Comparison of Cefoperazone + Sulbactam Versus Polymyxin B in the Management of Ventilator Associated Pneumonias Caused by Multi-Drug Resistant Acinetobacter

Authors

  • Fazal Rabbi Intensive Care Unit Saidu Group of Teaching Hospital Swat, Pakistan
  • Ajab Khan Afridi Medical Complex and Teaching Hospital, Pakistan
  • Syed Muhammad Muneeb Ali Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan
  • Syed Mujahid Gilani Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan
  • Taha Muhammad Usman Pasha Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan
  • Aqsa Ahmad Premium International Hospital Islamabad, Pakistan
  • Fazal Mustaan Luqman International Hospital, Pakhtoon Khwa, Pakistan
  • Tawseef Ahmad Songkla University, Hat-Yai, Thailand

DOI:

https://doi.org/10.59890/ijasr.v1i2.482

Keywords:

Polymoxin B, Procalcitonin, Ventilator Associated Pneumonia

Abstract

The present study entails a comparative analysis of the efficacy of polymyxin B and cefoperazone with sulbactam in the treatment of pneumonias induced by multidrug-resistant Acinetobacter strains. In the experimental group, the gender distribution was exactly the same (males: 21; females: 15). More co-morbidities exist in Group-II than in Group-I. In groups I and II, the mean ICU stays were respectively 11.86 days plus 2.06 SD and 11.47 days plus 1.61 SD. Day 2 post-therapy saw group mean CPIS at 7.781.48 and group-II at 7.081.23, respectively. The clinical response was seen in group-I (n=11/36) and group-II (n=24/36) patients in accordance with our operational criteria. Similar mortality rates applied to both groups. In line with our hypothesis, 31% (n=9/29) of group I survivors and 65.6% (n=21/32) of group II survivors both showed effectiveness (p=0.007).

References

Kohbodi GA, Rajasurya V, Noor A. Ventilator-Associated Pneumonia. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.

Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical infectious diseases. 2016;63(5):e61-e111.

Timsit J-F, Esaied W, Neuville M, Bouadma L, Mourvillier B. Update on ventilator-associated pneumonia. F1000Research. 2017;6.

Metersky ML, Wang Y, Klompas M, Eckenrode S, Bakullari A, Eldridge N. Trend in ventilator-associated pneumonia rates between 2005 and 2013. Jama. 2016;316(22):2427-9.

Charles MP, Kali A, Easow JM, Joseph NM, Ravishankar M, Srinivasan S, et al. Ventilator-associated pneumonia. The Australasian medical journal. 2014;7(8):334.

Feng D-Y, Zhou Y-Q, Zhou M, Zou X-L, Wang Y-H, Zhang T-T. Risk factors for mortality due to ventilator-associated pneumonia in a Chinese hospital: a retrospective study. Medical science monitor: international medical journal of experimental and clinical research. 2019;25:7660.

Wu D, Wu C, Zhang S, Zhong Y. Risk factors of ventilator-associated pneumonia in critically III patients. Frontiers in pharmacology. 2019;10:482.

Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. The Lancet infectious diseases. 2013;13(8):665-71.

Kalanuria AA, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Critical care. 2014;18:1-8.

Schreiber MP, Shorr AF. Challenges and opportunities in the treatment of ventilator-associated pneumonia. Expert Review of Anti-Infective Therapy. 2017;15(1):23-32.

Huang Y, Zhou Q, Wang W, Huang Q, Liao J, Li J, et al. Acinetobacter baumannii ventilator-associated pneumonia: Clinical efficacy of combined antimicrobial therapy and in vitro drug sensitivity test results. Frontiers in pharmacology. 2019;10:92.

Hu G, Liu W, Wang M. Polymyxin B, Cefoperazone Sodium-Sulbactam Sodium, and Tigecycline against Multidrug-Resistant Acinetobacter baumannii Pneumonia. Evidence-Based Complementary and Alternative Medicine. 2022;2022.

Langley JM, Frenette L, Chu L, McNeil S, Halperin S, Li P, et al. A randomized, controlled non-inferiority trial comparing A (H1N1) pmd09 vaccine antigen, with and without AS03 adjuvant system, co-administered or sequentially administered with an inactivated trivalent seasonal influenza vaccine. BMC infectious diseases. 2012;12:1-13.

Romero-Gomez M, Mingorance J. The effect of the blood culture bottle type in the rate of direct identification from positive cultures by matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry. Journal of Infection. 2011;62(3):251-3.

Khan FU, Fang Y. Effectiveness of pharmacist-led brief educational intervention for adherence to the antibiotics for lower respiratory tract infections (EATSA) in Post-conflict rural areas of Pakistan: study protocol for a randomized controlled trial. Antibiotics. 2021;10(10):1147.

Unver E, Cikman A, Karakecili F, Koc A, Binay UD, Karavas E. Microorganisms Causing Ventilator-Associated Pneumonia and Their Antibiotic Susceptibility. Eurasian Journal of Medical Investigation. 2019;3(3):227-31.

Broyles MR, editor Impact of procalcitonin-guided antibiotic management on antibiotic exposure and outcomes: real-world evidence. Open forum infectious diseases; 2017: Oxford University Press US.

Brotfain E, Borer A, Koyfman L, Saidel-Odes L, Frenkel A, Gruenbaum SE, et al. Multidrug resistance Acinetobacter bacteremia secondary to ventilator-associated pneumonia: risk factors and outcome. Journal of Intensive Care Medicine. 2017;32(9):528-34.

Giamarellou H, Poulakou G. Multidrug-resistant Gram-negative infections: what are the treatment options? Drugs. 2009;69:1879-901.

Kanj SS, Kanafani ZA, editors. Current concepts in antimicrobial therapy against resistant gram-negative organisms: extended-spectrum β-lactamase–producing enterobacteriaceae, carbapenem-resistant enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. Mayo Clinic Proceedings; 2011: Elsevier.

Thomas R, Velaphi S, Ellis S, Walker AS, Standing JF, Heath P, et al. The use of polymyxins to treat carbapenem resistant infections in neonates and children. Expert opinion on pharmacotherapy. 2019;20(4):415-22.

Tsuji BT, Pogue JM, Zavascki AP, Paul M, Daikos GL, Forrest A, et al. International consensus guidelines for the optimal use of the polymyxins: endorsed by the American college of clinical pharmacy (ACCP), European society of clinical microbiology and infectious diseases (ESCMID), infectious diseases society of America (IDSA), international society for anti‐infective pharmacology (ISAP), society of critical care medicine (SCCM), and society of infectious diseases pharmacists (SIDP). Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2019;39(1):10-39.

Pogue J, Ortwine J, Kaye K. Clinical considerations for optimal use of the polymyxins: a focus on agent selection and dosing. Clinical Microbiology and Infection. 2017;23(4):229-33.

Falagas ME, Kyriakidou M, Voulgaris GL, Vokos F, Politi S, Kechagias KS. Clinical use of intravenous polymyxin B for the treatment of patients with multidrug-resistant Gram-negative bacterial infections: an evaluation of the current evidence. Journal of Global Antimicrobial Resistance. 2021;24:342-59.

Dubrovskaya Y, Chen T-Y, Scipione MR, Esaian D, Phillips MS, Papadopoulos J, et al. Risk factors for treatment failure of polymyxin B monotherapy for carbapenem-resistant Klebsiella pneumoniae infections. Antimicrobial agents and chemotherapy. 2013;57(11):5394-7.

Khan FU, Fang Y, Khan Z, Khan FU, Malik ZI, Ahmed N, et al. Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan. European Journal of Inflammation. 2020;18:2058739220960547.

Bento Talizin T, Dantas de Maio Carrilho CM, Magalhães Carvalho Grion C, Tibery Queiroz Cardoso L, Toshiyuki Tanita M, Boll KM, et al. Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance. Plos one. 2020;15(8):e0237880.

Yokota M, Kim A, Goto T, Harada T, Takeda M, Namiki M, et al. Polymyxin B-direct hemoperfusion therapy improves mean arterial pressure in septic shock. Critical Care. 2013;17:1-59.

Khan FU, Khan Z, Fang Y. Need of Guidelines and Antimicrobial Stewardship in Pakistan for Perioperative Surgical Practices to Prevent Surgical Site Infections. Journal of the College of Physicians and Surgeons Pakistan. 2020;30(8):882-4.

Downloads

Published

2023-10-31

How to Cite

Rabbi, F., Khan, A., Ali, S. M. M., Gilani, S. M., Pasha, T. M. U., Ahmad, A., Mustaan, F., & Ahmad, T. (2023). Comparison of Cefoperazone + Sulbactam Versus Polymyxin B in the Management of Ventilator Associated Pneumonias Caused by Multi-Drug Resistant Acinetobacter. International Journal of Applied and Scientific Research, 1(2), 193–200. https://doi.org/10.59890/ijasr.v1i2.482