A prospective evaluation of synergistic effect of sulbactam and tazobactam combination with meropenem or colistin against multidrug resistant Acinetobacter baumannii

Authors

  • Mohammed Ali M.Marie
  • Lakshmana Gowda Krishnappa Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
  • Alhusain J. Alzahrani Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
  • Murad A. Mubaraki Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
  • Abdullah A. Alyousef Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia

DOI:

https://doi.org/10.17305/bjbms.2015.526

Keywords:

Acinetobacter baumannii, additive, meropenem, synergy, sulbactam, tazobactam

Abstract

The present study evaluates the synergistic effect of sulbactam/tazobactam in combination with meropenem or colistin against multidrug resistant (MDR) Acinetobacter baumannii isolated from hospitalized patients from a tertiary care hospital in Saudi Arabia. During the study period, 54 multidrug and carbapenem-resistant isolates of A. baumannii isolates were collected from blood and respiratory samples of patients with ventilator-associated pneumonia or bacteremia. Microbroth checkerboard assay (CBA) and E-test were performed to look for synergistic interface of sulbactam and tazobactam with meropenem or colistin. All 54 MDR isolates of A. baumannii were resistant to carbapenem. Minimum inhibitory concentration [50/90] value against sulbactam, tazobactam, meropenem, colistin was found to be 64/128, 64/128, 64/256, and 0.5/1.0 respectively. Synergy was detected in more isolates with CBA compared to E-test. All four combinations showed significant synergistic bactericidal activity. However, the combination with colistin showed greater synergistic effect than combination with meropenem. Antagonism was not detected with any of the combinations and any method, but indifference was seen in tazobactam and colistin combination alone. A significant bactericidal effect was seen with sulbactam combination with meropenem or colistin in both methods. A combination therapy can be a choice of treatment. As colistin is known to exhibit nephrotoxicity, the combination of sulbactam and meropenem might be considered as an alternative antibiotic treatment for such multi- and extremely resistant bacteria. Yet, sample size is small in our study, so further well-designed in vitro and clinical studies on large scale should confirm our findings.

References

Al-Anazi KA, Abdalhamid B, Alshibani Z, Awad K, Alzayed A, Hassan H, et al. Acinetobacter baumannii septicemia in a recipient of an allogeneic hematopoietic stem cell transplantation. Case Rep Transplant 2012;2012:646195. http://www.dx.doi.org/10.1155/2012/646195.

Chuang YC, Cheng CY, Sheng WH, Sun HY, Wang JT, Chen YC, et al. Effectiveness of tigecycline-based versus colistin- based therapy for treatment of pneumonia caused by multidrug-resistant Acinetobacter baumannii in a critical setting: A matched cohort analysis. BMC Infect Dis 2014;14:102. http://www.dx.doi.org/10.1186/1471-2334-14-102.

Dash M, Padhi S, Pattnaik S, Mohanty I, Misra P. Frequency, risk factors, and antibiogram of Acinetobacter species isolated from various clinical samples in a tertiary care hospital in Odisha, India. Avicenna J Med 2013;3:97-102. http://www.dx.doi.org/10.4103/2231-0770.120501.

Dougari HJ, Ndakidemi PA, Human IS, Benade S. Virulence factors and antibiotic susceptibility among verotoxic non O157: H7 Escherichia coli isolates obtained from water and waste water samples in Cape Town, South Africa. Afr J Biotechnol 2011;10:14160-8.

Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: Emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538-82. http://www.dx.doi.org/10.1128/CMR.00058-07.

Yu YS, Yang Q, Xu XW, Kong HS, Xu GY, Zhong BY. Typing and characterization of carbapenem-resistant Acinetobacter calcoaceticus-baumannii complex in a Chinese hospital. J Med Microbiol 2004;53:653-6. http://www.dx.doi.org/10.1099/jmm.0.05513-0.

Falagas ME, Karveli EA. The changing global epidemiology of Acinetobacter baumannii infections: A development with major public health implications. Clin Microbiol Infect 2007;13:117-9. http://www.dx.doi.org/10.1111/j.1469-0691.2006.01596.x.

Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006;42:692-9. http://www.dx.doi.org/10.1086/500202.

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;54:4678-83. http://www.dx.doi.org/10.1128/AAC.00497-10.

Fournier PE, Vallenet D, Barbe V, Audic S, Ogata H, Poirel L, et al. Comparative genomics of multidrug resistance in Acinetobacter baumannii. PLoS Genet 2006;2:e7. http://www.dx.doi.org/10.1371/journal.pgen.0020007.

Maragakis LL, Perl TM. Acinetobacter baumannii: Epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46:1254-63. http://www.dx.doi.org/10.1086/529198.

Manchanda V, Sanchaita S, Singh N. Multidrug resistant Acinetobacter. J Glob Infect Dis 2010;2:291-304. http://www.dx.doi.org/10.4103/0974-777X.68538.

Lakshmana Gowda K, Marie MA, Al-Sheikh YA, John J, Gopalkrishnan S, Chikkabidare Shashidhar P, et al. A 6-year surveillance of antimicrobial resistance patterns of Acinetobacter baumannii bacteremia isolates from a tertiary care hospital in Saudi Arabia during 2005-2010. Libyan J Med 2014;9:24039.

US Food and Drug Administration. Full prescribing information for Tygacil; 2010. p. 431-3. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/ label/2010/021821s021lbl.pdf. [Last accessed on 2014 Jun 30].

Falagas ME, Grammatikos AP, Michalopoulos A. Potential of old-generation antibiotics to address current need for new antibiotics. Expert Rev Anti Infect Ther 2008;6:593-600. http://www.dx.doi.org/10.1586/14787210.6.5.593.

Cetin ES, Tekeli A, Ozseven AG, Us E, Aridogan BC. Determination of in vitro activities of polymyxin B and rifampin in combination with ampicillin/sulbactam or cefoperazone/sulbactam against multidrug-resistant Acinetobacter baumannii by the E-test and checkerboard methods. Jpn J Infect Dis 2013;66:463-8. http://www.dx.doi.org/10.7883/yoken.66.463.

Berçot B, Poirel L, Dortet L, Nordmann P. In vitro evaluation of antibiotic synergy for NDM-1-producing Enterobacteriaceae. J Antimicrob Chemother 2011;66:2295-7. http://www.dx.doi.org/10.1093/jac/dkr296.

Krishnappa LG, Marie MA, Al Sheikh YA. Characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae and in vitro synergy of the colistin-meropenem combination. J Chemother 2014:1973947814Y0000000197.

Totir MA, Helfand MS, Carey MP, Sheri A, Buynak JD, Bonomo RA, et al. Sulbactam forms only minimal amounts of irreversible acrylate-enzyme with SHV-1 beta-lactamase. Biochemistry 2007;46:8980-7. http://www.dx.doi.org/10.1021/bi7006146.

Drawz SM, Bonomo RA. Three decades of beta-lactamase inhibitors. Clin Microbiol Rev 2010;23:160-201. http://www.dx.doi.org/10.1128/CMR.00037-09.

Corbella X, Ariza J, Ardanuy C, Vuelta M, Tubau F, Sora M, et al. Efficacy of sulbactam alone and in combination with ampicillin in nosocomial infections caused by multiresistant Acinetobacter baumannii. J Antimicrob Chemother 1998;42:793-802. http://www.dx.doi.org/10.1093/jac/42.6.793.

Choi JY, Kim CO, Park YS, Yoon HJ, Shin SY, Kim YK, et al. Comparison of efficacy of cefoperazone/sulbactam and imipenem/cilastatin for treatment of Acinetobacter bacteremia. Yonsei Med J 2006;47:63-9.

Winn W, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, et al. The nonfermentative Gram-negative bacilli. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th ed., Ch. 7. Baltimore, USA: Lippincott Williams & Wilkins; 2006. p. 309-55.

Weisburg WG, Barns SM, Pelletier DA, Lane DJ 16S ribosomal DNA amplification for phylogenetic study. J Bacteriol 1991;173:697-703.

Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational supplement. CLSI Document M100-S23. Wayne, PA: Clinical and Laboratory Standards Institute; 2013.

Ku K, Pogue JM, Moshos J, Bheemreddy S, Wang Y, Bhargava A, et al. Retrospective evaluation of colistin versus tigecycline for the treatment of Acinetobacter baumannii and/or carbapenem-resistant Enterobacteriaceae infections. Am J Infect Control 2012;40:983-7. http://www.dx.doi.org/10.1016/j.ajic.2011.12.014.

Al Sheikh YA, Marie MA, John J, Krishnappa LG, Dabwab KH. Prevalence of 16S rRNA methylase genes among ß-lactamase-producing Enterobacteriaceae clinical isolates in Saudi Arabia. Libyan J Med 2014;9:24432.

Marie MA, John J, Krishnappa LG, Gopalkrishnan S. Molecular characterization of the ß-lactamases in Escherichia coli and Klebsiella pneumoniae from a tertiary care hospital in Riyadh, Saudi Arabia. Microbiol Immunol 2013;57:805-10. http://www.dx.doi.org/10.1111/1348-0421.12104.

Spapen H, Jacobs R, Van Gorp V, Troubleyn J, Honoré PM. Renal and neurological side effects of colistin in critically ill patients. Ann Intensive Care 2011;1:14. http://www.dx.doi.org/10.1186/2110-5820-1-14.

Dong X, Chen F, Zhang Y, Liu H, Liu Y, Ma L. In vitro activities of rifampin, colistin, sulbactam and tigecycline tested alone and in combination against extensively drug-resistant Acinetobacter baumannii. J Antibiot (Tokyo) 2014;67:677-80. http://www.dx.doi.org/10.1038/ja.2014.99.

Peck KR, Kim MJ, Choi JY, Kim HS, Kang CI, Cho YK, et al. In vitro time-kill studies of antimicrobial agents against blood isolates of imipenem-resistant Acinetobacter baumannii, including colistin- or tigecycline-resistant isolates. J Med Microbiol 2012;61:353-60. http://www.dx.doi.org/10.1099/jmm.0.036939-0.

Zusman O, Avni T, Leibovici L, Adler A, Friberg L, Stergiopoulou T, et al. Systematic review and meta-analysis of in vitro synergy of polymyxins and carbapenems. Antimicrob Agents Chemother 2013;57:5104-11. http://www.dx.doi.org/10.1128/AAC.01230-13.

Pongpech P, Amornnopparattanakul S, Panapakdee S, Fungwithaya S, Nannha P, Dhiraputra C, et al. Antibacterial activity of carbapenem-based combinations againts multidrug-resistant Acinetobacter baumannii. J Med Assoc Thai 2010;93:161-71.

Kiffer CR, Sampaio JL, Sinto S, Oplustil CP, Koga PC, Arruda AC, et al. In vitro synergy test of meropenem and sulbactam against clinical isolates of Acinetobacter baumannii. Diagn Microbiol Infect Dis 2005;52:317-22. http://www.dx.doi.org/10.1016/j.diagmicrobio.2005.03.003.

Turk Dagi H, Kus H, Arslan U, Tuncer I. In vitro synergistic activity of sulbactam in combination with imipenem, meropenem and cefoperazone against carbapenem-resistant Acinetobacter baumannii isolates. Mikrobiyol Bul 2014;48:311-5. http://www.dx.doi.org/10.5578/mb.7104.

Simsek F, Gedik H, Yildirmak MT, Iris NE, Türkmen A, Ersoy A, et al. Colistin against colistin-only-susceptible Acinetobacter baumannii-related infections: Monotherapy or combination therapy? Indian J Med Microbiol 2012;30:448-52. http://www.dx.doi.org/10.4103/0255-0857.103767.

A prospective evaluation of synergistic effect of sulbactam and tazobactam combination with meropenem or colistin against multidrug resistant Acinetobacter baumannii

Downloads

Additional Files

Published

14-10-2015

How to Cite

1.
A prospective evaluation of synergistic effect of sulbactam and tazobactam combination with meropenem or colistin against multidrug resistant Acinetobacter baumannii. Biomol Biomed [Internet]. 2015 Oct. 14 [cited 2024 Mar. 29];15(4):24-9. Available from: https://bjbms.org/ojs/index.php/bjbms/article/view/526