TY - JOUR
T1 - Management of ventilator associated pneumonia with a new antibiotic adjuvant entity (ceftriaxone + sulbactam + disodium edetate) - A novel approach to spare carbapenems
AU - Sathe, Prachee
AU - Maddani, Sagar
AU - Kulkarni, Shilpa
AU - Munshi, Nita
N1 - Publisher Copyright:
© 2017
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background Ventilator associated pneumonia (VAP) is one of the most serious nosocomial infections in Intensive Care Unit (ICU). The aim of this study was to evaluate a new approach to spare the carbapenems for the management of patients diagnosed with VAP due to Acinetobacter baumannii (A. baumannii). Method This retrospective study was conducted on VAP patients presenting for treatment at tertiary care centre between May 2014 and March 2016. The case sheets of patients who have been treated for VAP with meropenem, antibiotic adjuvant entity (AAE) and colistin were analysed. Results Out of 113 patients analysed, 24 (21.3%) patients were having VAP due to MDR A. baumannii. Microbial sensitivity has shown that 87.5% of patients were sensitive to AAE and colistin whereas all of them were resistant to meropenem, imipenem and gentamycin. The mean treatment durations were 12.4 ± 2.1, 13.2 ± 2.4 and 14.3 ± 2.1 days for AAE, meropenem + colistin and AAE + colistin treatment groups. In AAE susceptible patients, the mean treatment duration and cost could be reduced by 23–24% and 43–53% if AAE is used empirically. In AAE-resistant patients, the mean treatment duration and cost could be reduced by 21% and 26% if AAE + colistin regime is used empirically instead of meropenem followed by AAE + colistin. Conclusions Clinical assessment with microbial eradication and pharmaco-economic evaluation clearly shows benefits in using AAE empirically in the management of A. baumannii infected VAP cases.
AB - Background Ventilator associated pneumonia (VAP) is one of the most serious nosocomial infections in Intensive Care Unit (ICU). The aim of this study was to evaluate a new approach to spare the carbapenems for the management of patients diagnosed with VAP due to Acinetobacter baumannii (A. baumannii). Method This retrospective study was conducted on VAP patients presenting for treatment at tertiary care centre between May 2014 and March 2016. The case sheets of patients who have been treated for VAP with meropenem, antibiotic adjuvant entity (AAE) and colistin were analysed. Results Out of 113 patients analysed, 24 (21.3%) patients were having VAP due to MDR A. baumannii. Microbial sensitivity has shown that 87.5% of patients were sensitive to AAE and colistin whereas all of them were resistant to meropenem, imipenem and gentamycin. The mean treatment durations were 12.4 ± 2.1, 13.2 ± 2.4 and 14.3 ± 2.1 days for AAE, meropenem + colistin and AAE + colistin treatment groups. In AAE susceptible patients, the mean treatment duration and cost could be reduced by 23–24% and 43–53% if AAE is used empirically. In AAE-resistant patients, the mean treatment duration and cost could be reduced by 21% and 26% if AAE + colistin regime is used empirically instead of meropenem followed by AAE + colistin. Conclusions Clinical assessment with microbial eradication and pharmaco-economic evaluation clearly shows benefits in using AAE empirically in the management of A. baumannii infected VAP cases.
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U2 - 10.1016/j.jcrc.2017.04.002
DO - 10.1016/j.jcrc.2017.04.002
M3 - Article
C2 - 28535440
AN - SCOPUS:85020725853
SN - 0883-9441
VL - 41
SP - 145
EP - 149
JO - Seminars in Anesthesia, Perioperative Medicine and Pain
JF - Seminars in Anesthesia, Perioperative Medicine and Pain
ER -