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In vitro antimicrobial synergy of colistin with rifampicin and carbapenems against colistin-resistant Acinetobacter baumannii clinical isolates

 Duck Jin Hong  ;  Jung Ok Kim  ;  Hyukmin Lee  ;  Eun-Jeong Yoon  ;  SeokHoon Jeong  ;  Dongeun Yong  ;  Kyungwon Lee 
 Diagnostic Microbiology and Infectious Disease, Vol.86(2) : 184-189, 2016 
Journal Title
 Diagnostic Microbiology and Infectious Disease 
Issue Date
Acinetobacter Infections/microbiology* ; Acinetobacter baumannii/drug effects* ; Acinetobacter baumannii/isolation & purification ; Anti-Bacterial Agents/pharmacology* ; Carbapenems/pharmacology* ; Colistin/pharmacology* ; Drug Resistance, Bacterial ; Drug Synergism* ; Humans ; Microbial Sensitivity Tests ; Prospective Studies ; Republic of Korea ; Rifampin/pharmacology* ; Tertiary Care Centers
Acinetobacter baumannnii ; Colistin ; Combination ; Meropenem ; Rifampicin ; Synergism
Increased use of colistin in a clinical setting had resulted in the emergence of colistin-resistant (CoR) Acinetobacter baumannii. Combination therapy has been studied as a new approach to treat infections caused by A. baumannii. Here, we investigated the in vitro antimicrobial synergistic activities of several antimicrobial agent combinations against CoR A. baumannii. A total of 41 non-duplicate clinical isolates of CoR A. baumannii from a tertiary care hospital in Korea were prospectively collected from April 2012 to December 2014. As a control group, 41 carbapenem-resistant but colistin-susceptible (CoS) A. baumannii strains were also evaluated. Minimum inhibitory concentrations (MICs) of antimicrobial agents were determined by Etest in triplicate, and in vitro synergy tests were performed by the Etest MIC:MIC ratio method. Synergistic activity was determined as the sum of each antimicrobial agent's fractional inhibitory concentration evaluated (ΣFIC): synergy, ≤0.5; indifference, >0.5-4; and antagonism, >4. Synergistic activities were more frequently observed in the CoR group than the CoS group for combinations of colistin-rifampicin (80.5% vs. 14.6%, P< 0.0001), colistin-meropenem (85.4% vs. 4.9%, P< 0.0001), and colistin-imipenem (46.3% vs. 2.4%, P< 0.0001). Combination with rifampicin or meropenem lowered colistin MICs against CoR A. baumannii clinical isolates to the susceptible range (≤ 2 μg/mL) more frequently (61.0%, 25/41, both) than combination with imipenem (29.3%, 12/41). Clinical trials are needed to prove the in vivo efficacy of those antimicrobial combinations that exhibited significant in vitro antimicrobial synergistic effects against CoR A. baumannii.
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1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Yong, Dong Eun(용동은) ORCID logo https://orcid.org/0000-0002-1225-8477
Lee, Kyungwon(이경원) ORCID logo https://orcid.org/0000-0003-3788-2134
Lee, Hyuk Min(이혁민) ORCID logo https://orcid.org/0000-0002-8523-4126
Jeong, Seok Hoon(정석훈) ORCID logo https://orcid.org/0000-0001-9290-897X
Hong, Duck Jin(홍덕진)
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