CEFPIROME MULTICENTER STUDY IN INTENSIVE- CARE UNIT

Cefpirome (CPO) is a new broad-spectrum cephalosporin, with a better a ctivity against Grampositive cocci, Pseudomonas spp. and Acinetobacter spp. than cefotaxime. The aim of this study was to determine the effi cacy and tolerance of CPO for the treatment of severe Gram-negative in fections in ICU patients. 88 observations of bacteriologically documen ted pneumonia, peritonitis, pyelonephritis and septicemia in 86 ICU pa tients were recorded. Antibiotherapy was given before microbiological results became available, and consisted of CPO 2 g and amikacin 10 mg/ kg administered b.i.d. Doses were adapted when required by renal failu re. Definitive inclusion was obtained when ampicillin resistance and C PO susceptibility were determined for the Gram-negative bacilli isolat ed. Tolerance was then analysed for all 86 patients, although efficacy was evaluated only for 28 patients. Among 102 isolated pathogens, CPO activity was determined for 82 cases and was effective against 71 (86 .5%). Clinical efficacy was obtained for 18 of 28 patients (64%), and bacteriological results were considered effective for 20 of 27 cases ( 74%), 1 case remaining undetermined. As regards tolerance at least one adverse effect was reported for 43 patients (50%). Among the 62 repor ted adverse effects, only 6 (2 cutaneous rashes, 4 biological abnormal ities) were considered to be possibly related to CPO. In none of these cases, was the treatment discontinued. The results of this study conf irm the efficacy of CPO, initially combined with amikacin, for the tre atment of severe Gram-negative resistant bacilli infections in ICU pat ients.