Lami J L, Wilson S E, Hopkins J A
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Am Surg. 1991 Dec;57(12):769-74.
The authors report three trials of B-lactams and carbapenems for soft tissue infections treated on a surgical service: 1) cefmetazole versus cefoperazone, n = 44; 2) cefotetan versus cefoxitin, n = 24; and 3) meropenem versus imipenem, n = 44. A total of 138 hospitalized patients were enrolled with 112 meeting evaluability criteria. Four hundred twenty-three isolates were cultured (mean, three/patient) of which 67 per cent were aerobes and 33 per cent anaerobes. Cure rates for each trial were: 1) 93 per cent; 2) 92 per cent; 3) 100 per cent. Failures were caused by resistant organisms (Streptococcus group D, Bacteroides fragilis and Pseudomonas) appearing in incompletely drained infection sites. Three patients receiving meropenem had adverse effects (headache, nausea) and one receiving cefoxitin (truncal rash). Operative drainage and debridement remain the critical elements in therapy. Agents with longer half lives allowing twice daily dosing (cefmetazole and cefotetan) were as effective and less expensive than multiple doses of short-acting agents. The extended spectrum carbapenems are most useful for severe infections or resistant organisms.
作者报告了三项在外科治疗软组织感染时使用β-内酰胺类和碳青霉烯类药物的试验：1）头孢美唑与头孢哌酮对比，n = 44；2）头孢替坦与头孢西丁对比，n = 24；3）美罗培南与亚胺培南对比，n = 44。共有138名住院患者入组，其中112名符合可评估标准。共培养出423株分离菌（平均每名患者3株），其中67%为需氧菌，33%为厌氧菌。每项试验的治愈率分别为：1）93%；2）92%；3）100%。治疗失败是由于在引流不完全的感染部位出现了耐药菌（D组链球菌、脆弱拟杆菌和铜绿假单胞菌）。三名接受美罗培南治疗的患者出现了不良反应（头痛、恶心），一名接受头孢西丁治疗的患者出现了（躯干皮疹）。手术引流和清创仍然是治疗的关键要素。半衰期较长、允许每日给药两次的药物（头孢美唑和头孢替坦）与多次使用短效药物一样有效且成本更低。广谱碳青霉烯类药物对严重感染或耐药菌最为有用。
