Imipenem/cilastatin versus piperacillin/tazobactam plus amikacin for empirical therapy in febrile neutropenic patients: results of the COSTINE study

Sanz, Miguel Á.; Bermúdez, Arancha; Rovira, Montserrat; Besalduch, Juan; Pascual, María-Jesús; Nocea, G; Sanz-Rodrı́guez, César

doi:10.1185/030079905x43631

Cited by 16 publications

(7 citation statements)

References 24 publications

(25 reference statements)

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“…In contrast, piperacillin/tazobactam (87.3%) and ciprofloxacin (61.8%) were the most frequently used initial antimicrobials in our NDE group. Previous studies have suggested that piperacillin/tazobactam and imipenem/cilastatin have similar efficacy and safety profiles [28-30]. Only one patient had ESBL-producing Enterobacteriaceae, and broad-spectrum antimicrobials may have different sensitivity patterns at other centers.…”

Section: Discussionmentioning

confidence: 98%

Early use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trial

et al. 2012

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IntroductionAlthough early use of broad-spectrum antimicrobials in critically ill patients may increase antimicrobial adequacy, uncontrolled use of these agents may select for more-resistant organisms. This study investigated the effects of early use of broad-spectrum antimicrobials in critically ill patients with hospital-acquired pneumonia.MethodsWe compared the early use of broad-spectrum antimicrobials plus subsequent de-escalation (DE) with conventional antimicrobial treatment (non-de-escalation, NDE) in critically ill patients with hospital-acquired pneumonia (HAP). This open-label, randomized clinical trial was performed in patients in a tertiary-care center medical intensive care unit (MICU) in Korea. Patients (n = 54) randomized to the DE group received initial imipenem/cilastatin plus vancomycin with subsequent de-escalation according to culture results, whereas patients randomized to the NDE group (n = 55) received noncarbapenem, nonvancomycin empiric antimicrobials.ResultsBetween November 2004 and October 2006, 109 MICU patients with HAP were enrolled. Initial antimicrobial adequacy was significantly higher in the DE than in the NDE group for Gram-positive organisms (100% versus 14.3%; P < 0.001), but not for Gram-negative organisms (64.3% versus 85.7%; P = 0.190). Mean intensive care unit (ICU) stay, and 14-day, 28-day, and overall mortality rates did not differ in the two groups. Among culture-positive patients, mortality from methicillin-resistant Staphylococcus aureus (MRSA) pneumonia was higher in the DE group, even after early administration of vancomycin. Multidrug-resistant organisms, especially MRSA, were more likely to emerge in the DE group (adjusted hazard ratio for emergence of MRSA, 3.84; 95% confidence interval, 1.06 to 13.91).ConclusionsThe therapeutic advantage of early administration of broad-spectrum antimicrobials, especially with vancomycin, was not evident in this study.

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Section: Discussionmentioning

confidence: 98%

Early use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trial

et al. 2012

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“…75 A more recent study of febrile neutropenic patients reported that overall treatment costs were 189.55 euros less with imipenem than piperacillin/tazobactam (P < 0.001). 155 Imipenem monotherapy has been recommended in polymicrobial infections where combination therapy would be more costly, although imipenem combination therapy was recommended if Pseudomonas was present. 85 This sustained susceptibility, efficacy, tolerability and cost-effectiveness are the hallmarks of appropriate initial therapy.…”

Section: De-escalation Therapymentioning

confidence: 99%

Two decades of imipenem therapy

Rodloff¹,

Goldstein²,

Torres³

2006

Journal of Antimicrobial Chemotherapy

146

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Imipenem, the first carbapenem discovered, was developed more than two decades ago in response to an unmet need for a highly potent, broad-spectrum antimicrobial agent with a strong safety profile. It has since been used to treat more than 26 million patients. In an era where antibiotic use has driven antibiotic resistance, choosing appropriate initial therapy for serious infection is critical. Appropriate antibiotic regimens must cover all likely pathogens, be administered promptly at the correct dosage and dosing interval, be well tolerated and prevent the emergence of resistance. While imipenem was initially reserved for use in intractable, serious infections, the benefits of early aggressive therapy are now known, making imipenem a core agent in de-escalation therapy due to proven efficacy and safety for indications such as nosocomial pneumonia, intra-abdominal infection, sepsis and febrile neutropenia. De-escalation therapy with an agent such as imipenem minimizes resistance development by initiating aggressive initial treatment and then tailoring therapy based on patient response and culture results, switching to a less expensive, narrower spectrum antibiotic regimen or shortening the duration of therapy. Imipenem has maintained sustained clinical efficacy, tolerability and in vitro activity against important bacterial pathogens for two decades. We review the factors that continue to make imipenem as appropriate an agent for de-escalation therapy now as it was 20 years ago.

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“…Broad-spectrum antipseudomonal cephalosporins (such as ceftazidime [7] and cefepime [8][9][10][11][12][13][14]), carbapenems (such as imipenem-cilastatin [15,16] and meropenem [17][18][19][20][21][22][23][24][25][26][27][28][29]), and b-lactam-b-lactamase inhibitor combinations (such as ticarcillin clavulanate [13,30,31] and piperacillintazobactam [10,17,[32][33][34][35][36][37]) have been evaluated as monotherapy in this setting. The Spanish and German guidelines support choices from each antibiotic class, whereas the American guidelines have not recommended b-lactam-b-lactamase inhibitor agents, such as piperacillin-tazobactam, as monotherapy, citing limited experience with these agents when the guidelines were published in 2002 [2].…”

mentioning

confidence: 99%

A Randomized, Open-Label, Multicenter Comparative Study of the Efficacy and Safety of Piperacillin-Tazobactam and Cefepime for the Empirical Treatment of Febrile Neutropenic Episodes in Patients with Hematologic Malignancies

Rotstein

et al. 2006

Clinical Infectious Diseases

108

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Imipenem/cilastatin versus piperacillin/tazobactam plus amikacin for empirical therapy in febrile neutropenic patients: results of the COSTINE study

Abstract: The clinical effectiveness of I/C was similar to that of P/T+A. In both treatment groups toxicity was low and did not limit antibiotic therapy. Resource consumption was lower with I/C.

Cited by 16 publications

References 24 publications

Early use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trial

Early use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trial

Two decades of imipenem therapy

A Randomized, Open-Label, Multicenter Comparative Study of the Efficacy and Safety of Piperacillin-Tazobactam and Cefepime for the Empirical Treatment of Febrile Neutropenic Episodes in Patients with Hematologic Malignancies

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