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Inicio Enfermedades Infecciosas y Microbiología Clínica Cefotaxima, 20 años después. Estudio observacional en pacientes críticos
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Vol. 19. Núm. 5.
Páginas 211-218 (mayo 2001)
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Vol. 19. Núm. 5.
Páginas 211-218 (mayo 2001)
Acceso a texto completo
Cefotaxima, 20 años después. Estudio observacional en pacientes críticos
Cefotaxime, twenty years later. Observational study in critically ill patients
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6426
Francisco Álvarez-Lermaa,1
Autor para correspondencia
16839@imas.imim.es

Correspondencia: F. Álvarez-Lerma. Servicio de Medicina Intensiva. Hospital del Mar. Paseo Marítimo 25-29. 08003 Barcelona.
, Mercedes Palomarb, Pedro Olaecheac, Rafael Sierrad, Enrique Cerdae
a Hospital del Mar. Barcelona
b Hospital Vall d’Hebrón. Barcelona
c Hospital de Galdakao. Vizcaya
d Hospital Puerta del Mar. Cádiz
e Hospital de Getafe. Madrid
Grupo de Estudio de Infección en el Paciente Crítico*
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Objetivo

Conocer, tras 20 años de la comercialización de cefotaxima, los motivos y formas de su utilización, las dosis a las que se administra así como su efectividad y tolerancia en pacientes críticos ingresados en Servicios de Medicina Intensiva (UCI) de nuestro país.

Diseño

Estudio abierto, prospectivo, observacional y multicéntrico. SUJETOS. Se han incluido como casos todos los pacientes a los que se ha prescrito cefotaxima en monoterapia o en combinación con otros antibióticos.

Resultados

Se han incluido 624 pacientes en 44 UCI (media de 14 casos). Cefotaxima se ha indicado para tratamiento de 274 infecciones comunitarias (43,9%), 194 profilaxis (31,1%) y 156 infecciones nosocomiales (25,0%). Destacan las neumonías, tanto las comunitarias (149, 34,7%) como las relacionadas con ventilación mecánica (62, 14,4%), seguido de las traqueobronquitis (60, 13,9%) y de las infecciones del sistema nervioso central (42, 9,8%). Más de la mitad de las infecciones (222, 51,6%) se han presentado como síndrome de respuesta inflamatoria sistémica (SIRS), mientras que 133 (30,9%) como sepsis grave y 75 (17,4%) como shock séptico. En 374 (87,0%) de los 430 casos de tratamiento de infecciones la prescripción se ha realizado de forma empírica y en 150 de ellos (40,1%) se ha logrado la confirmación posterior de la etiología. En 120 (27,9%) casos se ha administrado en monoterapia y en el resto en asociación con uno o más antibióticos.

La utilización de cefotaxima en profilaxis se ha valorado como fracaso en 31 (16,0%) de los 194 casos, mientras que en tratamiento se han considerado como fracaso en 98 (22,8%) de los 430 casos, 51 casos (18,6%) infecciones comunitarias, 27 (27,3%) infecciones adquiridas en UCI y 20 (35,1%) infecciones nosocomiales adquiridas fuera de UCI.

En 127 (29,5%) de los 430 tratamientos de infecciones se ha modificado el tratamiento inicial, en 36 (28,3%) ocasiones por fracaso clínico, en 40 (31,5%) por aislamiento de un patógeno no cubierto, en 28 (22,0%) por aparición de patógenos multirresistentes, en 7 (5,5%) para reducir el espectro terapéutico y 16 casos por otras razones. También se ha modificado en 21 (6,0%) de los 194 casos en los que se utilizó como profilaxis.

En 32 (5,1%) pacientes se han detectado 37 efectos adversos que se relacionaron de forma posible o probable con la utilización de cefotaxima. Los más importantes han sido diarreas en 15 (2,4%) ocasiones y rash cutáneo en 6 (1,0%) casos.

Conclusiones

Cefotaxima continúa siendo uno de los tratamientos de elección en infecciones comunitarias y nosocomiales así como en diferentes profilaxis. Se utiliza preferentemente de forma empírica y asociado a otros antibióticos. La eficacia clínica y microbiológica es elevada mientras que los efectos adversos relacionados con su uso han sido escasos.

Palabras clave:
cefotaxima
profilaxis
infecciones comunitarias
infecciones nosocomiales
pacientes críticos
UCI
Objective

Afer twenty years of commercial availability of cefotaxime, the objective of this study was to know the reasons and modes of use, administration dosage as well as its effectiveness and tolerance in critically ill patients admittted to Intensive Care Units (ICU) in our country.

Design

Open, prospective, observational, multicenter study. SUBJECTS. All patients who had cefotaxime administered in monotherapy or in combination with other antibiotics were included as cases in this study.

Results

A total of 624 patients were included in 44 ICUs (average 14 cases). Cefotaxime was indicated for therapy of 274 community- acquired infections (43.9%), 194 prophylaxis (31.1%), and 156 nosocomial infections (25.0%). Both community-acquired pneumonia (149, 34.7%) and mechanical ventilation associated pneumonia (62, 14.4%) predominated, followed by trachebronchitis (60, 13.9%) and central nervous system infections (42, 9.8%). Over half of infections (222, 51.6%) presented as systemic inflammatory response syndrome (SIRS), 133 (30.9%) as severe sepsis, and 75 (17.4%) as septic shock.

In 374 (87.0%) out of the 430 cases of infection treatment, cefotaxime wan prescribed on an empirical basis and in 150 of them (40.1%) a further confirmation of the causative agent was obtained. In 120 (27.9%) cases, cefotaxime was administered as monotherapy and in the remaining cases in association with one or more antibiotics. The use of cefotaxime as prophylaxis was evaluated as failure in 31 (16.0%) of the cases, whereas in treatment it was considered as failure in 98 (22.8%) of the 430 cases, 51 community-acquired infections, 27 (27.3%) of ICU-acquired infections, and 20 (35.1%) nosocomial infections acquired outside the ICU.

In 127 (29.5%) of the 430 infection treatments the initial treatment was changed. The reasons for the change included clinical failure (36, 28.3%), recovery of an uncovered pathogen with the antibiotic (40, 31.5%), emergence of multi-resistant pathogens (28, 22.0%), to decrease the therapeautic spectrum (7, 5.5%), and other reasons (16). Cefotoxime was also changed in 21 (6.0%) of the 194 cases in which it was used as prophylaxis.

In 32 (5.1%) patients 37 adverse effects were noted which were associated with a possible or likely use of cefotaxime. Most notably, diarrhoea in 15 (2.4%) occasions and skin rash in 6 cases (1.0%).

Conclusions

Cefotaxime is still one of the therapies of choice for community-acquired and nosocomial infections as well as in different prophylactic modes. It is mostly used on an empirical basis and associated with other antibiotics. Clinical and microbiological efficieny is high whereas adverse effects related to its use have been scarce.

Key words:
Cefotaxime
prophylaxis
community-acquired infections
nosocomial infections
critically ill patients
ICU
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