Efficacy of Ceftriaxone+Sulbactam+EDTA Combination for Complicated Urinary Tract Infection Patients: A Retrospective Case Series

Abstract

Background: In India, antimicrobial resistance (AMR) remains a major challenge for treatment of infectious diseases mainly due to inappropriate and high consumption of antibiotics. Judicious choice of antibiotics and its optimistic utilization can be one of the potent ways to control the epidemic rise in AMR. The objective of this case series was to determine the clinical utility of antibiotic adjuvant entity (CSE-1034) (Ceftriaxone+Sulbactam+EDTA) in complicated urinary tract infection (cUTI) cases. Methods: Patients suffering from multi-drug resistant (MDR) cUTIs and treated with CSE-1034 as monotherapy or combination therapy were screened and further analyzed. CSE-1034 therapy was started empirically in all these subjects and continued or discontinued based on culture sensitivity profile and clinical outcome. All the statistical analysis was performed using Chi-square test. Results: 20 culture-positive patients with mean age of 51±7.3 years were included in this case series. The most common pathogen isolated was E. coli (60%) followed by K. pneumonia (25%) and A. baumannii (15%). Culture sensitivity profile has shown that pathogens isolated from all subjects showed no sensitivity to Cefazolin, Ceftriaxone, Cefipime, 25% to Pipericillin-Tazobactam (pip-taz), 20% to Cefaperozone-Sulbactam, 5% to fluoroquinolones and 90% to Meropenem. Susceptibility pattern to CSE-1034 and Colistin was 100%. 90% (18/20) patients treated empirically with CSE-1034 were cured with CSE-1034 monotherapy and 10% (2/20) with CSE-1034+Levofloxacin combination therapy. Conclusion: From this case series, it can be suggested that CSE-134 alone or in combination with Levofloxacin appears to be an effective drug for treatment of MDR cUTI and can serve as effective replacement to Pip-Taz and β-lactam/β-lactam inhibitor combinations.