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BMC microbiology
10 20, 2023;23 (1): 298.

In Vitro antibiotic combinations of Colistin, Meropenem, Amikacin, and Amoxicillin/clavulanate against multidrug-resistant Klebsiella pneumonia isolated from patients with ventilator-associated pneumonia.

Ghazal Bayatinejad, Mohammadreza Salehi, Reza Beigverdi, Shahnaz Halimi, Mohammad Emaneini, Fereshteh Jabalameli
Author Information
  1. Ghazal Bayatinejad: Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  2. Mohammadreza Salehi: Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  3. Reza Beigverdi: Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  4. Shahnaz Halimi: Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  5. Mohammad Emaneini: Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  6. Fereshteh Jabalameli: Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. jabalamf@tums.ac.ir.
PMID: 37864176 DOI: 10.1186/s12866-023-03039-w

Abstract

BACKGROUND: Hospital infections such as ventilator-associated pneumonia (VAP) due to multidrug-resistant Klebsiella pneumoniae (MDR-KP) strains have increased worldwide. In addition, biofilm production by these resistant isolates has confronted clinicians with higher treatment failure and infection recurrence. Given the paucity of new agents and limited data on combination therapy for MDR-KPs, the present study sought to evaluate the in vitro activity of several antibiotic combinations against planktonic and biofilm MDR-KPs isolated from patients with VAP.
RESULTS: All 10 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates demonstrated multidrug resistance against the tested antibiotics. At planktonic mode, combinations of colistin-meropenem and amoxicillin/clavulanate in combination with meropenem, colistin, or amikacin showed synergism against 60-70% isolates. On the other hand, in the biofilm state, colistin-based combinations exhibited synergism against 50-70% isolates and the most effective combination was colistin-amikacin with 70% synergy.
CONCLUSIONS: The results revealed that combinations of amoxicillin/clavulanate with colistin, meropenem, or amikacin in the planktonic mode and colistin with amoxicillin/clavulanate, meropenem, or amikacin in the biofilm mode could effectively inhibit CRKP isolates, and thus could be further explored for the treatment of CRKPs.

Keywords

Biofilm Carbapenem-resistant Klebsiella pneumoniae Checkerboard method Colistin Combination therapy Fractional inhibitory concentration (FIC). Klebsiella pneumoniae Multidrug resistant pathogen Synergism Synergistic effect

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MeSH Term

Humans
Meropenem
Colistin
Amikacin
Pneumonia, Ventilator-Associated
Klebsiella pneumoniae
Drug Synergism
Anti-Bacterial Agents
Klebsiella Infections
Amoxicillin-Potassium Clavulanate Combination
Microbial Sensitivity Tests

Chemicals

Meropenem
Colistin
Amikacin
Anti-Bacterial Agents
Amoxicillin-Potassium Clavulanate Combination
Journal Article Research Support, Non-U.S. Gov't

Word Cloud

Created with Highcharts 10.0.0Klebsiellaisolatescombinationspneumoniaebiofilmpneumoniacombinationplanktonicmodeamoxicillin/clavulanatemeropenemcolistinamikacinventilator-associatedVAPmultidrug-resistantresistanttreatmenttherapyMDR-KPsantibioticisolatedpatientsCRKPsynergismColistinBACKGROUND:HospitalinfectionsdueMDR-KPstrainsincreasedworldwideadditionproductionconfrontedclinicianshigherfailureinfectionrecurrenceGivenpaucitynewagentslimiteddatapresentstudysoughtevaluatevitroactivityseveralRESULTS:10carbapenem-resistantdemonstratedmultidrugresistancetestedantibioticscolistin-meropenemshowed60-70%handstatecolistin-basedexhibited50-70%effectivecolistin-amikacin70%synergyCONCLUSIONS:resultsrevealedeffectivelyinhibitthusexploredCRKPsVitroMeropenemAmikacinAmoxicillin/clavulanateBiofilmCarbapenem-resistantCheckerboardmethodCombinationFractionalinhibitoryconcentrationFICMultidrugpathogenSynergismSynergisticeffect

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