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首页> 外文期刊>Antimicrobial agents and chemotherapy. >Prospective randomized comparison of imipenem-cilastatin and piperacillin-tazobactam in nosocomial pneumonia or peritonitis (published erratum appears in Antimicrob Agents Chemother 1999 Mar;43(3):726)
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Prospective randomized comparison of imipenem-cilastatin and piperacillin-tazobactam in nosocomial pneumonia or peritonitis (published erratum appears in Antimicrob Agents Chemother 1999 Mar;43(3):726)

机译：亚胺培南-西司他丁与哌拉西林-他唑巴坦在医院内肺炎或腹膜炎中的前瞻性随机比较（发表的勘误表见Antimicrob Agents Chemother 1999年3月; 43（3）：726）

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Nosocomial pneumonia and acute peritonitis may be caused by a wide array of pathogens, and combination therapy is often recommended. We have previously shown that imipenem-cilastatin monotherapy was as efficacious as the combination of imipenem-cilastatin plus netilmicin in these two settings. The efficacy of imipenem-cilastatin is now compared to that of piperacillin-tazobactam as monotherapy in patients with nosocomial pneumonia or acute peritonitis. Three hundred seventy one patients with nosocomial pneumonia or peritonitis were randomly assigned to receive either imipenem-cilastatin (0.5 g four times a day) or piperacillin-tazobactam (4.5 g three times a day). Three hundred thirteen were assessable (154 with nosocomial pneumonia and 159 with peritonitis). For nosocomial pneumonia, clinical-failure rates in the piperacillin-tazobactam group (13 of 75 [17%]) and in the imipenem-cilastatin group (23 of 79 [29%]) were similar (P = 0.09), as were the numbers of deaths due to infection (6 in the imipenem-cilastatin group [8%], 7 in the piperacillin-tazobactam group [9%]) (P = 0.78). For acute peritonitis, clinical success rates were comparable (piperacillin-tazobactam, 72 of 76 [95%]; imipenem-cilastatin, 77 of 83 [93%]). For infections due to Pseudomonas aeruginosa, 45 patients had nosocomial pneumonia (21 in the piperacillin-tazobactam group and 24 in the imipenem-cilastatin group) and 10 had peritonitis (5 in each group). In the patients with nosocomial pneumonia, clinical failure was less frequent in the piperacillin-tazobactam group (2 of 21 [10%]) than in the imipenem-cilastatin [corrected] group (12 of 24 [50%]) (P = 0.004). Bacterial resistance to allocated regimen was the main cause of clinical failure (1 in the piperacillin-tazobactam group and 12 in the imipenem-cilastatin group). For the patients with peritonitis, no difference in clinical outcome was observed (five of five cured in each group). The overall frequencies of adverse events related to treatment in the two groups were similar (24 in the piperacillin-tazobactam group, 22 in the imipenem-cilastatin group). Diarrhea was significantly more frequent in the piperacillin-tazobactam group (10 of 24) than in the imipenem-cilastatin group (2 of 22). This study suggests that piperacillin-tazobactam monotherapy is at least as effective and safe as imipenem-cilastatin monotherapy in the treatment of nosocomial pneumonia or peritonitis. In P. aeruginosa pneumonia, piperacillin-tazobactam achieved a better clinical efficacy than imipenem-cilastatin, due to reduced development of microbiological resistance. Tolerance was comparable, with the exception of diarrhea, which was more frequent with piperacillin-tazobactam.
机译：多种病原体可能引起医院内肺炎和急性腹膜炎，因此经常推荐联合治疗。我们先前已经证明，在这两种情况下，亚胺培南-西司他丁单药治疗与亚胺培南-西司他丁加奈替米星的联合治疗一样有效。现在将亚胺培南-西司他丁与哌拉西林-他唑巴坦的单药治疗在医院内肺炎或急性腹膜炎中的疗效进行比较。 371例院内肺炎或腹膜炎患者被随机分配接受亚胺培南-西司他丁（0.5克，每天四次）或哌拉西林-他唑巴坦（4.5克，一天三次）。 313例（医院内肺炎154例，腹膜炎159例）。对于医院内肺炎，哌拉西林-他唑巴坦组（75例中的13例[17％]）和亚胺培南-西司他丁组（79例中的23例[29％]）的临床失败率相似（P = 0.09）。因感染引起的死亡人数（亚胺培南-西司他丁组6例[8％]，哌拉西林-他唑巴坦组7例[9％]）（P = 0.78）。对于急性腹膜炎，临床成功率相当（哌拉西林-他唑巴坦，72例，76 [95％];亚胺培南-西司他丁，77例，83 [93％]）。对于铜绿假单胞菌引起的感染，有45例院内肺炎（哌拉西林-他唑巴坦组21例，亚胺培南-西司他丁组24例）和腹膜炎10例（每组5例）。在医院内肺炎患者中，哌拉西林-他唑巴坦组（21例中的2例[10％]）比亚胺培南-西司他丁[校正]组（24例中的12例[50％]）少发生临床失败（P = 0.004 ）。细菌对分配方案的耐药性是导致临床失败的主要原因（哌拉西林-他唑巴坦组1例，亚胺培南-西司他丁组12例）。对于腹膜炎患者，未观察到临床结局差异（每组五例治愈）。两组与治疗相关的不良事件的总发生率相似（哌拉西林-他唑巴坦组为24，亚胺培南-西司他丁组为22）。哌拉西林-他唑巴坦组（24个中的10个）比亚胺培南-西司他丁组（22个中的2个）腹泻明显更为频繁。这项研究表明，在医院内肺炎或腹膜炎的治疗中，哌拉西林-他唑巴坦单一疗法至少与亚胺培南-西司他丁单一疗法一样有效和安全。在铜绿假单胞菌肺炎中，由于减少了微生物耐药性，哌拉西林-他唑巴坦的临床疗效优于亚胺培南-西司他丁。除腹泻外，耐受性相当，腹泻除外，哌拉西林-他唑巴坦更为常见。

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