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Comparative Study between Usage of Meropenem/Gentamicin versus ceftazidime/Avibactam in the Treatment of ARDS Induced by both Lung Trauma and VAP

Mohamed Gaber Ibrahium Mostafa Allam

Introduction: Contused lungs threaten life of the polytrauma patients. Accumulation of fluid in the lungs markedly reduces oxygenation and facilitates development of Ventilator associated pneumonia (VAP). VAP is a subtype of health care acquired pneumonia with high mortality rate (45%). Antibiotics are considered as the corner stone of management in treatment of VAP.

Aim: To evaluate and compare the effect of use of combination of meropenem/gentamicin versus the use of ceftazidime/avibactam in the treatment of ARDS induced by both VAP and lung contusion and early weaning from the ventilator and compare their effect on the mortality rate.

Patients and methods: Prospective double blind study conducted on 200 patients of King Abdul-Aziz Specialized Hospital. Patients were allocated in two groups: Group A included 100 patients received meropenem/ gentamicin while Group B included another 100 patients received ceftazidime/avibactam. The duration of the study was 14 days. In this study, diagnosis of lung contusion confirmed by computerized axial tomography (CT) of the chest, while VAP Diagnosed by modified clinical pulmonary infection scores (CPIS).

Results: 15, 38 and 46 patients in group A showed controlled tracheal secretion respectively in 3 studied period compared to 28, 75 and 83 in group B, less parenchymatous lung infiltration in the chest X-ray 12, 40 and 48 patients in group A compared to 24, 88 and 91 patients in group B, improvement of the hypoxic index 48, 76 and 85 patients in group A compared to 66, 90 and 98 patients in B, normalization of temperature 16, 36 and 54 patients in group A, while 40, 76 and 90 patients in B and reduction of total Leucocytic count 18, 35 and 57 patients in group A, while 38, 70 and 87 patients in group B, there was 15 out of 98 patients in group A not weaned while only 5out of 100 patients in group B cases failed to be weaned from mechanical ventilation within the studied period (2 weeks).

Conclusion: The use of ceftazidime/avibactam more rapidly control all parameters of CPIS and provide faster weaning from the ventilator with non-significant lower mortality rate than meropenem/gentamicin.