Combination therapy provides a useful therapeutic approach to overcome
resistance until new antibiotics become available. In this study, the
pharmacodynamics, including the morphological effects, of polymyxin B (PMB) and
meropenem alone and in combination against KPC-producing
Klebsiella pneumoniae clinical isolates was examined. Ten
clinical isolates were obtained from patients undergoing treatment for
mediastinitis. KPCs were identified and MICs were measured using microbroth
dilution. Time–kill studies were conducted over 24 h with PMB
(0.5–16 mg/L) and meropenem (20–120 mg/L) alone or in
combination against an initial inoculum of ca. 106 CFU/mL. Scanning
electron microscopy (SEM) was employed to analyse changes in bacterial
morphology after treatment, and the log change method was used to quantify the
pharmacodynamic effect. All isolates harboured the
blaKPC-2 gene and were resistant to meropenem
(MICs ≥8 mg/L). Clinically relevant PMB concentrations (0.5, 1.0 and 2.0
mg/L) in combination with meropenem were synergistic against all isolates except
BRKP28 (polymyxin- and meropenem-resistant, both MICs >128 mg/L). All PMB and
meropenem concentrations in combination were bactericidal against
polymyxin-susceptible isolates with meropenem MICs ≤16 mg/L. SEM
revealed extensive morphological changes following treatment with PMB in
combination with meropenem compared with the changes observed with each
individual agent. Additionally, morphological changes decreased with increasing
resistance profiles of the isolate, i.e. increasing meropenem MIC. These
antimicrobial effects may not only be a summation of the effects due to each
antibiotic but also a result of differential action that likely inhibits
protective mechanisms in bacteria.