Abstract

COMPARATIVE STUDY OF EFFICACY OF CEFTRIAXONE AND CEFOPERAZONE - TAZOBACTAM IN EMPIRICAL TREATMENT OF INFECTION IN INTRAVENOUS CATHETERIZED DIALYSIS PATIENTS WITH CHRONIC KIDNEY DISEASE

Sruthy S. S.*, Neethu P. Rajeev, Sandra George, Christy K. Jose, Dr. Subash B. Pillai and Dr. Santhosh M. Mathews

ABSTRACT

Background: Infections are common complications among patients on chronic haemodialysis. Haemodialysis patients with a catheter have a 2 to 3 fold increased risk of hospitalization for infection and death compared with patients with an arteriovenous fistula or graft . Broad spectrum antibiotics should be initiated to cover both gram positive and gram negative organisms. Aim: To compare the efficacy of ceftriaxone and cefoperazone-tazobactam in empirical treatment of intravenously catheterized dialysis patients with chronic kidney disease. Methods: It is a prospective cohort study of 60 iv catheterized dialysis patients who are taking ceftriaxone (n=30) or cefaperazonetazobactam (n=30) in empirical therapy for iv catheterized infection. The subjects were recruited from pushpagiri medical college hospital thiruvalla. It was a 6 months study in which patients were recruited based on the inclusion and exclusion criteria. All patients were provided with a brief introduction regarding the study and the confidentiality of the data. A written informed consent was obtained from the patient or care-giver. Patients diagnosed with CKD under heamodialysis and developed fever while on iv catheter were included in the study. A predesigned proforma was used for the purpose of data collection. To assess the health related quality of life, the WHOQOL-BREF questionnaire and Karnofsky Performance Status Scale were used.t test and chi square test were used to determine the strength of the correlation between the antibiotic therapy and the number of days taken to alleviate the symptoms. Results: 75% of the patients enrolled in this study had therapeutic success and the rest 25% of patients had therapeutic failure.The success-failure ratio of ceftriaxone group was 5 where as in cefoperazone–tazobactam group was 2.From Karnofsky performance rating scale, patients are unable to work, requires considerable assistance and frequent medical care. From whoqol - bref procedure, it is found that the physical health of catheterized patients on both groups were poor, the psychological health and environmental support were also found to be poor while the social relationship domain was found to be moderate. Ceftriaxone and cefoperazone-tazobactam have comparable efficacy in the empirical treatment of infections in intravenous catheterised dialysis patients with chronic kidney disease. The acquisition cost of ceftriaxone is less than that of cefoperazone-tazobactam, so the former is cost effective.

Keywords: Ceftriaxone, Cefoperazone-tazobactam, whoqol – bref procedure, karnofsky scale, catheter related infection, empirical therapy.