In Vitro Activity of 22 Antibiotics against Achromobacter Isolates from People with Cystic Fibrosis. Are There New Therapeutic Options?

Abstract

Bacteria belonging to the genus Achromobacter are increasingly isolated from respiratory samples of people with cystic fibrosis (PWCF). The management of this multidrug-resistant genus is challenging and characterised by a lack of international recommendations, therapeutic guidelines and data concerning antibiotic susceptibility, especially concerning the newer antibiotics. The objective of this study was to describe the antibiotic susceptibility of Achromobacter isolates from PWCF, including susceptibility to new antibiotics. The minimum inhibitory concentrations (MICs) of 22 antibiotics were determined for a panel of 23 Achromobacter isolates from 19 respiratory samples of PWCF. Two microdilution MIC plates were used: EUMDROXF® plate (Sensititre) and Micronaut-S Pseudomonas MIC® plate (Merlin) and completed by a third method if necessary (E-test® or UMIC®). Among usual antimicrobial agents, the most active was imipenem (70% susceptibility). Trimethoprim-sulfamethoxazole, piperacillin and tigecycline (65%, 56% and 52% susceptibility, respectively) were still useful for the treatment of Achromobacter infections. Among new therapeutic options, β-lactams combined with a β-lactamase-inhibitor did not bring benefits compared to β-lactam alone. On the other hand, cefiderocol appeared as a promising therapeutic alternative for managing Achromobacter infections in PWCF. This study provides the first results on the susceptibility of clinical Achromobacter isolates concerning new antibiotics. More microbiological and clinical data are required to establish the optimal treatment of Achromobacter infections.

Antimicrobial Susceptibility Pattern and Prevalence of the Emerging Nosocomial Pathogen Achromobacter xylosoxidans in a North Indian Tertiary Care Hospital

“…As described in an article by Isler et al, A. xylosoxidans is intrinsically resistant to penicillins, first-and second-generation cephalosporins, ceftriaxone, cefotaxime, aztreonam, tetracycline, and aminoglycosides. 4 In our study, Aztreonam and ceftriaxone were zero percent (0%) susceptible to Achromobacter. Whereas, aminoglycosides such as Amikacin and Gentamicin had shown a very low sensitivity pattern in vitro with 9% and 5% sensitivity, respectively.…”

“…These results were similar to the study by Beaurelle et al which also has reported the zero (0%) susceptibility to Aztreonam and Gentamicin, and only 13% sensitivity for Amikacin. 4 The most effective agents against Achromobacter species are Trimethoprimsulfamethoxazole, ceftazidime, piperacillin and carbapenems. 31 In our study, the maximum susceptibility is seen for Cotrimoxazole (80.59%), followed by carbapenems like Meropenem (80.52%) and Imipenem with 68.83%.…”

“…1 A. xylosoxidans is the most common species recovered from clinical samples, including those derived from persons with cystic fibrosis followed by Achromobacter ruhlandii. [4][5][6][7][8] It is considered as a cause of opportunistic infections in humans which can manifest as pulmonary infections like chronic respiratory infections. Also, the Extra-pulmonary manifestations are seen as sepsis, bacteraemia, endophthalmitis, keratoconjunctivitis, catheter associated bloodstream infection, endocarditis, pneumonia, meningitis, and peritonitis and even as device associated infections.…”

Green Nail Syndrome Treated with Ozenoxacin: Two Case Reports

“…no guidelines or previous reports have been published, and antibiotic stewardship has been crucial to act on both pathogens and thus reduce adverse events. However, for A. xylosoxidans , there are no solid data, in vivo or in vitro, regarding optimal topical antibiotic treatment [15]. Following the antibiogram and after a review of the literature, we decided to treat the patients with topical ozenoxacin 1% cream for 12 weeks.…”

In vitro and in vivo activity of cefiderocol against Achromobacter spp. and Burkholderia cepacia complex, including carbapenem-non-susceptible isolates

“…It has also shown in vitro activity against clinical isolates of Achromobacter spp. from patients with CF ( 15 ) and of B. pseudomallei from patients with mainly blood, lung, skin, and soft tissue infections ( 8 ).…”