Timentin in the antimicrobial treatment of nosocomial and polymicrobial infections

Abstract

The combination of ticarcillin and clavulanic acid (Timentin) was used in a nonrandomized open study in 28 patients with severe nosocomial infections. The infections were polymicrobial in 19 cases. Ten patients were bacteraemic and all were severely ill, receiving mechanical ventilation and with at least one organ system failure. Seventeen patients were treated with Timentin alone, 11 with a combination of Timentin and aminoglycosides. Timentin was used empirically, before identification of the bacteria in 14 patients (group I) and after identification of all the micro-organisms in 14 patients (group II). In group I, the empirical choice of Timentin was wrong in four cases, because at least one micro-organism was resistant to this drug. In the remaining 24 evaluable patients 12 patients were definitively cured. A relapse of the infection occurred in two cases. Five patients were initially improved but a secondary failure occurred due to a residual abscess in one case and to the underlying disease in four cases. Five initial failures due to the underlying disease in three cases were noted. The antimicrobial spectrum of Timentin is valuable in the management of nosocomial and polymicrobial infection, especially intra-abdominal infections and this study confirms a good clinical efficacy. However, combination with aminoglycosides seems mandatory, at least until the identification of all the micro-organisms involved in the infection.

Factors associated with multidrug-resistant bacteria in secondary peritonitis: impact on antibiotic therapy

“…The management of post‐operative peritonitis is different, in that the bacteria are frequently resistant to antimicrobial therapy, and it has been shown that inadequate antimicrobial therapy prolongs hospitalisation and is associated with clinical failure and a higher mortality rate [2,21]. In this context, empirical antimicrobial therapy is based on the local ecology, and frequently requires the use of expanded‐spectrum multidrug regimens that include an aminoglycoside or a quinolone, or a carbapenem and vancomycin [7,22]. Nosocomial non‐post‐operative peritonitis represents a particular entity that, until recently, was classified as post‐operative peritonitis with a high frequency of resistant bacteria [7,22].…”

“…In this context, empirical antimicrobial therapy is based on the local ecology, and frequently requires the use of expanded‐spectrum multidrug regimens that include an aminoglycoside or a quinolone, or a carbapenem and vancomycin [7,22]. Nosocomial non‐post‐operative peritonitis represents a particular entity that, until recently, was classified as post‐operative peritonitis with a high frequency of resistant bacteria [7,22]. However, a large multicentre study in France has shown that the microbiological characteristics of nosocomial non‐post‐operative peritonitis mimic those of community‐acquired peritonitis.…”

Clinical and Therapeutic Features of Nonpostoperative Nosocomial Intra-abdominal Infections

“…[2][3][4] Physicians have to assume that these infections share several clinical and microbiological characteristics in common with other nosocomial infections due to preoperative hospitalization and colonization with nosocomial flora. 5 However, these patients might also present a number of similarities with community-acquired intra-abdominal infections, such as absence of previous surgery or similar etiologies of intra-abdominal infection.…”

A Prospective Study of the Pattern of Use of Antimicrobial Agents in Surgical Prophylaxis in a Tertiary Care Centre

“…[8,9] Pre-operative antibiotic therapy can reduce the incidence of surgical site infections [14,15]. The most common organisms causing surgical site infections are MRSA, Staphylococcus epidermidis, enteric gram+ve cocci [16,17], gram-ve bacilli and anaerobes [18].…”