I. Overview
of Imipenem
Imipenem is a new type of β-lactam antibiotic with extended-spectrum and potent antibacterial activity. It is an important member of the carbapenem antibiotic family and has significant antibacterial activity against Gram-positive bacteria, Gram-negative bacteria, anaerobic bacteria and other pathogens.
It has unique chemical structure, can effectively penetrate the cell wall of bacteria, and has high affinity with penicillin-binding proteins (PBPs) in bacteria, thus inhibiting the synthesis of bacterial cell wall, leading to the rupture and death of bacterial cells, and achieving the effect of sterilization.
2. Application
in the treatment of infection
1. Gram-negative bacterial infection
Many Gram-negative bacteria, such as Escherichia coli and Klebsiella pneumoniae, are gradually resistant to common antibiotics. Imipenem can often maintain good antibacterial activity against these drug-resistant bacteria. For example, when hospital-acquired pneumonia is caused by gram-negative bacteria that produce extended-spectrum beta-lactamases (ESBLs), imipenem may be the first-line drug of choice. It can rapidly inhibit the growth and reproduction of bacteria, reduce lung inflammation, and improve the respiratory function and clinical signs and symptoms of patients.
2. Gram-positive bacterial infection
Imipenem alone may not be the best choice
for severe Gram-positive infections, such as sepsis caused by methicillin-resistant Staphylococcus aureus (MRSA) infection, but it often plays an important role in the combination regimen. When combined with specific drugs for MRSA, such as vancomycin, it can expand the antibacterial spectrum, cover the possible mixed infection pathogens more comprehensively, and improve the therapeutic effect.
3. Anaerobic infection
Imipenem has obvious antibacterial advantages
in abdominal infection, pelvic infection and other diseases that often involve anaerobic mixed infection. Because it has strong bactericidal ability to common anaerobic bacteria such as Bacteroides fragilis, it can effectively remove anaerobic bacteria in the focus of infection, prevent further deterioration of infection and promote the rehabilitation of patients. For example, in the case of severe abdominal infection caused by appendiceal perforation, accompanied by a large number of anaerobic bacteria, imipenem can quickly control infection and reduce the risk of serious complications such as sepsis.
4. Infection
in patients with low immune function
For patients with low immune function, such as cancer patients receiving radiotherapy and chemotherapy, patients with long-term use of immunosuppressants after organ transplantation, once infection occurs, the disease often progresses rapidly and seriously. Imipenem, with its broad-spectrum antibacterial characteristics, can be used as an empirical drug to give timely treatment in the absence of specific pathogens, so as to gain time for subsequent adjustment of medication according to drug sensitivity results, and greatly improve the success rate of infection treatment in such patients.
III. Analysis
of Relevant Cases
Case 1:
Patient Li, male, 65 years old, was admitted for acute exacerbation of chronic obstructive pulmonary disease (COPD). Pulmonary infection was found after admission, and sputum culture showed ESBLs-producing Klebsiella pneumoniae infection. In view of the resistance of the bacteria to a variety of commonly used antibiotics, doctors decisively choose imipenem for anti-infective treatment. In the course of treatment, the patient’s body temperature gradually returned to normal, the symptoms of cough and expectoration were significantly alleviated, and the pulmonary rales were gradually reduced. After two weeks of standardized treatment, the patient’s pulmonary infection was effectively controlled and discharged after in stable condition.
Case 2:
Zhang Mou, female, 32 years old, suffered from severe abdominal infection due to acute appendicitis perforation. A large amount of purulent exudate was seen in the abdominal cavity during the operation. Postoperative pathology and culture results suggested that there were a variety of bacterial mixed infections, including Escherichia coli, Bacteroides fragilis and so on. Doctors immediately used imipenem for anti-infective treatment, while giving appropriate supportive treatment measures. Within a week of imipenem treatment, the patient’s abdominal pain, abdominal distension and other symptoms gradually relieved, abdominal drainage fluid gradually decreased and became clear, and finally the patient recovered and discharged smoothly.
Case 3:
Zhao Mou, male, 48 years old, is a patient after kidney transplantation, taking immunosuppressants for a long time. Recently, fever, fatigue and other symptoms occurred, and blood culture suggested mixed infection of Gram-negative bacteria and Gram-positive bacteria, but the specific strains were not completely clear. Considering the patient’s low immune function and critical condition, the doctor first chose imipenem for empirical anti-infective treatment. After a few days of treatment, with the results of further drug sensitivity tests, the medication regimen was adjusted appropriately, but imipenem played a vital role in controlling infection and stabilizing the condition in the early stage, and finally the patient successfully overcome the difficulties of infection.
IV. Precautions and Adverse Reactions
Although imipenem has many advantages in the treatment of infections, there are some caveats.
1.Precautions
It is mainly excreted through the kidney, so it is necessary to adjust the dosage according to the renal function in patients with renal insufficiency to avoid the accumulation of drugs in the body leading to increased adverse reactions. At the same time, there may be interactions between imipenem and some other drugs, for example, the combination of imipenem with sodium valproate may reduce the blood concentration of sodium valproate, thus affecting its antiepileptic effect, so the combination of imipenem should be carefully evaluated.
2. Adverse reactions
Common adverse reactions include gastrointestinal reactions, such as nausea, vomiting, diarrhea, etc.; central nervous system reactions, such as headache, dizziness, convulsions, etc., especially in patients with high doses or renal insufficiency. In addition, allergic reactions such as rash and itching may occur.
V. Conclusion
Imipenem plays an important role in the treatment of a variety of infectious diseases, especially for drug-resistant infections, mixed infections and infections in immunocompromised patients. Through the rational use of imipenem, and pay close attention to its use precautions and adverse reactions, combined with specific cases to develop personalized treatment, can effectively improve the effect of infection treatment, improve the prognosis of patients, and protect the health of patients. However, with the widespread use of antibiotics, the problem of bacterial resistance is also developing. In the future, it is still necessary to further study how to better play the antibacterial advantages of imipenem, while reducing its adverse reactions and resistance.
