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Query: KEGG:D00206 (IPM)
 1,479 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An epidemiologic investigation was carried out in Ogaki Municipal Hospital to clarify the status of nosocomial MRSA Infection between 1989 and 1991. In 1989, coagulase type IV, enterotoxin A-producing, and phage group I strains, which were highly resistant to multiple antibiotics and isolated in the internal wards, accounted for 43.4% of all MRSA strains clinically isolated in the entire hospital. In 1990, coagulase type II strains that were sensitive to GM but resistant to FMOX and IPM increased. There were significant differences in the frequency of detection of various strains among wards, suggesting an inter-ward variation in MRSA strains. Changes in environmental strains reflected those in clinical strains. The findings suggest the necessity of measures not only for long-hospitalized MRSA carriers themselves but also for the environment of patients, medical staff, and those taking care of patients.
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PMID:[An assessment of nosocomial infections of methicillin-resistant Staphylococcus aureus based on coagulase typing and phage typing]. 150 55

The efficacy of imipenem-cilastatin was compared with that of tobramycin and metronidazole for the treatment of appendicitis-associated abdominal infections in children in an open, randomized trial. Two hundred eighteen patients between 2.5 and 16.8 years of age hospitalized for appendectomy because of suspected acute appendicitis were allocated to 5 treatment groups. The appendix was perforated in 54 (33.8%) of the 160 cases with appendicitis. All patients responded favorably to treatment. Infection in the wound occurred in 15 of 125 (12.0%) of those without preoperative antibiotic therapy and in 5 of 83 (6.0%) of those given imipenem preoperatively (P = 0.12; 95% confidence interval, -2.2 to 14.2%). C-reactive protein decreased significantly faster in those with perforated appendix treated with imipenem than in those treated with tobramycin and metronidazole (58.2 mg/liter vs. 89.4 mg/liter, P less than 0.05 on the third postoperative day). Imipenem-cilastatin was at least as effective and economically comparable as tobramycin and metronidazole for the treatment of appendicitis-associated infections in children.
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PMID:Imipenem-cilastatin vs. tobramycin and metronidazole for appendicitis-related infections. 160 80

Antibiotic usage for initial empirical treatment of infections in hospitalized patients was assessed by means of a questionnaire sent to physicians in charge of surgical and medical intensive care units, departments of neurosurgery, neurology, general surgery, thoracic surgery, internal medicine and pediatrics. Analysis of a total of 82 questionnaires filled in by the various departments revealed that the most frequently used regimens for initial empirical therapy were combinations of a broad spectrum penicillin with an amino-glycoside or of a second generation cephalosporin with an aminoglycoside in intensive care. Third generation cephalosporins ranked third among combination partners with aminoglycosides. Imipenem and fluoroquinolones were used only rarely for first line treatment. Second line treatment was most frequently with third generation cephalosporins or imipenem/cilastatin for internal wards and intensive care with an extension for staphylococcal infections with vancomycin or teicoplanin as the most frequent additional antibiotics. Patterns of antibiotic usage changed with regard to infection sites with a predominance of third generation cephalosporins or broad spectrum penicillins in combination with an aminoglycoside and metronidazole in abdominal sepsis and peritonitis. In case of pneumonia a differentiation between community acquired and hospital acquired pneumonias was made. Treatment was predominantly carried out with penicillin G, ampicillin or a second generation cephalosporin with or without the addition of an aminoglycoside in case of community acquired pneumonia. The addition of clindamycin or metronidazole was considered for suspected staphylococcal infection or aspiration pneumonia. Third generation cephalosporins were preferred for pneumonia treatment in surgical patients.
Infection
PMID:Antibiotic usage for initial empirical treatment of infections in hospitalized patients in West Germany. 188 63

Ten patients about to undergo a colorectal operation lasting an average of three hours received 500 mg each of imipenem and cilastatin i.v. preoperatively. During the operation blood and tissue samples were taken in order to determine the serum kinetics of the substances as well as the levels of imipenem in the cutis, subcutis, fascia, muscle, parietal peritoneum and colon. The imipenem concentrations were measured by HPLC. The mean peak serum concentration was 26 mg/l, the mean half-life 55 min and the AUC 40 mg/l/h-1. The serum pharmacokinetics of imipenem was subject to substantially larger fluctuations in this patient group than in subjects or patients without surgery. Imipenem rapidly penetrates into tissue, with peak concentrations being reached after 10-25 min. The highest imipenem concentrations were found in the colon, the lowest in the cutis and subcutis. After 1 h a level of 8 mg/kg imipenem was still found in the colon. The concentrations were greater than 1 mg/kg in all tissues for more than 3 h p. a. and thus within this period exceeded the MICs of Escherichia coli and Bacteroides fragilis, the indicator organisms of intraabdominal infections.
Infection
PMID:Pharmacokinetics of imipenem in patients undergoing major colon surgery. 207 10

Infections of the foot in the person with diabetes are the result of a complex myriad of pathophysiologic alterations. Neuropathy, vascular disease, and host immune alterations all interact to present a fertile ground for significant microbiologic invasion. When infection occurs, it is commonly due to a mixed flora of aerobic and anaerobic organisms, although "pure" aerobic or anaerobic infections are sometimes seen. Treatment of these infections requires a broad approach, including surgery, local care, and antibiotics. Most often, treatment against aerobic and anaerobic pathogens will be necessary. These infections can be divided into two categories based on clinical appearance. Severe life- or limb-threatening infections can present with massive cellulitis of the foot and leg, high fever, significantly elevated white blood count, septicemia, and tissue gas. Appropriate antibiotics in this setting include either combination or single-agent therapy. Imipenem/cilastatin offers coverage of all usual pathogens along with potentially lower toxicity and lower cost than combinations. Combinations containing clindamycin and aztreonam or ciprofloxacin may be useful for patients allergic to beta-lactam antibiotics. Less severe infections can usually be treated with a single-agent antibiotic such as ticarcillin/clavulanic acid or ampicillin/sulbactam. Cephalosporins with anaerobic activity, including cefoxitin, cefotaxime, and ceftizoxime, can be used in areas where enterococci are not a major problem.
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PMID:Microbiology and antimicrobial therapy of diabetic foot infections. 220 47

Patients under immunosuppressive therapy with malignant diseases, malformations, premature infants or children after major surgical interventions and trauma are particularly susceptible to infections. In these patients nosocomial infections with multiply resistant organisms may occur despite broad spectrum antibiotic prophylaxis or antimicrobial chemotherapy of existing infections. In an open clinical study 31 infants and children with an overall 45 episodes of life-threatening hospital-acquired infections occurring under broad spectrum antimicrobial coverage were treated with imipenem/cilastatin alone or in various combinations. All the patients were immunocompromised. The most frequent single diagnosis was sepsis--documented by a positive blood culture--followed by nosocomial pneumonia, urinary tract infection and peritonitis. In seven patients an infection of implanted biomaterial was present which could not be controlled by the previously administered antimicrobial therapy. Imipenem/cilastatin was given in a dose of 50 mg/kg BW. Therapy was well tolerated, no side effects were observed. A total of 34 of 45 episodes could be successfully treated with imipenem/cilastatin alone or in various combinations. One child died from refractory candida sepsis; five further children died from the underlying disorder, the respective infectious complications having been controlled adequately. Treatment failures were due to infection with Candida albicans, Pseudomonas cepacia and resistant Streptococcus faecium. Imipenem/cilastatin proved to be a suitable antibiotic for the treatment of life-threatening nosocomial infections and reinfections in children.
Infection
PMID:Treatment of nosocomial infections in children undergoing antimicrobial chemotherapy. 227 26

Minimal inhibitory concentrations (MICs) of imipenem, ceftazidime, piperacillin, tobramycin, azthreonam and carumonam were assessed for 400 urinary isolates from hospitalized patients with complicated and/or nosocomial urinary tract infections yielding greater than or equal to 10(5) colony forming units (cfu). More than 90% of the gram-negative pathogens were sensitive to all the antibiotics tested. However, only imipenem and piperacillin exhibited MIC90 values in the therapeutic range for gram-positive pathogens (approximately half of which were staphylococci and enterococci). Perioperative prophylaxis with 0.5 g imipenem/cilastatin administered at different time intervals before the operation (up to six hours) was performed in patients undergoing resection (n = 31), respectively enucleation (n = 1) of a prostatic adenoma or lithotriptic treatment (n = 4). Imipenem yielded peak plasma concentrations of 12.2 to 134.8 mg/l (mean 49.4 mg/l). The estimated half life time in these patients was approximately three hours. Considerable intra as well as interindividual variations were found for imipenem concentrations in prostatic adenoma. However, they were sufficiently high to reach sensitive pathogens (MICs up to 1 mg/l) for up to two-and-a-half hours. Up to six hours after dosing the concentrations in prostatic secretions ranged between 1 and 2 mg/l. A total of 20 urological patients suffering from complicated urinary tract infections (15 men, five women) received a short-term i.v. infusion of 0.5 mg imipenem/cilastatin t.i.d. for seven to 16 days (median seven days). In all these patients urines were sterile during therapy as well as one to two days after therapy. Follow-up examinations performed seven to ten days after the end of treatment in 19 of these patients showed ten patients to be free of infection (55%); these patients were classified as success. Seven patients (37%) presented a relapse (same pathogen) and two patients (10%) a re-infection (different pathogen). Imipenem/cilastatin was well tolerated locally and systemically.
Infection 1986
PMID:[Imipenem/cilastatin: in vitro activity, concentrations in plasma and prostatic adenoma and therapeutic results in patients with complicated urinary tract infections]. 242 54

Sixty-one hospitalized infants aged one day to six months were enrolled in an open, multicenter noncomparative clinical study of the efficacy and safety of imipenem/cilastatin. Patients weighing less than 1500 g (four males/ten females, Group 1) and those greater than or equal to 1500 g (31 males/16 females, Group 2) were analyzed separately. Total daily dose (divided into b.i.d. (27) or t.i.d. (34) regimens) ranged from 50 to 101.4 mg/kg given for 10.8 days (means, range 2 to 35 days) for Group 1 and 39.7 to 103 mg/kg given for 11.2 days (means, range 1 to 41 days) for Group 2. The investigators graded the intensity of signs and symptoms of infections as moderate or severe in 86 and 91% of patients in groups 1 and 2, respectively, and bacterial pathogens were isolated pretreatment in 43 and 32% of patients. Eighty-eight percent of all bacterial pathogens were susceptible to imipenem in vitro. The most commonly isolated pathogens were Pseudomonas aeruginosa and Klebsiella pneumoniae. Patients who had confirmed bacterial infections and who did not receive concomitant antibiotics were considered evaluable for efficacy, including 6 (43%) in Group 1 and 15 (32%) in Group 2. Infection sites were (Group 1) respiratory (100%), and (Group 2) skin and skin structures (33%), urinary (11%), gastrointestinal (11%), septicemia alone (11%) and meningitis or respiratory (28% and 6% with sepsis, respectively). Safety analysis included all patients. Imipenem/cilastatin was well tolerated in 93% of Group 1 and 85% of Group 2 patients. Three patients' treatments were discontinued due to rash, oliguria or poor local tolerability. Three patients in Group 1 and four in Group 2 died; deaths were considered unrelated to imipenem/cilastatin. Results are as follows: (table; see text) In summary, 81% (17 of 21) of evaluable patients were clinically cured or improved, among whom 3 of 21 patients (14%) had serious clinical or laboratory adverse experiences which were considered possibly related to imipenem/cilastatin. These results are comparable to results reported with other single or multiple antibiotic regimens.
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PMID:Imipenem/cilastatin therapy for serious infections in neonates and infants. 333 Oct 42

The concentration of imipenem in organic bone, determined in 16 patients by bioassay after short infusion (15 min) of 1 g imipenem/cilastatin was 4.3 +/- 2.06 mg/kg (geometric mean +/- standard deviation, n = 13) after 45 minutes, and 2.8 +/- 1.86 mg/kg (n = 26) after 88 minutes. Imipenem penetrates into inorganic hydroxylapatite (imbution), however, its antimicrobial activity is lost. The mean serum concentration in 12 patients (mean age 77 years) with normal renal and hepatic function 15 minutes after the beginning of the infusion was 93.1 mg/l imipenem. The mean serum half life t (1/2 beta) was 1.32 hours, the total body clearance 108.6 1/h, and the volume of distribution during the beta phase V(beta) 12.4 1.
Infection 1986
PMID:[Bone concentrations of imipenem after a dose of imipenem/cilastatin]. 346 40

Seven patients were treated for bacterial infections with imipenem/cilastatin. Imipenem is a new broad-spectrum beta-lactam antibiotic with antimicrobial activity against gram-positive and gram-negative bacilli. Before and during treatment parameters of blood coagulation and platelet function were studied. Blood coagulation was not influenced by the antibiotic. But there was a temporary inhibition of collagen-induced platelet aggregation during the first days of treatment. No clinical signs of enhanced spontaneous bleeding tendency were observed.
Infection 1986
PMID:[Hemostatic parameters influenced by imipenem/cilastatin]. 375 48


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