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

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

Abstract


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


Keywords


Acinetobacter baumannii, Etest methods, Microbial drug resistance, Synergistic effect

Full Text:

PDF

References


Zilberberg MD, Kollef MH, Shorr AF. Secular trends in Acinetobacter baumannii resistance in respiratory and blood stream specimens in the United States, 2003 to 2012: A survey study. J Hosp Med 2015; doi: 10.1002/jhm.2477.

Thamlikitkul V, Tiengrim S, Seenama C. In vitro activity of polymyxin B against carbapenem-resistant Acinetobacter baumannii. J Med Assoc Thai 2014; 97: 1254-1258.

Peerayeh SN, Karmostaji A, Sarasiabi SS, Javadpour S, Davoodian P, Moradi N. In Vitro Activity of Tigecycline and Colistin against clinical isolates of Acinetobacter baumannii in Hospitals in Tehran and Bandar-Abbas, Iran. Electron Physician 2014; 1;6: 919-924.

Berditsch M, Jäger T, Strempel N, Schwartz T, Overhage J, Ulrich AS. Synergistic effect of membrane-active peptides polymyxin B and gramicidin S on multidrug-resistant strains and biofilms of Pseudomonas aeruginosa. Antimicrob Agents Chemother 2015; 59:5288-5296.

Bush LM, Johnson CC. Ureidopenicillins and beta-lactam/beta-lactamase inhibitor combinations. Infect Dis Clin North Am 2000; 14:409-433.

Jean SS, Hsieh TC, Hsu CW, Lee WS, Bai KJ, Lam C. Comparison of the clinical efficacy between tigecycline plus extended-infusion imipenem and sulbactam plus imipenem against ventilator-associated pneumonia with pneumonic extensively drug-resistant Acinetobacter baumannii bacteremia, and correlation of clinical efficacy with in vitro synergy tests. J Microbiol Immunol Infect 2016; 49: 924-933.

Peleg AY, Adams J, Paterson DL. Tigecycline Efflux as a Mechanism for Nonsusceptibility in Acinetobacter baumannii. Antimicrob Agents Chemother 2007;51:2065-2069.

Performance standards for antimicrobial susceptibility testing, “Twenty third Information Supplement. 2013. M100-S23. p.66.

Sopirala MM, Mangino JE, Gebreyes WA, Biller B, Bannerman T, Balada-Llasat JM, et al. Synergy testing by Etest, microdilution checkerboard, and time-kill methods for pan-drug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 2010;54: 4678-4683.

Lowings M, Ehlers MM, Dreyer AW, Kock MM. High prevalence of oxacillinases in clinical multidrug-resistant Acinetobacter baumannii isolates from the Tshwane region, South Africa - an update. BMC Infect Dis 2015; 15:521.

Nageeb W, Metwally L, Kamel M, Zakaria S. In vitro antimicrobial synergy studies of carbapenem-resistant Acinetobacter baumannii isolated from intensive care units of a tertiary care hospital in Egypt. J Infect Public Health 2015; 8:593-602.

Van TD, Dinh QD, Vu PD, Nguyen TV, Pham CV, Dao TT, et al. Antibiotic susceptibility and molecular epidemiology of Acinetobacter calcoaceticus-baumannii complex strains isolated from a referral hospital in northern Vietnam. J Glob Antimicrob Resist 2014;2: 318-321.

Ghajavand H, Esfahani BN, Havaei SA, Moghim S, Fazeli H. Molecular identification of Acinetobacter baumannii isolated from intensive care units and their antimicrobial resistance patterns. Adv Biomed Res 2015; 4: 110.

Kooti S, Motamedifar M, Sarvari J. Antibiotic resistance profile and distribution of oxacillinase genes among clinical isolates of Acinetobacter baumannii in Shiraz teaching hospitals, 2012-2013. Jundishapur J Microbiol 2015; 8(8):e20215.

Sharif F, Moniri R, Bagheri Josheghani S, Dastehgoli. K. Antibiotic susceptibility patterns and blaPER-1 β-lactamase-producing Acinetobacter baumannii isolated from hospitalized patients. J Glob Antimicrob Resist 2015; 3: 47-48.

Pajand O, Rezaee MA, Nahaei MR, Mahdian R, Aghazadeh M, Soroush MH, et al. Study of the carbapenem resistance mechanisms in clinical isolates of Acinetobacter baumannii: comparison of burn and non-burn strains. Burns 2013; 39:1414-1419.

Pournaras S, Koumaki V, Gennimata V, Kouskouni E, Tsakris A. In Vitro Activity of Tigecycline Against Acinetobacte rbaumannii: Global Epidemiology and Resistance Mechanisms. Adv Exp Med Biol 2016; 897:1-14.

Ocampo PS, Lázár V, Papp B, Arnoldini M, Abel zurWiesch P, Busa-Fekete R, et al. Antagonism between bacteriostatic and bactericidal antibiotics is prevalent. Antimicrob Agents Chemother 2014; 58:4573-4582.

Principe L, D'Arezzo S, Capone A, Petrosillo N, Visca P. In vitro activity of tigecycline in combination with various antimicrobials against multidrug resistant Acinetobacter baumannii. Ann Clin Microbiol Antimicrob 2009 21;8:18.

Petersen PJ, Labthavikul P, Jones CH, Bradford PA. In vitro antibacterial activities of tigecycline in combination with other antimicrobial agents determined by chequerboard and time-kill kinetic analysis. J Antimicrob Chemother 2006;57:573-576.

Ozbek B, Sentürk A. Postantibiotic effects of tigecycline, colistin sulfate, and levofloxacin alone or tigecycline-colistin sulfate and tigecycline-levofloxacin combinations against Acinetobacter baumannii. Chemotherapy 2010; 56:466-471.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.