheo-bronchial secretions. All of the isolates were susceptible to imipenem. 91% of the infections without and 77% with involvement of P. aeruginosa were successfully treated. Two patients who had not responded to previous treatment succumbed to the consequences of progressive respiratory distress syndrome. All of the gram-positive and 85% of the gram-negative pathogens (Pseudomonas not included) were eliminated in the course of therapy. By contrast, 64% of the isolates of P. aeruginosa persisted; half of these became imipenem-resistant. Nine patients showed adverse reactions including one case of pseudomembranous colitis or laboratory abnormalities which were all reversible. Imipenem/cilastatin proved highly effective and was relatively well tolerated; it is suitable as a single agent for the initial treatment of nosocomial respiratory tract infections in ventilated patients, although only with limitations in cases of infection due to P. aeruginosa.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cilastatin; Cilastatin, Imipenem Drug Combination; Cross Infection; Cyclopropanes; Drug Combinations; Female; Humans; Imipenem; Male; Middle Aged; Prospective Studies; Respiration, Artificial; Respiratory Insufficiency; Respiratory Tract Infections; Thienamycins