Compassionate use of a novel ß-lactam enhancer-based investigational antibiotic cefepime/zidebactam (WCK 5222) for the treatment of extensively-drug-resistant NDM-expressing Pseudomonas aeruginosa infection in an intra-abdominal infection-induced sepsis patient: a case report.

Infections in critically-ill patients caused by extensively-drug-resistant (XDR)-Pseudomonas aeruginosa are challenging to manage due to paucity of effective treatment options. Cefepime/zidebactam, which is currently in global Phase 3 clinical development (Clinical Trials Identifier: NCT04979806, registered on July 28, 2021) is a novel mechanism of action based ß-lactam/ ß-lactam-enhancer combination with a promising activity against a broad-range of Gram-negative pathogens including XDR P. aeruginosa. We present a case report of an intra-abdominal infection-induced sepsis patient infected with XDR P. aeruginosa and successfully treated with cefepime/zidebactam under compassionate use. The 50 year old female patient with past-history of bariatric surgery and recent elective abdominoplasty and liposuction developed secondary pneumonia and failed a prolonged course of polymyxins. The organism repeatedly isolated from the patient was a New-Delhi metallo ß-lactamase-producing XDR P. aeruginosa resistant to ceftazidime/avibactam, imipenem/relebactam and ceftolozane/tazobactam, susceptible only to cefepime/zidebactam. As polymyxins failed to rescue the patient, cefepime/zidebactam was administered under compassionate grounds leading to discharge of patient in stable condition. The present case highlights the prevailing precarious scenario of antimicrobial resistance and the need for novel antibiotics to tackle infections caused by XDR phenotype pathogens.

A case series of melioidosis: An underdiagnosed infection.

Melioidosis is an infection caused by Burkholderia pseudomallei. It is a non notifiable disease and is not included in Integrated Disease Surveillance Program by National Center of Disease Control. India is predicted to have highest burden of disease with an estimated mortality of 32,000 per year. Melioidosis presents with a wide range of clinical manifestations like pneumonia, liver and splenic abscess, septicemia etc. This wide spectrum of presentation and mimicry with other infections leads to its misdiagnosis or underdiagnosis. The only source of disease burden in India is few case reports and the true burden and distribution of disease still needs to be assessed. We, hereby, report a case series of four cases aged 28 years, 53 years, 33 years and 22 years. All cases had different clinical presentation ranging from abdominal wall abscess to septicemia and neurological manifestations making the diagnosis challenging. Three of the four cases were discharged after complete recovery while one case went leave against medical advice. To our knowledge this is the first series describing complete recovery of three out of four cases. This case series will help the physicians to raise their index of clinical suspicion of melioidosis in high risk patients presenting with various findings thus improving the chances of correct diagnosis and treatment.

Effect of Intramuscular Dexmedetomidine Administration Before Extubation on Post-Extubation Haemodynamics, Postoperative Sedation, and Analgesic Requirements: A Double Blind Placebo Controlled Study.

BACKGROUND: Dexmedetomidine, an α2-adrenoreceptor agonist has been successfully used for attenuating stress response to laryngoscopy. The present study was designed to evaluate the effects of intramuscular dexmedetomidine 30 minutes before extubation on hemodynamic response in patients undergoing laminectomy for prolapsed intervertebral disc (PIVD) under endotracheal intubation and general anesthesia. METHODS: Present double-blinded randomized placebo-controlled study, included 100 patients from either sex with American Society of Anesthesiologists grades I and II and age from 18 to 60 years undergoing laminectomy for PIVD under general anesthesia. Patients were randomly divided into two groups of 50 each based on computer generated random numbers. The study group received dexmedetomidine (2.0 µg/ kg, i.m.) in 2.5 mL saline, and the control group received normal saline (placebo, i.m.) 2.5 mL. Drugs had been administered 30 minutes before anticipated time of extubation intramuscularly at the deltoid region. Comparison of continuous variables between two groups was done by using student's unpaired t-test. Categorical data were analyzed by using chi-square test and Fischer Exact test as applicable. RESULTS: Heart rate was found to be significantly lower in the study group, 15 minutes before extubation (P = 0.003), during and after extubation (P ＜ 0.0001). The systolic and diastolic blood pressure was significantly lower in the study group during and after extubation (P ＜ 0.05). Cough was significantly lower in the study group during extubation. No significant difference was observed in other complications (respiratory stridor, incidence of laryngospasm or bronchospasm and reintubation) between the two groups. Pain score at 5 minutes, 2 hours, and 4 hours post-extubation was significantly lower in the study group (P ＜ 0.01). P-value ＜ 0.05 was considered statistically significant. CONCLUSIONS: Dexmedetomidine provides haemodynamic stability during extubation and post-extubation. It also provides post-operative calmness and reduces analgesic requirement and post-extubation complications.

COVID-19 pneumonia in kyphoscoliosis: The success stories.

Coronavirus disease (COVID-19) pandemic has led to millions of deaths worldwide. Old age, immunocompromised state and multiple comorbidities are described as risk factors. Kyphoscoliosis (KS) is the most common spine abnormality and a risk factor of respiratory failure. Management of pneumonia in a patient with severe kyphoscoliosis is challenging to the intensivist. We report successful management of two patients with severe kyphoscoliosis who developed severe COVID-19 pneumonia.

Intravenous Lignocaine to Blunt Extubation Responses: A Double-Edged Sword.

Extubation after general anesthetic procedures is often accompanied by transient undesirable responses such as hypertension, tachycardia, coughing, bucking, and raised intracranial and intraocular pressures. In neurosurgical procedures, they need to be stringently controlled to prevent the rise in cerebral blood flow, increase in intracranial pressure, and intracranial bleeding. Intravenous (IV) lignocaine (1-1.5 mg/kg) administration is one such method to blunt extubation responses. We describe a case where IV lignocaine was administered within the recommended doses to inhibit the extubation response, but the same resulted in generalized convulsions because of the clinical and physiological status of the patient at that point of time. Intravenous lignocaine administered to obtund extubation responses can itself manifest in toxic reactions depending on the preexisting clinical and physiological state of the patients. Thus, extreme caution and vigilance is to be maintained whenever IV local anesthetics are used for such purposes.