الفهرس 
Dual carbapenems versus carbapenem-colistin combination in management of multidrug resistant Klebsiella pneumonia-induced sepsis in pediatrics
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Abstract
Background and objectives: The emergence of multidrug resistant Klebsiella pneumonia(MDR-Kp) poses a significant threat because of the limited therapeutic options for treatment. from the available options is combining first and second-line antibiotics as carbapenem and colistin. Recently, the association of two carbapenems (ertapenem plus meropenem), has been proposed as rescue treatment for MDR-Kp infections. The aim of this study is to compare the clinical efficacy and safety of the carbapenem-colistin combination versus dual carbapenem strategy in children with sepsis due to MDR-Kp.
Methods: A total of 60 sepsis pediatric patients in Cairo University specialized pediatric hospital’s intensive care units were divided into two groups (30 patients each); the first group received intravenous meropenem plus colistin, and the second group received dual carbapenems (ertapenem combined with meropenem).
Results: The dual carbapenem combination group showed microbiological eradication of MDR-Kpwith 83.3% versus 63.3% in the colistin-meropenem group; (P=0.08). Both groups showed significant decrease in C-reactive protein (P<0.001) from start to end of therapy but was statistically insignificant between the two regimens, (P=0.447). The procalcitonin serum levels in cured patients were within normal range in both groups. In addition, PCT proved being a better marker for monitoring sepsis progression and a guide for discontinuation of antibiotics than CRP (p=0.017). A significant decrease in the white blood cells count was observed within each group (P<0.001) and between groups at the end of therapy (P=0.007). The dual carbapenem regimen showed significantly less duration of therapy with mean 9.8 ± 2 versus 11 ± 2 (P=0.028). Both groups didn’t negatively affect kidney or liver function tests.
Conclusion: Both regimens (colistin-meropenem combination and dual carbapenems) showed comparable effects regarding the clinical improvement of patients with sepsis due to MDR-Kp. They also showed comparable effects on the improvement of laboratory markers measured. The dual carbapenem regimen showed a better microbiological eradication of Klebsiella pneumonia (P value 0.08) and statistically significant shorter duration of therapy.Also this study highlighted the advantage of PCT over CRP as sepsis eradication marker