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Dose-Dependent Synergistic Interactions of Colistin with Rifampin, Meropenem, and Tigecycline against Carbapenem-Resistant Klebsiella pneumoniae Biofilms.

TitleDose-Dependent Synergistic Interactions of Colistin with Rifampin, Meropenem, and Tigecycline against Carbapenem-Resistant Klebsiella pneumoniae Biofilms.
Publication TypeJournal Article
Year of Publication2019
AuthorsGeladari, A., Simitsopoulou M., Antachopoulos C., & Roilides E.
JournalAntimicrob Agents Chemother
Volume63
Issue3
Date Published2019 03
ISSN1098-6596
KeywordsAdult, Bacteremia, Biofilms, Carbapenem-Resistant Enterobacteriaceae, Colistin, Drug Synergism, Humans, Klebsiella Infections, Klebsiella pneumoniae, Meropenem, Microbial Sensitivity Tests, Rifampin, Tigecycline
Abstract

Carbapenem-resistant (CR-) can cause biofilm-related bloodstream infections associated with significant morbidity and mortality worldwide. We investigated the bactericidal activities of colistin (CST), rifampin (RIF), meropenem (MEM), gentamicin (GEN), and tigecycline (TGC) alone and that of CST in combination with RIF, MEM, GEN, or TGC against CR- mature biofilms. Twenty CR- blood isolates were derived from an equal number of bloodstream infections in adult patients. Biofilm formation was assessed by staining with 0.4% crystal violet and measuring the optical density spectrophotometrically at 545 nm. Biofilm damage was measured as the percent reduction of metabolic activity by an XTT [2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide salt] assay. The MIC for biofilms was determined as the minimum concentration that caused ≥50% bacterial damage compared to that for untreated controls. Antibacterial drug interactions were analyzed by the Bliss independence model. Four of the 20 CR- isolates were biofilm producers. Biofilm MICs of CST, RIF, MEM, GEN, and TGC for these isolates were 64, 8, >256, 128, and 8 mg/liter, respectively. Synergistic interactions were observed at 32 to 64 mg/liter of CST combined with 0.25 to 4 mg/liter of RIF, at 32 mg/liter of CST combined with 0.007 to 0.25 mg/liter of MEM, and at 16 to 32 mg/liter of CST combined with 16 to 64 mg/liter of TGC. The synergy was highest for CST plus RIF, with a mean Δ ± standard error (SE) of 49.87% ± 9.22%, compared to 29.52% ± 4.97% for CST plus MEM ( < 0.001) and 32.44% ± 6.49% for CST plus TGC ( < 0.001). Indifferent results were exhibited by CST plus GEN. None of the combinations exhibited antagonism. These drug interaction findings, especially those for CST with RIF, may be of importance in the treatment of biofilm-related CR- infections.

DOI10.1128/AAC.02357-18
Alternate JournalAntimicrob Agents Chemother
PubMed ID30642942
PubMed Central IDPMC6395917

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