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. 1994 Jun;38(6):1309–1313. doi: 10.1128/aac.38.6.1309

Prospective randomized comparison of imipenem monotherapy with imipenem plus netilmicin for treatment of severe infections in nonneutropenic patients.

A Cometta 1, J D Baumgartner 1, D Lew 1, W Zimmerli 1, D Pittet 1, P Chopart 1, U Schaad 1, C Herter 1, P Eggimann 1, O Huber 1, et al.
PMCID: PMC188203  PMID: 8092830

Abstract

Nosocomial pneumonia and sepsis, as well as severe diffuse peritonitis, must be treated early in order to prevent complications such as septic shock and organ dysfunctions. With the availability of new broad-spectrum and highly bactericidal antibiotics, the need of combining beta-lactams with aminoglycosides for the treatment of severe infections should be reassessed. A prospective randomized controlled study was performed to compare imipenem monotherapy with a combination of imipenem plus netilmicin in the empiric treatment of nosocomial pneumonia, nosocomial sepsis, and severe diffuse peritonitis. A total of 313 patients were enrolled, and 280 were assessable. The antibiotic treatment was successful in 113 of 142 patients (80%) given the monotherapy and in 119 of 138 patients (86%) given the combination (P = 0.19). The failure rates for the most important type of infection, i.e., pneumonia, were similar in the two groups, as well as the number of superinfections. While creatinine increase was associated with factors not related to antibiotic therapy for all eight patients of the monotherapy group, no factor other than the antibiotics could be found for 6 of the 14 cases of nephrotoxicity observed in the combination group (P = 0.014). Finally, the emergence of Pseudomonas aeruginosa resistant to imipenem occurred in 8 monotherapy patients and in 13 combination therapy patients. In conclusion, imipenem monotherapy appeared as effective as the combination of imipenem plus netilmicin for the treatment of severe infection. The addition of netilmicin increased nephrotoxicity, and it did not prevent the emergence of P. aeruginosa resistant to imipenem.

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Selected References

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  1. Bohnen J., Boulanger M., Meakins J. L., McLean A. P. Prognosis in generalized peritonitis. Relation to cause and risk factors. Arch Surg. 1983 Mar;118(3):285–290. doi: 10.1001/archsurg.1983.01390030017003. [DOI] [PubMed] [Google Scholar]
  2. Bone R. C., Fisher C. J., Jr, Clemmer T. P., Slotman G. J., Metz C. A., Balk R. A. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med. 1987 Sep 10;317(11):653–658. doi: 10.1056/NEJM198709103171101. [DOI] [PubMed] [Google Scholar]
  3. Calandra T., Cometta A. Antibiotic therapy for gram-negative bacteremia. Infect Dis Clin North Am. 1991 Dec;5(4):817–834. [PubMed] [Google Scholar]
  4. Eliopoulos G. M., Eliopoulos C. T. Antibiotic combinations: should they be tested? Clin Microbiol Rev. 1988 Apr;1(2):139–156. doi: 10.1128/cmr.1.2.139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Garner J. S., Jarvis W. R., Emori T. G., Horan T. C., Hughes J. M. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988 Jun;16(3):128–140. doi: 10.1016/0196-6553(88)90053-3. [DOI] [PubMed] [Google Scholar]
  6. Gribble M. J., Chow A. W., Naiman S. C., Smith J. A., Bowie W. R., Sacks S. L., Grossman L., Buskard N., Growe G. H., Plenderleith L. H. Prospective randomized trial of piperacillin monotherapy versus carboxypenicillin-aminoglycoside combination regimens in the empirical treatment of serious bacterial infections. Antimicrob Agents Chemother. 1983 Sep;24(3):388–393. doi: 10.1128/aac.24.3.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gudiol F., Pallarés R., Ariza X., Fernández-Viladrich P., Rufi G., Liñares J. Comparative clinical evaluation of aztreonam versus aminoglycosides in gram-negative septicaemia. J Antimicrob Chemother. 1986 May;17(5):661–671. doi: 10.1093/jac/17.5.661. [DOI] [PubMed] [Google Scholar]
  8. Haley R. W., Culver D. H., White J. W., Morgan W. M., Emori T. G., Munn V. P., Hooton T. M. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985 Feb;121(2):182–205. doi: 10.1093/oxfordjournals.aje.a113990. [DOI] [PubMed] [Google Scholar]
  9. Kreger B. E., Craven D. E., Carling P. C., McCabe W. R. Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. Am J Med. 1980 Mar;68(3):332–343. doi: 10.1016/0002-9343(80)90101-1. [DOI] [PubMed] [Google Scholar]
  10. Moellering R. C., Jr Antimicrobial synergism--an elusive concept. J Infect Dis. 1979 Oct;140(4):639–641. doi: 10.1093/infdis/140.4.639. [DOI] [PubMed] [Google Scholar]
  11. Mouton Y., Deboscker Y., Bazin C., Fourrier F., Moulront S., Philippon A., Socolovsky C., Suinat J. L., Tondriaux A. Etude prospective randomisée contrôlée imipénème-cilastatine versus céfotaxime-amikacine dans le traitement des infections respiratoires inférieures et des septicémies de réanimation. Presse Med. 1990 Apr 4;19(13):607–612. [PubMed] [Google Scholar]
  12. Odio C. M., Umana M. A., Saenz A., Salas J. L., McCracken G. H., Jr Comparative efficacy of ceftazidime vs. carbenicillin and amikacin for treatment of neonatal septicemia. Pediatr Infect Dis J. 1987 Apr;6(4):371–377. doi: 10.1097/00006454-198704000-00006. [DOI] [PubMed] [Google Scholar]
  13. Rubinstein E., Green M., Modan M., Amit P., Bernstein L., Rubinstein A. The effects of nosocomial infections on the length and costs of hospital stay. J Antimicrob Chemother. 1982 Jan;9 (Suppl A):93–100. doi: 10.1093/jac/9.suppl_a.93. [DOI] [PubMed] [Google Scholar]
  14. Salata R. A., Gebhart R. L., Palmer D. L., Wade B. H., Scheld W. M., Groschel D. H., Wenzel R. P., Mandell G. L., Duma R. J. Pneumonia treated with imipenem/cilastatin. Am J Med. 1985 Jun 7;78(6A):104–109. doi: 10.1016/0002-9343(85)90110-x. [DOI] [PubMed] [Google Scholar]
  15. Solomkin J. S., Meakins J. L., Jr, Allo M. D., Dellinger E. P., Simmons R. L. Antibiotic trials in intra-abdominal infections. A critical evaluation of study design and outcome reporting. Ann Surg. 1984 Jul;200(1):29–39. doi: 10.1097/00000658-198407000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]

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