Treatment of gram-negative infections in patients before and after renal transplantation.

Sixty-six Gram-negative infections, occurring in thirty-four patients before and after human cadaveric renal transplantation, were treated with either gentamicin or carbenicillin. All patients were difficult chemotherapeutic problems and many were receiving immunosuppressive therapy. The majority of the infections occurred either in the urinary tract or in the peritoneal cavity following dialysis. Laboratory studies with gentamicin showed that 98% of the strains of Gram-negative bacilli from this group of patients were sensitive to 5 μg/ml. Seventy-seven per cent of all Gram-negative bacilli were sensitive to 100 μg/ml of carbenicillin. The outcome of treatment was found to depend on the presence of an underlying abnormality. An overall cure rate of 75% was achieved in simple infections but where the infection was complicated by an underlying abnormality the rate fell to 45% and reinfection was very common (67%). There was no significant difference in the cure rate obtained with gentamicin or carbenicillin. Acute toxic effects due to gentamicin were seen in one case but many patients died before assessment was possible. No toxic effects were seen with carbenicillin treatment but intramuscular injections often caused local pain. Gentamicin and carbenicillin are two valuable additions to the antibiotics available for the treatment of Gram-negative infections. The success of treatment in these infections, however, will depend on the accessibility of the primary focus of infection to the antibiotic and the nature of the underlying abnormality.