Abstract
Objective: The objective of the study was to see the in vitro activity of arbekacin, a novel aminoglycoside, against multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacilli (GNB) so that it can become a good alternative as empirical treatment for severe sepsis.
 Methods: Identification and antibiotic sensitivity testing of the GNB isolated from the clinical samples were done using the VITEK-II system in a tertiary care hospital, Kolkata. MDR and XDR strains were selected by their definitions and molecular characterization was done by multiplex polymerase chain reaction. The minimum inhibitory concentration (MIC) value of arbekacin was detected by the E-test strip and compared with other aminoglycosides.
 Results: A total of 140 drug-resistant strains including ESBL- and carbapenemase-producing GNB were selected for the study. Arbekacin showed reduced values of MIC50 and MIC90 compared to other aminoglycosides for most of the drug-resistant GNB.
 Conclusion: Hence, in this drug-resistant era, arbekacin with the advantage of a single daily dose can be used as an empirical choice in severe sepsis as monotherapy or in combination with other antibiotics such as colistin or polymyxin to fight against MDR and XDR bugs.
Highlights
Antimicrobial resistance poses a major threat to public health and makes therapeutic decisions more challenging
Arbekacin is stable to the aminoglycoside-inactivating enzymes such as aminoglycoside phosphotransferase (APH), aminoglycoside adenylyltransferase (AAD), and aminoglycoside acetyltransferase, whereas gentamicin, amikacin, tobramycin, and kanamycin were completely inactivated by APH (2′′) [8]
140 representatives drug-resistant Gramnegative bacilli (GNB) were selected according to their antibiotic resistance pattern (Table 2)
Summary
Antimicrobial resistance poses a major threat to public health and makes therapeutic decisions more challenging. India carries one of the largest burdens of drug-resistant pathogens worldwide [1]. Emergence of their multidrug-resistant (MDR) and extensively drugresistant (XDR) Gram-negative pathogens adds on to the complexity of infection, rendering them difficult to treat [2]. Due to the introduction of AHB to 1-N position of DKB, the resulting arbekacin exhibited activity against drug-resistant bacteria [7]. Arbekacin is a good bactericidal drug against MRSA, enterococci and shows concentration-dependent and long-lasting postantibiotic effects [9,10,11,12], but its activity against MDR and XDR Gramnegative bacilli (GNB) is not evaluated. The objective of the study was to see the in vitro activity of arbekacin against MDR and XDR GNB isolated from different clinical samples
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