Original Research

Evaluation of ceftriaxone-sulbactam-disodium edetate adjuvant combination against multi-drug resistant Gram-negative organisms

Shilpi Gupta, Mahadevan Kumar, Shelinder P.S. Shergill, Kundan Tandel
African Journal of Laboratory Medicine | Vol 9, No 1 | a991 | DOI: https://doi.org/10.4102/ajlm.v9i1.991 | © 2020 Shilpi Gupta, Mahadevan Kumar, Shelinder P.S. Shergill, Kundan Tandel | This work is licensed under CC Attribution 4.0
Submitted: 04 February 2019 | Published: 10 December 2020

About the author(s)

Shilpi Gupta, Department of Microbiology, Military Hospital, Bhopal, India
Mahadevan Kumar, Department of Microbiology, Bharati Vidyapeeth University Medical College, Pune, India
Shelinder P.S. Shergill, Department of Microbiology, Armed Forces Medical College, Pune, India
Kundan Tandel, Department of Microbiology, Command Hospital (Central Command), Lucknow, India

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Background: Multi-drug resistant (MDR) Gram-negative bacteria are an emerging threat, both in hospital and community settings. As very few antibiotics are effective against such infections, the need of the hour is a new antibiotic or drug combination which can overcome the effect of extended-spectrum β-lactamases (ESBL) and metallo β-lactamases (MBL). A new antibiotic combination of ceftriaxone, sulbactam and disodium edetate (CSE) has recently been proposed to tackle the MDR organisms.

Objective: Our study was carried out to assess the susceptibility of ESBL- and MBL-producing Gram-negative organisms to CSE.

Methods: The study was conducted in a tertiary-care hospital in Delhi, India, from February 2017 to June 2017. A total of 179 MDR (85 ESBL + 94 MBL) Gram-negative isolates from various clinical samples, identified by an automated system (Vitek 2) were tested against CSE using the Kirby-Bauer disc diffusion method. Susceptibility to CSE was recorded based on interpretative zone sizes of ceftriaxone as per 2017 Clinical and Laboratory Standards Institute guidelines.

Results: The most common isolate was Escherichia coli (76/179; 42.4%) followed by Klebsiella pneumoniae (53/179; 29.6%) and Acinetobacter baumanii (27/179; 15.1%). The in vitro susceptibility of ESBL- and MBL-producing Gram-negative isolates to CSE was found to be 58/85 (68.2%) for ESBL and 37/94 (39.4%) for MBL.

Conclusion: The in vitro susceptibility results obtained for CSE against ESBL-producing organisms is promising. It has the potential to emerge as a carbapenem-sparing antibiotic, active against ESBL-producing strains. Further clinical studies are required to establish the clinical efficacy of CSE against MDR pathogens.


ceftriaxone sulbactam, disodium edetate; multi-drug resistance; carbapenem-sparing


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