Alternative empiric therapy to carbapenems in management of drug resistant gram negative pathogens: a new way to spare carbapenems

Prashant Bhatia
2015 Research Journal of Infectious Diseases  
Increasing prevalence of carbapenem resistance in Gram negative bacteria due to excessive and indiscriminate use of carbapenems has forced the medical fraternity to find out ways to spare carbapenems. This retrospective study was aimed to explore a new fixed dose combination (FDC) of ceftriaxone+sulbactam with adjuvant disodium edetate as a carbapenem sparing drug in the management of moderate to severe bacterial infections of lower respiratory tract infections (LRTIs), urinary tract infections
more » ... (UTIs) and intra-abdominal infections (IAIs). Methods: A retrospective analysis involves those patients in whom FDC or meropenem was used empirically for the management of these infections caused by multidrug resistant pathogens. Results: The average age of evaluated patients was 58.17±13.98 years. Out of 107 patients, 95 patients selected for the evaluations in which LRTIs, UTIs and IAIs were diagnosed in 43 (45.26%), 32 (33.68%) and 20 (21.05%) patients, respectively. The most common pathogen was Escherichia coli (38.94%), followed by Klebsiella species (26.31%), Pseudomonas species (18.94%) and Acinetobacter species (15.78%). According to the susceptibility results, FDC appeared as the most active antibacterial agent against E. coli (94.54%) followed by Acinetobacter species (93.33%), Pseudomonas species (88.88%) and Klebsiella species (84%). On the other hand, meropenem susceptibility to E. coli was 86.47% followed by Acinetobacter species (78.57%), Pseudomonas species (66.66%) and Klebsiella species (64%). Further our results revealed that FDC has >75% clinical success compared to meropenem (~61% clinical success). Conclusion: These results depict non-inferiority of new FDC in the treatment of moderate to severe Gram negative bacterial infections caused by carbapenem resistant organisms and therefore, it should be considered as an alternative to carbapenem for treating LRTIs, UTIs and IAIs.
doi:10.7243/2052-5958-3-2 fatcat:27ahxf6udjbqjidbz4nukk6dxa