A New Antibiotic Adjuvant Entity (Ceftriaxone + Sulbactam + Disodium Edetate): An Alternative to Carbapenems for the Management of Intensive Care Unit Infection

Aims: Carbapenem resistant bacterial infections have limited treatment options and are associated with high mortality. Here we present a retrospective analysis of treatment and outcome for ICU patients suffering from moderate to severe urinary tract infection (UTI), lower respiratory tract infection (LRTI) and intra-abdominal infections (IAI) to assess the efficacy of novel antibiotic adjuvant entity (AAE); ceftriaxone + sulbactam + disodium edetate, as an effective alternative for carbapenems in critically ill patients.

Materials and Methods: A retrospective study was conducted to evaluate efficacy of AAE in 84 patients showing sensitivity to AAE with UTI, LRTI and IAI treated at IVY hospital, Mohali, India between January 2013 to November 2014. The antibiotic therapy was initiated empirically and continued based on the results of the microbiological susceptibility testing and clinical outcome.

Results: 64 (76.19%), patients were diagnosed with single-organism infections, among which, 14 (16.16%) bacteria were resistant to meropenem and all the bacteria were susceptible to AAE. Empirical meropenem treatment was given to 25 patients, of which 18 (72%) patients achieved clinical success. 24 (75%) patients of 32 patients treated with AAE, achieved clinical success and the remaining 8 patients were cured when colistin was given with AAE. 20 (23.80%), patients were diagnosed with polymicrobial infections. Among 20 polymicrobial infectious patients, bacterial samples of 12 patients showed sensitivity towards AAE and meropenem, where as the remaining 8 (40%) samples showed intermediate susceptibility towards both cabapenem and AAE. 9 (45%) patients were cured with AAE, while the remaining 11 patients were cured with AAE and colistin combination therapy.

Conclusion: From the above study, it can be concluded that patients experience similar rates of clinical response in carbapenem susceptible cases and in some cases where patients failed to respond to carbapenem therapy but responded to AAE treatment. Hence, AAE can be used as an alternative to carbapenems in the treatment of moderate and severe infections caused by Gram negative organisms.