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The piperacillin/tazobactam role in the treatment of complicated intra-abdominal infections (cIAI) in Ukrainian hospitals: 40 clinical cases series analysis

The anesthesiologist and specialist on medical emergency conditions, Surgeon

Resume. Antibiotic therapy is one of the key components of complicated intra abdominal infection (cIAI) treatment. The challenge of effective treatment of cIAI is early recognition, adequate source control, appropriate antibacterial therapy, and fluid resuscitation in patients with sepsis. According to WHO recommendations, piperacillin / tazobactam is the first-line antibiotic for the treatment of complicated intra-abdominal infections, although it used quite rare as the first choice agent in Ukraine.

Materials and methods: Analysis was conducted in the period from December 1, 2022 to June 30, 2023. The research centers were 4 health care facilities: Communal non-commercial enterprise “Kyiv City Clinical Hospital of Emergency Medical Care”, Emergency medical care hospital of Vinnytsia, Communal non-commercial enterprise “Odesa Regional Clinical Hospital of the Odesa Regional Council”, Communal non-commercial enterprise “Kyiv City Clinical Hospital №4”. After inclusion in the research, patients were prescribed empiric therapy with piperacillin/tazobactam (Refex) and patient data were entered into a form. The results of drug therapy were recorded before the start of therapy (day 0), on the 3rd day after the start of therapy and on the 6th day after the start of therapy.

Results: 40 patients were included in the research. The most common pathogens cultured from patients wounds were: 24 cases (60%) from the “ESKAPE” group: E. Coli 9 cases (22.5%), S. Aureus 1 case (2.5%), St. Haemolyticus accounted for 3 cases (7.5%), Kl. Pneumonia 4 cases (10%), Acinetobacter spp. 1 case (2.5%) of Ps. Aeroginosa 3 cases (7.5%), Enterobacter 1 case (2.5%), Enterbacter cloaceae accounted for 2 cases (5%). Other pathogens were cultured in 16 cases.

Pathogens sensitivity were as follows: 2 cases (5%) were sensitive to amoxicillin clavunate, 3 cases (7.5%) were sensitive to ampicillin and cefepime, 4 cases (10% of pathogens) were sensitive to ceftriaxone, 12.5% of pathogens were sensitive to imipinem and clindamycin (5 cases each), 7 cases were sensitive to amikacin (17.5%). 47.5% of flora (19 cases) were sensitive to piperacillin/tazobactam. Pan-resistant strains that were not sensitive to any of the studied drugs accounted for 37.5% (15 cases).

Conclusions: Therapy with piperacillin / tazobactam (Refex) in all analyzed clinical cases was evaluated by doctors as effective and safe. All patients survived and were discharged from the hospital, none of them developed sepsis or acute kidney injury. Among the analyzed cases, the sensitivity to piperacillin/tazobactam was the highest.

Keywords: piperacilline/tazobactam, intraabdominal infections, antibiotic resistance.

Authors: Bielka K.Y., Fomina G.A., Goncharenko O.V., Zgrzheblovska L.V., Koychev E.A., Malysh I.R., Solarik S.O.

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