ABSTRACT
Background: Carbapenem-resistant enterobacteriaceae (CRE) is associated with high mortality in critically ill patients, with limited treatment options. This study aims to compare clinical response, microbiological response, and mortality in patients treated with ceftazidime-avibactam with or without aztreonam (CAZ-AVI + AZT) and colistin or polymyxin B (polymyxins) in CRE infections. Materials and methods: This single-center prospective observational study included adult patients with CRE infections treated with CAZ-AVI+AZT or polymyxins between January 2022 and December 2022 at a Tertiary Care Medical Center in India. The clinical response, microbiological response, and mortality were compared between the two groups using a Cox multivariate regression model adjusted for the baseline SOFA score and comorbidities. Results: A total of 89 patients were enrolled, with 59 (66%) patients receiving CAZ-AVI + AZT and 30 receiving polymyxins. Baseline demographics and clinical characteristics were similar between the two groups. The Cox multivariate regression analysis showed a statistically significant difference in clinical failure on day 14 with the CAZ-AVI + AZT group vs polymyxins (HR = 0.78, 95% CI 0.63-0.95, p = 0.018). There was no difference in microbiological failure (HR = 1.08, 95% CI 0.66-1.77, p = 0.76), microbiological relapse (HR = 0.75, 95% CI 0.36-3.02, p = 0.62), and hospital mortality (HR = 1.04, 95% CI 0.75-1.43, p = 0.796) between the two groups. Conclusion: Treatment with ceftazidime-avibactam with or without aztreonam for CRE infections associated with a better clinical response compared with polymyxins monotherapy but without any difference in microbiological response or mortality. How to cite this article: Vijayakumar M, Selvam V, Renuka MK, Rajagopalan RE. The Comparative Efficacy of Ceftazidime-Avibactam with or without Aztreonam vs Polymyxins for Carbapenem-resistant Enterobacteriaceae Infections: A Prospective Observational Cohort Study. Indian J Crit Care Med 2023;27(12):923-929.
ABSTRACT
Background: Recognition of clinically significant bleeding (CSB) is vital for effective management of dengue patients. The primary objective was to identify the predictors of CSB among dengue patients and to formulate a simple scoring system. The secondary objective was to compare the grades of bleeding and severity of thrombocytopenia. Materials and methods: We conducted a retrospective study of adults aged above 18 years with dengue, admitted to the intensive care unit (ICU) of a tertiary care hospital in South India from 2015 to 2021. Demographic, clinical, and laboratory variables on admission were collected. The association of clinically significant bleeding with the above parameters was assessed by univariate and multivariate analysis. Results: A total of 9,817 dengue cases were hospitalized during the study period. A total of 120 patients with thrombocytopenia (<100000 cells/mm3) were admitted to the ICU and of them 38 (31.6%) had CSB. On univariate analysis fever, sequential organ function assessment (SOFA) score, elevated activated partial thromboplastin time (aPTT), and altered sensorium were significantly associated with CSB. The multivariate model identified SOFA score [adjusted odds ratio (aOR): 1.52; 95% confidence interval (CI): 1.11-2.08], temperature >38.3°C (aOR: 2.71; 95% CI: 1.1-6.47) and elevated aPTT > 40 seconds (aOR: 4.66; 95% CI: 1.42-15.3) as independent risk factors. A clinical predictive score was developed incorporating these three parameters. The performance of the score identified by the receiver operating characteristic (ROC) curve [area under the curve (AUC): 0.81; 95% CI: 0.73-0.91] demonstrated a sensitivity of 81% and specificity of 77%. Conclusion: This study revealed that temperature above 38.3°C, elevated aPTT, and an increase in SOFA score were identified as independent risk factors for CSB. A clinical predictive score derived from these variables can identify patients likely to develop CSB. How to cite this article: Logia P, Selvam V, Parasuraman V, Renuka MK, Rajagopalan RE. Predictors of Clinically Significant Bleeding in Thrombocytopenic Dengue Patients Admitted to Intensive Care Unit: A Retrospective Study. Indian J Crit Care Med 2023;27(12):888-894.
