title: Waging war against extended spectrum Beta lactamase and metallobetalactamase producing pathogens- novel adjuvant antimicrobial agent cse1034- an extended hope.
abstract: Preamble: In the visage of multidrug resistance among gram negative bacilli, we look forward to carbapenem group of drugs as empiric choice in seriously ill patients. However increasing resistance to carbapenems, the last resort, is of growing concern for all. It's high time to look beyond Carbapenems and emphasize on Carbapenem sparers.
  
  
  OBJECTIVE
  This study is to find the susceptibility pattern of the novel adjuvant antimicrobial CSE 1034 a combination of Ceftriaxone+sulbactam+disodium edetate for the current ESBL and MBL isolates in a tertiary care centre.
  
  
  METHODS
  A total of 823 gram negative bacterial isolates were obtained from different clinical specimens during the period of March, 2013 to October, 2013. The overall prevalence of metallobetalactamase producing gram negative organisms was 11 percent (n=91). We included a total of 141 clinical isolates for this study.
  
  
  RESULTS
  Among 141 clinical isolates, 50 isolates (35%) were ESBL producers and 91 (65%) were MBL producers. Maximum numbers of ESBL producers were identified in Escherichia coli followed by Klebsiella pneumoniae, Acinetobacter baumannii and Proteus spp. Maximum numbers of MBL producers were identified in Klebsiella pneumoniae followed by Pseudomonas aeruginosa. CSE 1034 (Ceftriaxone+sulbactam+disodium edetate) showed fairly good in-vitro susceptibility for these ESBL and MBL producing isolates. It exhibited 64 % to 100% susceptibility and 18% to 22% intermediate sensitivity to ESBL producing isolates and 42 % to 89 % susceptible and 10 % to 51 % intermediate response to MBL producing isolates.
  
  
  CONCLUSIONS
  With increasing resistance to the commonly prescribed drugs used to treat infections caused by variety of gram negative organisms, Ceftriaxone+sulbactam+disodium edetate, a novel Antibiotic Adjuvant Entity (AAE) may be a promising option.
authors.affiliation: Consultant Microbiologist, Department of Microbiology, (Laboratory Medicine) S L Raheja Hospital (A Fortis Associate) Mahim (W), Mumbai, Maharastra, India .
authors.forename: Manisa
authors.initials: M
authors.lastname: Sahu
authors.affiliation: Chief Intensivist, Intensive Care Unit, S L Raheja Hospital (A Fortis Associate) Mahim (W), Mumbai, Maharastra, India .
authors.forename: S
authors.initials: S
authors.lastname: Sanjith
authors.affiliation: Technologist Supervisor, Department of Microbiology, (Laboratory Medicine) S L Raheja Hospital (A Fortis Associate) Mahim (W), Mumbai, Maharastra, India .
authors.forename: Pallavi
authors.initials: P
authors.lastname: Bhalekar
authors.affiliation: Technologist, Department of Microbiology, (Laboratory Medicine) S L Raheja Hospital (A Fortis Associate) Mahim (W), Mumbai, Maharastra, India .
authors.forename: Dipti
authors.initials: D
authors.lastname: Keny
keywords: Antibiotic adjuvant entity; CSE 1034; Extended-spectrum-β-lactamase (ESBL); Gram negative bacteria; Metallo-β-lactamases (MBL)