The randomized comparison of cefoperazone-sulbactam with imipenem-cilastatin in the treatment of intraabdominal infections

Abstract

Peritonitis is a polimicrobial disease. Both aerobes and anaerobes can be cultured from the infected site. Therefore, the antibiotic agent should be carefully selected. Nowadays monotherapeutic agents are safely and effectively used in the treatment of infra-abdominal infections. The present study was carried out on the patients who were surgically treated for infra-abdominal infections. The patients who died within the postoperative 24 hours, who were younger than 18 years, who received immunosupressive treatment and who had allergic reactions during antibiotherapy were excluded from the study. A total of 50 patient were studied and two equally numbered patient groups were formed. One group (Croup A) received intravenous 2 g/24 hours imipenem-cilastatin and the other group (Group B) received intravenous 2 g/24 hours cefoperazone-sulbactam. The mean ages of patients were 46.1 and 50.8 years for groups A and B, respectively. The patients were evaluated for APACHE II scores at the admission and after the antibiotherapy diagnoses cultures from the secondary peritonitis sites were peroperatively obtained. The culture results mean antibiotic usage durations and treatment results were evaluated. Mean APACHE II score at the admission were 14.3 and 12.7 for groups A and B respectively. Mean intensive care unit stay was 6 days for group A and 8 days for group B. In group A 17 patients (68%) had recovery and 6 patients (24%) had resistance to antibiotic treatment. In group B, 14 patients (56%) had recovery and 8 patients (32%) had resistance to antibiotics. Staphylococcus aureus and Escherichia coli were the most frequently isolated microorganisms. The mean APACHE II scores after the treatment were 9.6 and 8.5 for groups A and B respectively. Two patients (8%) in group A and 3 patients (12%) in group B had postoperative intra-abdominal abscess and all the patients underwent percutaneus drainage in the guidance of computerized tomography. Five patients (20%) in each group had wound infections. Two patients in group A died ofmyocardial infarction and septic shock in the early postoperative period. As a result of this study, for the patients with high APACHE II scores, imipenem-cilastatin and cefoperazone-sulbactam can be used as effectively and therapeutic agents in the treatment of intra-abdominal infections. We could not demonstrate any superiority of one combination over the other. However, treatment costs can be a factor for the selection of antibiotics.