Nosocomial Infections Caused by Acinetobacter spp. — Therapeutic Problems
E. Bergogne-Bénézin, M.L. Joly-Guillou, K.J. Towner in Acinetobacter, 2020
Finally, some overall recommendations can be made for the treatment of Acinetobacter meningitis. Imipenem should be used for eradication of infections caused by multiresistant strains. Ticarcillin, ureidopenicillins or fluoroquinolones may be appropriate for use against susceptible strains. The combined use of an aminoglycoside administered by the i.v. and/or local route may not always be necessary, provided that high doses of ß-lactams or fluoroquinolones are used. Meropenem is a novel carbapenem antibiotic that is currently active against Acinetobacter, with CSF concentrations that range from 0.3-6.5 mg/L at 2.5-3.0 h following a 40 mg/kg infusion (Dagan et al., 1994). This agent may also be useful for the treatment of Acinetobacter meningitis caused by otherwise resistant strains.
Acute Pancreatitis
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
The issue was reexamined in those with severe pancreatitis in a well-performed randomized study of 38 patients by Kalfarentzos et al. [44]. Severe pancreatitis was defined as three or more Imrie criteria or an APACHE II score >8 combined with a CRP concentration >120 mg/L within 48 h of admission and Grade D or E findings by Balthazar CT criteria. All patients received antibiotic prophylaxis with imipenem. The 18 patients randomized to EN had a naso-enteric tube placed fluoroscopically within 48 h of admission (two patients had unsuccessful placement and were excluded from analysis). Feedings were initiated immediately thereafter in resuscitated, “stable” patients. There was no difference in the clinical course of either group with respect to the need for operation, LOS, and mortality. Target nutritional goals were reached and nitrogen balance improved progressively and equally in both groups. The mean number of infections per patient as well as the overall complication rate was significantly less in those receiving EN; however, a few pancreatic infections were noted. EN was significantly less expensive. The authors conclude that early EN in those with severe pancreatitis is safe and preferential to TPN.
Antimicrobials during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Imipenem is a carbapenem antibiotic derived from thienamycin. It is usually combined with cilastatin, which inhibits the renal metabolism of imipenem. Cilastatin has no antimicrobial activity. Imipenem is effective against Gram-positive and Gram-negative aerobic and anaerobic organisms. It is often effective as single-agent therapy for polymicrobial pelvic infections in women. No studies of imipenem use in pregnancy and birth defects are published. Imipenem—cilastatin combination was not teratogenic in rats or rabbits, according to the manufacturer package insert. This drug has few indications for use of this very ‘potent’ antibiotic in pregnant women. Potential maternal side effects include hypersensitivity, central nervous system toxicity, and pseudomembranous colitis.
An overview of cilastatin + imipenem + relebactam as a therapeutic option for hospital-acquired and ventilator-associated bacterial pneumonia: evidence to date
Published in Expert Opinion on Pharmacotherapy, 2021
Júlia Sellarès-Nadal, Simeón Eremiev, Joaquin Burgos, Benito Almirante
Imipenem (N-formimidoyl-thienamycin) is a broad-spectrum antimicrobial agent that belongs to the carbapenem family. Carbapenems are β-lactams that are derived from thienamycin, which is produced by Streptomyces cattleya, a soil organism [28]. Their difference from penicillins is the substitution of a carbon atom rather than the sulfur atom at C1 and the presence of a double bond between C2 and C3 in the five-membered ring structure [29]. The carbon atom at C1 improves the efficacy and spectrum of carbapenems. Moreover, carbapenems are intrinsically resistant to hydrolysis by a great number of β-lactamases due to their hydroxyethyl side chain at C6 [30]. The trans configuration at C6 is characteristic of carbapenems, in contrast to the cis side chains of penicillins and cephalosporins, and explains the stability of carbapenems to β-lactamases. In the renal tubules, imipenem undergoes rapid degradation by an enzyme called dehydropeptidase (DPH-1). This is the reason why cilastatin must be administered, a molecule that has no antimicrobial activity but plays a role in inhibiting DPH-1, decreasing the nephrotoxic metabolites of impipenem. Other mechanism why cilastin prevent nephrotoxicity of imipenem are by the anti-inflammatory and antioxidative activity, as well as the reduction of renal transport and accumulation of toxins [23,25]
Integrated metabolomics and 16S rRNA sequencing to investigate the regulation of Chinese yam on antibiotic-induced intestinal dysbiosis in rats
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2019
Yaping Sun, Tong Liu, Yanpo Si, Bing Cao, Yanli Zhang, Xiaoke Zheng, Weisheng Feng
Lmipenem/cilastatin sodium as a mixture antibiotic which could prevent and treat some serious disease caused by aerobic/anaerobic bacteria for its more safety and less adverse reaction [21]. But current research shows that imipenem can cause kidney toxicity and even urolithiasis [22]. As well as it could induced an oxidative stress-status and histopathological changes in the testis and altered spermatogenesis in particular at both 50 and 80 mg/kg dose-levels [23]. A study on the analysis of urine samples collected from cynomolgus monkey dosed with imipenem revealed a significant increase of β-hydroxybutyrate and ketone bodies, indicating a disruption of energy metabolism resulting from the suppression of gut microflora [24]. Research shows: normal Wistar rats were exposed to a broad spectrum β-lactam antibiotic imipenem/cilastatin sodium, at 50 mg/kg/daily for 4 days, then 14 days after recovery, the flora and metabolites began to recover, but still not exactly the same as the normal group [25]. Imipenem has an extremely wide range of activities against aerobic and anaerobic gram-positive bacteria as well as gram-negative bacteria. Therefore, in our study, imipenem was selected to rapidly and completely remove microorganisms from the gastrointestinal tract.
Ertapenem-associated neurotoxicity in the spinal cord injury (SCI) population: A case series
Published in The Journal of Spinal Cord Medicine, 2018
Ursula C. Patel, Mallory A. Fowler
On day five of ertapenem therapy, the patient was noted to be confused, asking the same questions repetitively. On day six, he was documented as being oriented to person only and remained in a confused and forgetful state for the next three days. Medications at the time of confusion included dantrolene, diazepam, baclofen, tizanidine, cholecalciferol, simethicone, potassium, docusate enemas, and various topicals for wound care. Psychiatry was consulted and determined that confusion was likely related to delirium and that medications were probably not the etiology. All labs checked around this time returned unremarkable. A CT of the head was performed seven days into ertapenem therapy and revealed only mild cerebral atrophy. Haloperidol was given as needed for agitation, baclofen dosing was tapered down and eventually stopped, and diazepam dosing was tapered down. Ertapenem was discontinued on the ninth day of therapy and flap surgery was rescheduled due to the patient’s delirium. His mental status continued to improve over the next few days following ertapenem discontinuation, however never fully returned to baseline until documented as such six weeks later. Flap surgery was performed a month after discontinuation of the ertapenem. Further use of ertapenem was avoided during this admission but various beta lactam antimicrobials, including imipenem/cilastatin, were used after this incident and confusion never returned.
Related Knowledge Centers
- Anaerobic Organism
- Antibiotic
- Bacteria
- Intravenous Therapy
- Beta-Lactam
- Thienamycin
- Streptomyces Cattleya
- Aerobic Organism
- Gram-Positive Bacteria
- Gram-Negative Bacteria