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KMID : 0882420100790010041
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Korean Journal of Medicine
2010 Volume.79 No. 1 p.41 ~ p.47
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In Vitro Effects of Combined Antibiotics against Multidrug-resistant Pseudomonas aeruginosa
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Pai Hyun-Joo
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Abstract
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Background/Aims: The inhibitory effects of the combination of β-lactam with ciprofloxacin or amikacin against clinical isolates of multidrug-resistant Pseudomonas aeruginosa were evaluated.
Methods: This study examined ten isolates with variable levels of resistance to ceftazidime, cefepime, piperacillin/tazobactam meropenem, ciprofloxacin, and amikacin. The efficacy of the combined antibiotics was studied using a checkerboard method or in vitro killing assay.
Results: The combination of ceftazidime, cefepime, aztreonam, piperacillin-tazobactam, or meropenem with amikacin showed synergistic effects for all of the strains regardless of the minimum inhibitory concentration (MIC) of amikacin, but combination with ciprofloxacin showed a synergistic effect for the isolate with a low MIC of ciprofloxacin by the checkerboard method. The isolates with a high MIC of ciprofloxacin showed an indifferent effect in combination with β-lactam and ciprofloxacin. The in vitro killing assay showed that meropenem with ciprofloxacin acted synergistically for the isolates with a MIC of 16 μg/mL of ciprofloxacin. However, amikacin showed synergistic effects with meropenem for the isolates with high-level resistance against amikacin, i.e., up to an MIC of 128 μg/mL. Contrary to the checkerboard method results, no synergy was observed for the combination of ceftazidime/piperacillin-tazobactam and amikacin.
Conclusions: Meropenem with amikacin can be the first choice for infections caused by multidrug-resistant P. aeruginosa when the level of resistance is not known.
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KEYWORD
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Multidrug-resistant P. aeruginosa, Checkerboard, In vitro killing assay
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