In vitro antimicrobial synergy studies of carbapenem-resistant Acinetobacter baumannii isolated from intensive care units of a tertiary care hospital in Egypt

Nageeb, Wedad M.; Metwally, Lobna; Kamel, Mahmoud; Zakaria, Sahar

doi:10.1016/j.jiph.2015.05.007

Cited by 17 publications

(7 citation statements)

References 20 publications

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“…However, the effects of drug ratio in the spray drying feed solution on the surface coating and aerosolisation are unknown. In this study, colistin was co-spray-dried with a hydrophobic antibiotic, azithromycin, at various mass ratios as such combination has shown synergy in antimicrobial effects (22, 23). Surface coating coverage by azithromycin on particle surfaces was characterised by two surface analytical techniques, X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS).…”

Section: Introductionmentioning

confidence: 99%

How Much Surface Coating of Hydrophobic Azithromycin Is Sufficient to Prevent Moisture-Induced Decrease in Aerosolisation of Hygroscopic Amorphous Colistin Powder?

Zhou

Loh²,

et al. 2016

AAPS J

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Aerosolisation performance of hygroscopic particles of colistin could be compromised at elevated humidity due to increased capillary forces. Co-spray drying colistin with a hydrophobic drug is known to provide a protective coating on the composite particle surfaces against moisture-induced reduction in aerosolisation performance; however, the effects of component ratio on surface coating quality and powder aerosolisation at elevated relative humidities are unknown. In this study, we have systematically examined the effects of mass ratio of hydrophobic azithromycin on surface coating quality and aerosolisation performance of the co-spray dried composite particles. Four combination formulations with varying drug ratios were prepared by co-spray drying drug solutions. Both of the drugs in each combination formulation had similar in vitro deposition profiles, suggesting that each composite particle comprise two drugs in the designed mass ratio, which is supported by XPS and ToF-SIMS data. XPS and ToF-SIMS measurements also revealed that 50 % by weight (or 35 % by molecular fraction) of azithromycin in the formulation provided a near-complete coating of 96.5 % (molar fraction) on the composite particle surface, which is sufficient to prevent moisture-induced reduction in FPFrecovered and FPFemitted. Higher azithromycin content did not increase coating coverage, while contents of azithromycin lower than 20 %w/w did not totally prevent the negative effects of humidity on aerosolisation performance. This study has highlighted that a critical amount of azithromycin is required to sufficiently coat the colistin particles for short-term protection against moisture.

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Section: Introductionmentioning

confidence: 99%

How Much Surface Coating of Hydrophobic Azithromycin Is Sufficient to Prevent Moisture-Induced Decrease in Aerosolisation of Hygroscopic Amorphous Colistin Powder?

Zhou

Loh²,

et al. 2016

AAPS J

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“…Author concluded that azithromycin and polymyxin B combination is justifiable and advised. It may be converted into convenient curative strategy by synergism between two or more drugs results in lowering the effective MIC values with addition to their pharmacological and biological effects to determine the actual therapeutic dosage of these antimicrobial in combinations for clinical practice [19]. Manikal et al interrogated synergism method i.e.…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of In-vitro Synergy Testing Methods in Carbapenem-Resistant Acinetobacter Species

Soni

Gupta²,

Gombar³

et al. 2019

Journal of Microbiology and Infectious Diseases

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Objective: There is an increasing incidence of Acinetobacter species causing serious hospital acquired infections such as blood stream infections (BSI), catheter associated urinary tract infections (CAUTI) and lower respiratory tract infections(LRTI) with high mortality rate of 30-75% in patients having long hospital stay especially in critical care units (CCUs). During the past decade, multi drug resistant Acinetobacter isolates have presented a real challenge to clinicians and are posing difficulties in treatment. Carbapenem-resistant Acinetobacter species particularly A. baumannii, represent a growing public health concern, since they often confer resistance to other critically important antimicrobials. Methodology: In the present study, various antibiotic combinations such as colistin + meropenem, imipenem + tigecycline, polymyxin B + azithromycin and doripenem + sulbactam are used for MDR Acinetobacter infections and tested for in-vitro combination test by Epsilometric test and Broth Micro dilution and confirmation done by time kill assay. Results: We found synergistic results with all three methods used in study with three combinations significantly (p<0.05) but with one combination i.e. doripenem+sulbactam, synergy found only with Etest not with MCB and time kill assay (p~0.069). Conclusions: We have also observed and compared outcome of the patients with respect to the treatment received during hospital stay, but we did not found significant difference between two groups, (two drug regimen & three drug regimen) regarding their mortality.

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“…According to the suggestions by Odds ( 32 ), sitafloxacin and sulbactam exhibited no interaction in 84% of XDR- A. baumannii strains included in the present study. The time-kill assay was performed to further investigate the bactericidal activity of the two drugs and their combination ( 33 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Sulbactam enhances the in�vitro activity of sitafloxacin against extensively‑drug resistant Acinetobacter baumannii

Wang

Leng

et al. 2018

Exp Ther Med

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The present study aimed to determine the in vitro activities of sulbactam and sitafloxacin against extensively-drug resistant Acinetobacter baumannii (XDR-A. baumannii). A total of 50 strains of XDR-A. baumannii were isolated from clinical specimens. Broth microdilution assay was applied to determine the minimum inhibitory concentration (MIC) for sulbactam and sitafloxacin. Microdilution checkerboard method was used to determine the in vitro activity of this antimicrobial combination. Accordingly, the fractional inhibitory concentration (FIC) and FIC index (FICI) were calculated. Time-kill study was also carried out for four strains with different susceptibilities to determine the bactericidal activities of individual or combined use of sitafloxacin and sulbactam. Isolates with MICs of sitafloxacin ≤2 mg/l were considered to be susceptible to sitafloxacin. The susceptibility rate for sitafloxacin was 92% originally. When combined with sulbactam, this rate increased to 96%. Microdilution checkerboard results indicated that, when tested in combination, sulbactam/sitafloxacin exhibited marked synergistic and partial synergistic effects on 16 and 50% of the 50 strains, respectively. Time-kill assay suggested that sulbactam enhanced the bactericidal activity of sitafloxacin and the combination induced a synergistic effect. For strains that were not susceptible to sitafloxacin, the bactericidal activities of the combination of sitafloxacin and sulbactam at a sub-MIC concentration were impaired. However, this impairment could be overcome with the increase of the concentration to 1X MIC. The present study demonstrated that sulbactam enhanced the in vitro antimicrobial activity of sitafloxacin against XDR-A. baumannii.

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In vitro antimicrobial synergy studies of carbapenem-resistant Acinetobacter baumannii isolated from intensive care units of a tertiary care hospital in Egypt

Cited by 17 publications

References 20 publications

How Much Surface Coating of Hydrophobic Azithromycin Is Sufficient to Prevent Moisture-Induced Decrease in Aerosolisation of Hygroscopic Amorphous Colistin Powder?

How Much Surface Coating of Hydrophobic Azithromycin Is Sufficient to Prevent Moisture-Induced Decrease in Aerosolisation of Hygroscopic Amorphous Colistin Powder?

Comparative Evaluation of In-vitro Synergy Testing Methods in Carbapenem-Resistant Acinetobacter Species

Sulbactam enhances the in�vitro activity of sitafloxacin against extensively‑drug resistant Acinetobacter baumannii

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