Rifampicin/imipenem combination in the treatment of carbapenem-resistant Acinetobacter baumannii infections

Saballs, M.

doi:10.1093/jac/dkl274

Cited by 81 publications

(58 citation statements)

References 8 publications

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“…As rifampin was shown to be synergistic with CO or imipenem both in vitro and clinically, we enrolled rifampin as a third agent to try in combination. 1,17,24 The best results were obtained in the TIG-CO combination. Synergistic activity was found in 72% of the isolates with the TIG-CO combination, in 60% with the CO-RIF combination, and in only 12% with the TIG-RIF combination.…”

Section: Discussionmentioning

confidence: 98%

In vitro synergistic activity of tigecycline and colistin against XDR-Acinetobacter baumannii

et al. 2009

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The emergence of extensive drug-resistant (XDR) Acinetobacter baumannii limits the therapeutic options and leads to high mortality in intensive care units. Combined antibiotic therapy is frequently recommended for the treatment of these infections. Colistin (CO) and tigecycline (TIG), alone or in combination with other antimicrobials, are the most commonly used antibiotics in the treatment of these resistant infections. In this study, the in vitro synergistic activity of TIG and CO were tested for 25 XDR-A. baumannii strains isolated from ventilator-associated pneumonia by the Etest method. Resistance to CO was not detected, whereas 8% of the strains were resistant to TIG. The TIG-CO combination was more synergistic than TIG-rifampin and CO-rifampin according to the fractional inhibitory concentration index. No antagonism was detected between the drugs in the study. There was no strong correlation between the activity of the combinations with reference to strains or genotypes. Our results suggest that the combined use of TIG and CO may be useful for the treatment of XDR-A. baumannii infections.

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Section: Discussionmentioning

confidence: 98%

In vitro synergistic activity of tigecycline and colistin against XDR-Acinetobacter baumannii

et al. 2009

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“…Moreover, rifampicin has been proposed as an alternative antimicrobial agent for the treatment of MDR A. baumannii, based on outcomes of in vitro studies 2,7,8 and in vivo infection models 12,27 . A previous study has shown that 64% of MDR A. baumannii were susceptible to rifampicin 7 .…”

Section: Discussionmentioning

confidence: 99%

“…One hundred A. baumannii isolates were collected from clinical specimens such as sputum (64), blood (12), urine (8), pus (from leg, 2; pleural empyema, 1; axilla, 2; vagina, 1; percutaneous endoscopic gastrostomy tube, 1; and eye, 1), body fluid (6) and tissue (2) from patients at Songklanagarind Hospital in Songkhla Province, Thailand during the JanuaryJuly 2010 period. Each isolate was collected from a different patient.…”

Section: Bacterial Strainsmentioning

confidence: 99%

“…The cefoperazone MIC breakpoint was used for cefoperazone/sulbactam 11 . Rifampicin MICs of 2 µg/ml were considered as susceptible, MICs of 4-8 µg/ml were considered as low-level resistant, and MICs of up to 256 µg/ml were considered as high-level resistant 12,13 . Escherichia coli (E. coli) ATCC 25922 was used as a control strain.…”

Section: Antimicrobial Susceptibility Testing and Mic Determinationmentioning

confidence: 99%

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Antimicrobial susceptibility of Acinetobacter baumannii isolated from hospital patients

Tunyapanit¹,

Pruekprasert²,

Laoprasopwattana³

et al. 2014

ScienceAsia

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ABSTRACT:The incidence of multidrug-resistant Acinetobacter baumannii (MDR A. baumannii) is increasing worldwide and is leading to therapeutic problems. We investigated the in vitro activities of cefoperazone/sulbactam, colistin, imipenem, and rifampicin alone and in double combinations against 100 A. baumannii isolates from patients at Songklanagarind Hospital in Songkhla Province, Thailand. The E-test method was used to determine antimicrobial susceptibility, the minimal inhibitory concentration (MIC) and for antimicrobial combination testing. A. baumannii isolates were susceptible to colistin (97%), cefoperazone/sulbactam (69%), imipenem (45%), and rifampicin (13%). Fifty-nine percent of them were MDR A. baumannii. Colistin was superior to cefoperazone/sulbactam, rifampicin and imipenem against MDR A. baumannii and the MIC50, MIC90 of colistin were 0.75 and 1 µg/ml, respectively. Non-MDR A. baumannii isolates were susceptible to cefoperazone/sulbactam (100%), colistin (95%), imipenem (93%) and rifampicin (2%). Combinations of cefoperazone/sulbactam plus colistin or rifampicin, imipenem plus colistin or rifampicin and colistin plus rifampicin showed indifferent effects against most MDR isolates. Of all the antimicrobial combinations tested, cefoperazone/sulbactam plus rifampicin produced the highest percentages (42%) of synergy, partial synergy, and additive results. The activity rate of cefoperazone/sulbactam against MDR A. baumannii was higher when combined with rifampicin than colistin. Thus colistin had the greatest activity against most MDR and non-MDR A. baumannii isolates among all of the antibiotics tested. Cefoperazone/sulbactam and imipenem showed good activity against non-MDR isolates, and cefoperazone/sulbactam combined with rifampicin may be useful in treating infections caused by MDR isolates.

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“…For example, studies have found conflicting results for the same antimicrobial combinations comparing animal in vivo studies with a follow-up clinical pilot study. 28,29 In this study, we performed time-kill analysis only for three different Acinetobacter species with similar MICs against various antimicrobial agents. The differences in the mechanisms of resistance seemed to result in different effective antibiotic combinations.…”

Section: Discussionmentioning

confidence: 99%

In vitro activity of various combinations of antimicrobials against carbapenem-resistant Acinetobacter species in Singapore

et al. 2009

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Outbreaks of carbapenem-resistant Acinetobacter species have emerged, especially in Singapore. Combination therapy may be the only viable option until new antibiotics are available. The objective of this study was to identify potential antimicrobial combinations against carbapenem-resistant Acinetobacter baumannii and Acinetobacter species in Singapore. From an ongoing surveillance program, two isolates of A. baumannii and an isolate of Acinetobacter species that were multidrug resistant were selected on the basis of their unique resistance mechanisms. The two A. baumannii isolates carried the carbapenemase bla OXA-23 -like gene and the Acinetobacter species carried a metallo-b-lactamase IMP-4 gene. Time-kill studies were conducted with approximately 10 5 CFU ml À1 at baseline with 0.5 times minimum inhibitory concentrations (MICs) of polymyxin B and tigecycline, and at a maximally achievable clinical concentration of meropenem(64 lg ml À1 ) and rifampicin(2 lg ml À1 ), alone and in combinations. The MICs (lg ml À1 ) of Acinetobacter species A105, A. baumannii AB112 and A. baumannii AB8879 to polymyxin B/tigecycline/rifampicin/meropenem were found to be 1/0.5/4/64, 1/4/4/32 and 2/2/2/64, respectively. In time-kill studies, enhanced combined killing effects were observed in the tigecycline-rifampicin combination; the tigecycline-rifampicin and rifampicin-polymyxin B combination; and the rifampicin-polymyxin B combination for Acinetobacter species A105, A. baumannii AB112 and A. baumannii AB8879, respectively, with 45 log kill at 24 h suggesting synergism, with no regrowth observed at 72 h. These findings demonstrate that in vitro synergy of antibiotic combinations in carbapenem-resistant Acinetobacter species may be strain dependent. It may guide us in choosing a preemptive therapy for carbapenem-resistant Acinetobacter species infections and warrants further investigations.

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Rifampicin/imipenem combination in the treatment of carbapenem-resistant Acinetobacter baumannii infections

Abstract: The results of our study argue against the use of a rifampicin/imipenem combination for the treatment of carbapenem-resistant A. baumannii infections. However, combinations of rifampicin with other antibiotics merit further studies.

Cited by 81 publications

References 8 publications

In vitro synergistic activity of tigecycline and colistin against XDR-Acinetobacter baumannii

In vitro synergistic activity of tigecycline and colistin against XDR-Acinetobacter baumannii

Antimicrobial susceptibility of Acinetobacter baumannii isolated from hospital patients

In vitro activity of various combinations of antimicrobials against carbapenem-resistant Acinetobacter species in Singapore

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