title: Management of Pneumonia and Blood Stream Infections with New Antibiotic Adjuvant Entity (Ceftriaxone + Sulbactam + Disodium Edetate)- A Novel Way to Spare Carbapenems.
abstract: BACKGROUND
  Nosocomial infections have been considered as a major health problem causing incremental morbidity, mortality and costs of therapy.
  
  
  OBJECTIVE
  This retrospective study was initiated with aim to analyse the comparative efficacy of a novel Antibiotic Adjuvant Entity (AAE), a combination of ceftriaxone + sulbactam + disodium edetate and meropenem in combination with colistin, for the management of Multi Drug Resistant (MDR) nosocomial Gram-negative bacterial infections.
  
  
  METHODS
  Case history sheets of patients with documented MDR nosocomial Gram-negative infections who received either AAE or meropenem in combination with colistin for management of infections over a period of 3 years (November 2012 - October 2015) were included in the study. Data related to clinical management, demographics, vital signs and laboratory parameters along with prior antibiotic therapy, dose and clinical outcomes were evaluated thoroughly to analyse the clinical benefits of this new AAE+ colistin therapy for management of MDR nosocomial infections.
  
  
  RESULTS
  Out of 115 patients short listed for the study, 52 patients had received AAE + colistin therapy and 63 patients have received meropenem + colistin. AAE + colistin therapy resulted in significantly higher efficacy (86.53%) as compared to meropenem + colistin (63.49%). A rising trend in clinical cure rates was observed in AAE based combination therapy in contrast to the decreasing trend in meropenem based combination therapy. A progressive decline in clinical cure rates was observed in meropenem treated group over a period of 3 years due to rising carbapenemases and multiple resistance by pathogens, where as AAE maintained the same efficacy.
  
  
  CONCLUSIONS
  The AAE + colistin therapy has shown better bacteriological and clinical efficacy as compared to meropenem + colistin in the management of various nosocomial MDR Gram-negative infections. A significant number of meropenem failure patients responded to the AAE therapy highlighting the new hope to spare carbapenems.
authors.affiliation: Professor, Department of Tuberculosis and Chest Disease, JN Medical College, Aligarh Muslim University , Aligarh, Uttar Pradesh, India .
authors.forename: Mohammad
authors.initials: M
authors.lastname: Shameem
authors.affiliation: Senior Resident, Department of Surgery, Firoz Hospital and Research Centre , Aligarh, Uttar Pradesh, India .
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Mir
keywords: Community acquired pneumonia; Elores; Gram-negative; Hospitale acquired pneumonia