[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: N V Beloborodova, S T Kuznetsova, D A Popov, E N Bachinskaia, T Iu Vostrikov
• Journal: Antibiotiki i khimioterapiia = Antibiotics and chemoterapy [sic] (Antibiot Khimioter) Vol. 50 Issue 4 Pg. 33-40 ( 2005) ISSN: 0235-2990 [Print] Russia (Federation)
• PMID: 16392338 (Publication Type: English Abstract, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Drug Combinations
• Cefoperazone
• sulperazone
• Sulbactam

Topics

• Adult
• Anti-Bacterial Agents (adverse effects, pharmacology, therapeutic use)
• Cefoperazone (adverse effects, pharmacology, therapeutic use)
• Child
• Child, Preschool
• Cross Infection (drug therapy, microbiology)
• Drug Combinations
• Gram-Negative Bacteria (drug effects, isolation & purification)
• Humans
• Infant
• Male
• Middle Aged
• Postoperative Complications (drug therapy, microbiology)
• Sulbactam (adverse effects, pharmacology, therapeutic use)