Does the Activity of the Combination of Imipenem and Colistin In Vitro Exceed the Problem of Resistance in Metallo-β-Lactamase-Producing
            <i>Klebsiella pneumoniae</i>
            Isolates?

Souli, María; Rekatsina, Panagiota Danai; Chryssouli, Zoi; Galani, Irene; Giamarellou, Helen; Kanellakopoulou, Kyriaki

doi:10.1128/aac.01271-08

Cited by 59 publications

(38 citation statements)

References 15 publications

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“…26,27,28 Present study observd 50% synergism, 30% additive effect, 20% indifference while combining colistin with imipenem. In accordance with the present study Souli et al 29 reported 56.3% synergism and 43.7% indifference. Combination of two b-lactum is less frequently reported but it may have broad antibacterial spectrum against gram negative bacilli.…”

Section: Discussionsupporting

confidence: 93%

In vitro efficacy of synergistic antibiotic combinations in imipenem resistant Pseudomonas aeruginosa strains

Farzana

Shamsuzzaman

2017

Bangladesh J Med Microbiol

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imipenem resistant isolates ranged from > _ 256 mg/L to < _ 8 mg/L for imipenem, > _ 1024 mg/L to < _ 64 mg/L for ceftriaxone, > _ 256 mg/L to < _ 8 mg/L for amikacin, > _ 16 mg/L to < _ 2 mg/L for colistin, > _ 512 mg/L to < _ 16 mg/L for piperacillin/tazobactam. Among antibiotic combinations, piperacillin/tazobactam-amikacin was most effective with 80% synergism next to which was imipenem-amikacin with 60% synergism, then imipenem-colistin with 50% synergism, imipenem-ceftriaxone with 30% synergism. Only one combination (piperacillin/tazobactum -imipenem showed 20% antagonism. All these combinations had considerable proportion of additive effect which is also desirable for these multi drug resistant isolates

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Section: Discussionsupporting

confidence: 93%

In vitro efficacy of synergistic antibiotic combinations in imipenem resistant Pseudomonas aeruginosa strains

Farzana

Shamsuzzaman

2017

Bangladesh J Med Microbiol

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“…Doripenem showed higher synergy rates than imipenem and meropenem but no significant difference between subgroups (Table 2). Data for ertapenem were available for only 2 tests, with a low synergy rate of 11% (10). When specifically examining carbapenem-resistant, colistin-susceptible K. pneumoniae (7 tests on 62 isolates), the overall synergy rate was 55% (95% CI, 36 to 73%) (see Table S3 in supplemental material).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-Analysis of In Vitro Synergy of Polymyxins and Carbapenems

Zusman

Avni

Leibovici

et al. 2013

Antimicrob Agents Chemother

220

170

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e Our objective was to examine the evidence of in vitro synergy of polymyxin-carbapenem combination therapy against Gramnegative bacteria (GNB). A systematic review and meta-analysis were performed. All studies examining in vitro interactions of antibiotic combinations consisting of any carbapenem with colistin or polymyxin B against any GNB were used. A broad search was conducted with no language, date, or publication status restrictions. Synergy rates, defined as a fractional inhibitory concentration index of <0.5 or a >2-log reduction in CFU, were pooled separately for time-kill, checkerboard, and Etest methods in a mixed-effect meta-analysis of rates. We examined whether the synergy rate depended on the testing method, type of antibiotic, bacteria, and resistance to carbapenems. Pooled rates with 95% confidence intervals (CI) are shown. Thirty-nine published studies and 15 conference proceeding were included, reporting on 246 different tests on 1,054 bacterial isolates. In time-kill studies, combination therapy showed synergy rates of 77% (95% CI, 64 to 87%) for Acinetobacter baumannii, 44% (95% CI, 30 to 59%) for Klebsiella pneumoniae, and 50% (95% CI, 30 to 69%) for Pseudomonas aeruginosa, with low antagonism rates for all. Doripenem showed high synergy rates for all three bacteria. For A. baumannii, meropenem was more synergistic than imipenem, whereas for P. aeruginosa the opposite was true. Checkerboard and Etest studies generally reported lower synergy rates than time-kill studies. The use of combination therapy led to less resistance development in vitro. The combination of a carbapenem with a polymyxin against GNB, especially A. baumannii, is supported in vitro by high synergy rates, with low antagonism and less resistance development. These findings should be examined in clinical studies.

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“…Similarly, the combination of colistin (polymyxin E) and tigecycline has been reported as synergistic against KPC-positive K. pneumoniae isolates in time-kill experiments (222). Interactions of colistin and imipenem were also examined in time-kill experiments with 42 VIM-producing K. pneumoniae isolates from a Greek hospital (241). In general, the combination of imipenem with colistin exhibited improved bactericidal activity against isolates that were susceptible either to both agents or to colistin alone.…”

Section: In Vitro Synergymentioning

confidence: 99%

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

et al. 2012

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SUMMARY The spread of Enterobacteriaceae , primarily Klebsiella pneumoniae , producing KPC, VIM, IMP, and NDM carbapenemases, is causing an unprecedented public health crisis. Carbapenemase-producing enterobacteria (CPE) infect mainly hospitalized patients but also have been spreading in long-term care facilities. Given their multidrug resistance, therapeutic options are limited and, as discussed here, should be reevaluated and optimized. Based on susceptibility data, colistin and tigecycline are commonly used to treat CPE infections. Nevertheless, a review of the literature revealed high failure rates in cases of monotherapy with these drugs, whilst monotherapy with either a carbapenem or an aminoglycoside appeared to be more effective. Combination therapies not including carbapenems were comparable to aminoglycoside and carbapenem monotherapies. Higher success rates have been achieved with carbapenem-containing combinations. Pharmacodynamic simulations and experimental infections indicate that modification of the current patterns of carbapenem use against CPE warrants further attention. Epidemiological data, though fragmentary in many countries, indicate CPE foci and transmission routes, to some extent, whilst also underlining the lack of international collaborative systems that could react promptly and effectively. Fortunately, there are sound studies showing successful containment of CPE by bundles of measures, among which the most important are active surveillance cultures, separation of carriers, and assignment of dedicated nursing staff.

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Does the Activity of the Combination of Imipenem and Colistin In Vitro Exceed the Problem of Resistance in Metallo-β-Lactamase-Producing Klebsiella pneumoniae Isolates?

Cited by 59 publications

References 15 publications

In vitro efficacy of synergistic antibiotic combinations in imipenem resistant Pseudomonas aeruginosa strains

In vitro efficacy of synergistic antibiotic combinations in imipenem resistant Pseudomonas aeruginosa strains

Systematic Review and Meta-Analysis of In Vitro Synergy of Polymyxins and Carbapenems

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

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