{"title":"氨曲南与头孢他啶/阿维巴坦、美罗培南/巴巴坦和亚胺培南/雷贝拉坦联用对产双碳青霉烯酶肠杆菌的体外协同和杀菌作用","authors":"Ying Fu, Yufeng Zhu, Feng Zhao, Bingyan Yao, Yunsong Yu, Jun Zhang, Qiong Chen","doi":"10.2147/IDR.S474150","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Our aim was to elucidate the resistance mechanisms and assess the combined synergistic and bactericidal activities of aztreonam in combination with ceftazidime/avibactam (CZA), meropenem/vaborbactam (MEV), and imipenem/relebactam (IMR) against Enterobacterales strains producing dual carbapenemases.</p><p><strong>Methods: </strong>Species identification, antimicrobial susceptibility testing and determination of carbapenemase type were performed for these strains. Plasmid sizes, plasmid conjugation abilities and the localization of carbapenemase genes were investigated. Whole-genome sequencing was performed for all strains and their molecular characteristics were analyzed. In vitro synergistic and bactericidal activities of the combination of aztreonam with CZA, MEV and IMR against these strains were determined using checkerboard assay and time-kill curve assay.</p><p><strong>Results: </strong>A total of 12 <i>Enterobacterales</i> strains producing dual-carbapenemases were collected, including nine <i>K. pneumoniae</i>, two <i>P. rettgeri</i>, and one <i>E. hormaechei</i>. The most common dual-carbapenemase gene pattern observed was <i>bla</i> <sub>(KPC-2+NDM-5)</sub> (n=4), followed by <i>bla</i> <sub>KPC-2+IMP-26</sub> (n=3), <i>bla</i> <sub>(KPC-2+NDM-1)</sub> (n=2), <i>bla</i> <sub>(KPC-2+IMP-4)</sub> (n=1), <i>bla</i> <sub>(NDM-1+IMP-4)</sub> (n=1) and <i>bla</i> <sub>(KPC-2+KPC-2)</sub> (n=1). In each strain, the carbapenemase genes were found to be located on two distinct plasmids which were capable of conjugating from the original strain to the receipt strain <i>E. coli</i> J53. The results of the checkerboard synergy analysis consistently revealed good synergistic effects of the combination of ATM with CZA, MEV and IMR. Except for one strain, all strains exhibited significant synergistic activity and bactericidal activity between 2 and 8 hours.</p><p><strong>Conclusion: </strong>Dual-carbapenemase-producing <i>Enterobacterales</i> posed a significant threat to clinical anti-infection treatment. However, the combination of ATM with innovative <i>β</i>-lactam/β-lactamase inhibitor compounds had proven to be an effective treatment option.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380864/pdf/","citationCount":"0","resultStr":"{\"title\":\"In vitro Synergistic and Bactericidal Effects of Aztreonam in Combination with Ceftazidime/ Avibactam, Meropenem/Vaborbactam and Imipenem/Relebactam Against Dual-Carbapenemase-Producing <i>Enterobacterales</i>.\",\"authors\":\"Ying Fu, Yufeng Zhu, Feng Zhao, Bingyan Yao, Yunsong Yu, Jun Zhang, Qiong Chen\",\"doi\":\"10.2147/IDR.S474150\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Our aim was to elucidate the resistance mechanisms and assess the combined synergistic and bactericidal activities of aztreonam in combination with ceftazidime/avibactam (CZA), meropenem/vaborbactam (MEV), and imipenem/relebactam (IMR) against Enterobacterales strains producing dual carbapenemases.</p><p><strong>Methods: </strong>Species identification, antimicrobial susceptibility testing and determination of carbapenemase type were performed for these strains. Plasmid sizes, plasmid conjugation abilities and the localization of carbapenemase genes were investigated. Whole-genome sequencing was performed for all strains and their molecular characteristics were analyzed. In vitro synergistic and bactericidal activities of the combination of aztreonam with CZA, MEV and IMR against these strains were determined using checkerboard assay and time-kill curve assay.</p><p><strong>Results: </strong>A total of 12 <i>Enterobacterales</i> strains producing dual-carbapenemases were collected, including nine <i>K. pneumoniae</i>, two <i>P. rettgeri</i>, and one <i>E. hormaechei</i>. The most common dual-carbapenemase gene pattern observed was <i>bla</i> <sub>(KPC-2+NDM-5)</sub> (n=4), followed by <i>bla</i> <sub>KPC-2+IMP-26</sub> (n=3), <i>bla</i> <sub>(KPC-2+NDM-1)</sub> (n=2), <i>bla</i> <sub>(KPC-2+IMP-4)</sub> (n=1), <i>bla</i> <sub>(NDM-1+IMP-4)</sub> (n=1) and <i>bla</i> <sub>(KPC-2+KPC-2)</sub> (n=1). In each strain, the carbapenemase genes were found to be located on two distinct plasmids which were capable of conjugating from the original strain to the receipt strain <i>E. coli</i> J53. The results of the checkerboard synergy analysis consistently revealed good synergistic effects of the combination of ATM with CZA, MEV and IMR. Except for one strain, all strains exhibited significant synergistic activity and bactericidal activity between 2 and 8 hours.</p><p><strong>Conclusion: </strong>Dual-carbapenemase-producing <i>Enterobacterales</i> posed a significant threat to clinical anti-infection treatment. However, the combination of ATM with innovative <i>β</i>-lactam/β-lactamase inhibitor compounds had proven to be an effective treatment option.</p>\",\"PeriodicalId\":13577,\"journal\":{\"name\":\"Infection and Drug Resistance\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-09-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380864/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infection and Drug Resistance\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/IDR.S474150\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infection and Drug Resistance","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/IDR.S474150","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
In vitro Synergistic and Bactericidal Effects of Aztreonam in Combination with Ceftazidime/ Avibactam, Meropenem/Vaborbactam and Imipenem/Relebactam Against Dual-Carbapenemase-Producing Enterobacterales.
Objective: Our aim was to elucidate the resistance mechanisms and assess the combined synergistic and bactericidal activities of aztreonam in combination with ceftazidime/avibactam (CZA), meropenem/vaborbactam (MEV), and imipenem/relebactam (IMR) against Enterobacterales strains producing dual carbapenemases.
Methods: Species identification, antimicrobial susceptibility testing and determination of carbapenemase type were performed for these strains. Plasmid sizes, plasmid conjugation abilities and the localization of carbapenemase genes were investigated. Whole-genome sequencing was performed for all strains and their molecular characteristics were analyzed. In vitro synergistic and bactericidal activities of the combination of aztreonam with CZA, MEV and IMR against these strains were determined using checkerboard assay and time-kill curve assay.
Results: A total of 12 Enterobacterales strains producing dual-carbapenemases were collected, including nine K. pneumoniae, two P. rettgeri, and one E. hormaechei. The most common dual-carbapenemase gene pattern observed was bla(KPC-2+NDM-5) (n=4), followed by blaKPC-2+IMP-26 (n=3), bla(KPC-2+NDM-1) (n=2), bla(KPC-2+IMP-4) (n=1), bla(NDM-1+IMP-4) (n=1) and bla(KPC-2+KPC-2) (n=1). In each strain, the carbapenemase genes were found to be located on two distinct plasmids which were capable of conjugating from the original strain to the receipt strain E. coli J53. The results of the checkerboard synergy analysis consistently revealed good synergistic effects of the combination of ATM with CZA, MEV and IMR. Except for one strain, all strains exhibited significant synergistic activity and bactericidal activity between 2 and 8 hours.
Conclusion: Dual-carbapenemase-producing Enterobacterales posed a significant threat to clinical anti-infection treatment. However, the combination of ATM with innovative β-lactam/β-lactamase inhibitor compounds had proven to be an effective treatment option.
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ISSN: 1178-6973
Editor-in-Chief: Professor Suresh Antony
An international, peer-reviewed, open access journal that focuses on the optimal treatment of infection (bacterial, fungal and viral) and the development and institution of preventative strategies to minimize the development and spread of resistance.
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