Iranian Journal of Microbiology 2017. 9(1):19-25.

Sensitivity of levofloxacinin combination with ampicillin-sulbactam and tigecycline against multidrug-resistant Acinetobacter baumannii
Nahid Madadi Goli, Rezvan Moniri, Sareh Bagheri Josheghani, Nilufar Dasteh Goli


Background and Objectives: The selection of alternative treatment options with antibiotic combinations may be used for successful managing of multidrug-resistant Acinetobacter baumannii. The aim of this study was to determine the synergistic effects of ampicillin-sulbactam combined with either levofloxacin or tigecycline against MDR A. baumannii.

Materials and Methods: A total 124 of A.baumannii isolates collected from clinical samples of hospitalized patients which assessed for antibiotic susceptibility using disk diffusion method. E-test was used on 10 MDR A. baumannii isolates to determine the minimum inhibitory concentration (MIC) of ampicillin-sulbactam, levofloxacin and tigecycline. Any synergistic effects were evaluated at their own MIC using E-test assay at 37°C for 24 hours. Synergy was defined as a fractional inhibitory concentration index (FICI) of ≤0.5.

Results: Levofloxacin plus ampicillin-sulbactam combination was found to have synergistic effects (FIC index: ≤0.5) in 90% of the isolates, but there was no synergistic effect for ampicillin-sulbactam/tigecycline and tigecycline/ levofloxacin combination. The antagonist effect in 50% of isolates (FIC index: >2) showed in combination of levofloxacin/tigecycline.

Conclusion: The emergence of multidrug A. baumannii isolates requires evaluating by combination therapy. The combination of levofloxacin plus a bactericidal antibiotic such as ampicillin-sulbactam is recommended. Results should be confirmed by clinical studies.

Keywords: Acinetobacter baumannii, Etest Methods, Microbial Drug Resistance, Synergistic effect


Acinetobacter baumannii; Etest Methods; Microbial Drug Resistance; Synergistic effect

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