Treatment of nosocomial infections in children undergoing antimicrobial chemotherapy.

Patients under immunosuppressive therapy with malignant diseases, malformations, premature infants or children after major surgical interventions and trauma are particularly susceptible to infections. In these patients nosocomial infections with multiply resistant organisms may occur despite broad spectrum antibiotic prophylaxis or antimicrobial chemotherapy of existing infections. In an open clinical study 31 infants and children with an overall 45 episodes of life-threatening hospital-acquired infections occurring under broad spectrum antimicrobial coverage were treated with imipenem/cilastatin alone or in various combinations. All the patients were immunocompromised. The most frequent single diagnosis was sepsis--documented by a positive blood culture--followed by nosocomial pneumonia, urinary tract infection and peritonitis. In seven patients an infection of implanted biomaterial was present which could not be controlled by the previously administered antimicrobial therapy. Imipenem/cilastatin was given in a dose of 50 mg/kg BW. Therapy was well tolerated, no side effects were observed. A total of 34 of 45 episodes could be successfully treated with imipenem/cilastatin alone or in various combinations. One child died from refractory candida sepsis; five further children died from the underlying disorder, the respective infectious complications having been controlled adequately. Treatment failures were due to infection with Candida albicans, Pseudomonas cepacia and resistant Streptococcus faecium. Imipenem/cilastatin proved to be a suitable antibiotic for the treatment of life-threatening nosocomial infections and reinfections in children.