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Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomised clinical trial in a university hospital

Abstract number: R2518

Saltoglu N., Dalkiran A., Tetiker T., Bayram H., Tasova Y., Dalay C., Sert M.

Objectives: In this prospective, randomised clinical trial of comparing the effectiveness and side effects of two antibiotic regimens, we assessed the patients with diabetic foot infections whose infection grade is between Wagner grade 2 and 4.

Patients and Methods: Of the 62 patients enrolled the study, we assigned patients randomly into piperacillin/tazobactam (4.5 gr IV q8 h) or imipenem/cilastatin (0.5g IV q6 h) group.

Results: A total of 86 microorganisms were isolated from 62 patients. Infections were polymicrobial in 40% of patients while 21% had no bacterial growth in the culture. 61% of the isolated microorganisms were Gram-positive while 74% were Gram-negative. 66% of the patients had history of previous antibiotic therapy and 40% had a previous history of hospitalisation within 3 weeks of the study. The frequency of the microorganisms isolated from each therapy group was similar and the most commonly isolated pathogens were Pseudomonas aeruginosa (20%), Enterobacteriacea spp. (20%), Staphylococcus spp. (32%) and Streptococcus spp. (13%). The presence of ESBL among the Enterobacteriacea isolates was found in five isolates while the meticillin resistance in Staphylococcus spp. was found in four isolates. The amputation rate was 60% and 69% for piperacillin/tazobactam and imipenem group, respectively. Most (64%) of the amputations due to infection was observed in patients with Wagner grade 3. Clinical cure rates were similar between the two treatment groups. The adverse effects were more common in the piperacillin/tazobactam than the imipenem group (30% vs. 9%; p = 0.055) with nephrotoxicity (20% vs 3%), hepatotoxicity (17% vs 3%) and haematological side effects (7% vs 0) being most frequent.

Conclusion: Our study suggests that both piperacillin/tazobactam and imipenem/ cilastatin can be used for the empirical treatment of severe diabetic foot infections with polymicrobial and/or resistant microorganisms. Considering their relatively low frequency of side effects, both agents can be used with confidence

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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