1887

Abstract

Carbapenemase-producing Enterobacteriaceae have become a major public health concern over the last decade and treatment options are limited.

We evaluated the synergistic activity of the combination of aztreonam (ATM) and clavulanate for 41 -lactam-resistant clinical isolates harbouring class B or/and class D carbapenemases combined or not with extended-spectrum -lactamases (ESBLs).

The MICs of ATM, with and without amoxicillin–clavulanate (AMC), were determined. Time-kill assays were performed for three representative strains.

The ATM–AMC combination had a synergistic effect on 34/41 (83 %) isolates. The MIC of ATM, in the presence of clavulanate, was ≤1 mg l for 15/41 (37 %) isolates and ≤4 mg l for 29/41 (71 %) isolates. Synergistic activity was observed for 34/37 (92 %) isolates producing ESBLs and carbapenemases, compared to 0/4 (0 %) for ESBL-negative strains. Complete or partial bactericidal activity was obtained when the MIC of the combination was 0.5 mg l and 1.5 mg l or 8 mg l, respectively.

The combination of ATM and AMC could be an attractive unconventional treatment for infections due to carbapenemase- and ESBL-producing Enterobacteriaceae.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001052
2019-09-01
2022-01-25
Loading full text...

Full text loading...

/deliver/fulltext/jmm/68/9/1292.html?itemId=/content/journal/jmm/10.1099/jmm.0.001052&mimeType=html&fmt=ahah

References

  1. Tzouvelekis LS, Markogiannakis A, Piperaki E, Souli M, Daikos GL. Treating infections caused by carbapenemase-producing Enterobacteriaceae. Clin Microbiol Infect 2014; 20:862–872 [View Article]
    [Google Scholar]
  2. Cprek JB, Gallagher JC. Ertapenem-containing double-carbapenem therapy for treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae . Antimicrob Agents Chemother 2016; 60:669–673 [View Article]
    [Google Scholar]
  3. Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT et al. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infect Dis 2017; 17:153–163 [View Article]
    [Google Scholar]
  4. Liu Y-Y, Wang Y, Walsh TR, Yi L-X, Zhang R et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis 2016; 16:161–168 [View Article]
    [Google Scholar]
  5. Djahmi N, Dunyach-Remy C, Pantel A, Dekhil M, Sotto A et al. Epidemiology of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii in Mediterranean countries. Biomed Res Int 2014; 2014:30578411 [View Article]
    [Google Scholar]
  6. Á S, Ghazawi A, Hashmey R, Haidermota A, Girgis S et al. Multihospital occurrence of pan-resistant Klebsiella pneumoniae Sequence Type 147 with an ISEcp1-directed bla OXA-181 insertion in the mgrB gene in the United Arab Emirates. Antimicrob Agents Chemother 2018; 61:
    [Google Scholar]
  7. Rodríguez-Baño J, Gutiérrez-Gutiérrez B, Machuca I, Pascual A. Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae . Clin Microbiol Rev 2018; 31: [View Article]
    [Google Scholar]
  8. Chew KL, Tay MKL, Cheng B, Lin RTP, Octavia S et al. Aztreonam-Avibactam Combination Restores Susceptibility of Aztreonam in Dual-Carbapenemase-Producing Enterobacteriaceae . Antimicrob Agents Chemother 2018; 62: [View Article]
    [Google Scholar]
  9. Zemelman C, Bello H, Domínguez M, González G, Mella S et al. Activity of cefepime, cefotaxime, ceftazidime, and aztreonam against extended-spectrum-producing isolates of Klebsiella pneumoniae and Escherichia coli from chilean hospitals. Diagn Microbiol Infect Dis 2001; 40:41–43 [View Article]
    [Google Scholar]
  10. Muñoz Bellido JL, Muñoz Criado S, García García I, Alonso Manzanares MA, Gutiérrez Zufiaurre MN et al. In vitro activities of beta-lactam-beta-lactamase inhibitor combinations against Stenotrophomonas maltophilia: correlation between methods for testing inhibitory activity, time-kill curves, and bactericidal activity. Antimicrob Agents Chemother 1997; 41:2612–2615 [View Article]
    [Google Scholar]
  11. Krueger TS, Clark EA, Nix DE. In vitro susceptibility of Stenotrophomonas maltophilia to various antimicrobial combinations. Diagn Microbiol Infect Dis 2001; 41:71–78 [View Article]
    [Google Scholar]
  12. Arpi M, Victor MA, Mortensen I, Gottschau A, Bruun B. In vitro susceptibility of 124 Xanthomonas maltophilia (Stenotrophomonas maltophilia) isolates: comparison of the agar dilution method with the E-test and two agar diffusion methods. APMIS Acta Pathol Microbiol Immunol Scand 1996; 104:108–114
    [Google Scholar]
  13. García Sánchez JE, Vazquez López ML, Blazquez de Castro AM, Perez Simon JA, Gutierrez NG et al. Aztreonam/clavulanic acid in the treatment of serious infections caused by Stenotrophomonas maltophilia in neutropenic patients: case reports. J Chemother 1997; 9:238–240 [View Article]
    [Google Scholar]
  14. Garrec H, Drieux-Rouzet L, Golmard J-L, Jarlier V, Robert J. Comparison of nine phenotypic methods for detection of extended-spectrum beta-lactamase production by enterobacteriaceae. J Clin Microbiol 2011; 49:1048–1057 [View Article]
    [Google Scholar]
  15. Bingen E, Bidet P, Birgy A, Sobral E, Mariani P et al. In vitro interaction between cefixime and amoxicillin-clavulanate against extended-spectrum-beta-lactamase-producing Escherichia coli causing urinary tract infection. J Clin Microbiol 2012; 50:2540–2541 [View Article]
    [Google Scholar]
  16. Balke B, Hogardt M, Schmoldt S, Hoy L, Weissbrodt H et al. Evaluation of the E test for the assessment of synergy of antibiotic combinations against multiresistant Pseudomonas aeruginosa isolates from cystic fibrosis patients. Eur J Clin Microbiol Infect Dis 2006; 25:25–30 [View Article]
    [Google Scholar]
  17. Childs SJ, Bodey GP. Aztreonam. Pharmacotherapy 1986; 6:138–149 [View Article]
    [Google Scholar]
  18. Scully BE, Swabb EA, Neu HC. Pharmacology of aztreonam after intravenous infusion. Antimicrob Agents Chemother 1983; 24:18–22 [View Article]
    [Google Scholar]
  19. Bodey GP, Yeo E, Ho DH, Rolston K, LeBlanc B. Clinical pharmacology of timentin (ticarcillin and clavulanic acid). Clin Pharmacol Ther 1985; 38:134–139 [View Article]
    [Google Scholar]
  20. García-Rodríguez JA, García Sánchez JE, Muñoz Bellido JL, García García MI, García Sánchez E. Kinetics of antimicrobial activity of aztreonam/clavulanic acid (2:1) against Xanthomonas maltophilia . J Antimicrob Chemother 1991; 27:552–554 [View Article]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001052
Loading
/content/journal/jmm/10.1099/jmm.0.001052
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error