[Clinical and bacteriological substantiation of the use of cefoperazone/sulbactam in complex therapy of patients with pyo-destructive forms of lower respiratory tract infection (LRTI)].

Antibacterial therapy is the most important component of the complex management of pyo-destructive forms of LRTI. Since the microbial flora is rather variable and polymorphous, antibiotics used in the treatment of LRTI should be active against both aerobic (especially gramnegative) and anaerobic pathogens. The aim of the study was to prove, on the basis of the bacteriological and clinical findings, the validity of the use of cefoperazone/sulbactam (CS), the only inhibitor-protected cephalosporin, for the monotherapy of patients with LRTI. The trial enrolled 32 patients (29 males and 3 females) with various forms of LRTI, including 22 patients with destructive pneumonia, 8 patients with acute and chronic lung abscesses and 2 patients with lung gangrene. Complications of the main disease such as empyema, bronchopleural fistula, pyopneumothorax and hemoptysis in 63.5% of the patients were recorded. To verify the microbiological diagnoses, bacteriological assay of the sputum, endobronchial secretion or the contents of the abscess and pleural cavities was performed. The main component of the complex conservative treatment was the monotherapy with CS administered intravenously in an average daily dose of 5.9+/-1.59 g divided into 2 portions. The maximum daily dose for the patients with lung gangrene was 12 g. The bacteriological efficacy was evaluated by the ESCMID (1993) criteria. The clinicoroentgenologic efficacy was estimated by regression of the main signs of LRTI. The pathogens of LRTI were isolated and identified in 87.5% of the patients. Nonsporulating anaerobic bacteria such as Prevotella spp., Bacteroidesfragilis, Fusobacterium spp., Peptococcus spp. and Peptostreptococcus spp. were isolated from 24 (75%) of them. AD the anaerobic organisms proved to be susceptible to CS (100%). As for the aerobic organisms, 85.5% of them was susceptible to CS. The clinical effect of the antibacterial therapy in 29 (90.6%) patients was registered. In 20 patients (64.5%) both clinical and roentgenologic cure was shown. The lethal outcome in 1 patient (3.1%) was stated.