Abstract
ObjectivesTo determine the in vitro activity of antibiotics, including arbekacin, cefminox, fosfomycin and biapenem which are all still unavailable in India, against Gram-negative clinical isolates.MethodsWe prospectively collected and tested all consecutive isolates of Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa and Acinetobacter spp. from blood, urine and sputum samples between March and November 2012. The minimum inhibition concentration (MIC) of 16 antibiotics was determined by the broth micro-dilution method.ResultsOverall 925 isolates were included; 211 E. coli, 207 Klebsiella spp., 153 P. aeruginosa, and 354 Acinetobacter spp. The MIC50 and MIC90 were high for cefminox, biapenem and arbekacin for all pathogens but interpretative criteria were not available. The MIC50 was categorized as susceptible for a couple of antibiotics, including piperacillin/tazobactam, carbapenems and amikacin, for E. coli, Klebsiella spp. and P. aeruginosa. However, for Acinetobacter spp., the MIC50 was categorized as susceptible only for colistin. On the other hand, fosfomycin was the only antibiotic that inhibited 90% of E. coli and Klebsiella spp. isolates, while 90% of P. aeruginosa isolates were inhibited only by colistin. Finally, 90% of Acinetobacter spp. isolates were not inhibited by any antibiotic tested.ConclusionFosfomycin and colistin might be promising antibiotics for the treatment of infections due to E. coli or Klebsiella spp. and P. aeruginosa, respectively, in India; however, clinical trials should first corroborate the in vitro findings. The activity of tigecycline should be evaluated, as this is commonly used as last-resort option for the treatment of multidrug-resistant Acinetobacter infections.
Highlights
Antimicrobial resistance has risen alarmingly worldwide during the last decade
[2] Carbapenemaseproducing Enterobacteriaceae cause difficult-to-treat infections usually characterized by high mortality. [3,4] high prevalence of infections caused by carbapenemase-producing Acinetobacter baumannii [5,6,7] and Pseudomonas aeruginosa, [6,8] as well as of infections caused by extended-spectrum beta-lactamases (ESBLs)-producing Enterobacteriaceae has been observed in India [9,10,11]
Arbekacin is primarily used for the treatment of infections caused by methicillin-resistant Staphylococcus aureus [12] and few in vitro data suggest that this antibiotic might be considered as an adjunct treatment for infections due to multidrug-resistant (MDR) Gram-negative pathogens., [13,14] Cefminox is active against anaerobic bacteria [15] as well as ESBL-producing Enterobacteriaceae
Summary
Antimicrobial resistance has risen alarmingly worldwide during the last decade. The widespread of Gram-negative organisms producing extended-spectrum beta-lactamases (ESBLs) conferring resistance to penicillins, cephalosporins, and fluoroquinolones, or carbapenemases conferring resistance even to carbapenems limits significantly the treatment armamentarium against infections. The introduction into clinical practice of antibiotics that are still unavailable in India could be a solution to the problem of the antimicrobial resistance. Arbekacin is primarily used for the treatment of infections caused by methicillin-resistant Staphylococcus aureus [12] and few in vitro data suggest that this antibiotic might be considered as an adjunct treatment for infections due to multidrug-resistant (MDR) Gram-negative pathogens., [13,14] Cefminox is active against anaerobic bacteria [15] as well as ESBL-producing Enterobacteriaceae. [20] fosfomycin, which is not marketed in India, is an ‘‘old’’ antibiotic, discovered in the late 60’s which has been re-evaluated the last years and re-introduced successfully into clinical practice in many countries of the world. Arbekacin is primarily used for the treatment of infections caused by methicillin-resistant Staphylococcus aureus [12] and few in vitro data suggest that this antibiotic might be considered as an adjunct treatment for infections due to multidrug-resistant (MDR) Gram-negative pathogens., [13,14] Cefminox is active against anaerobic bacteria [15] as well as ESBL-producing Enterobacteriaceae. [16] As regards biapenem, this is active against Gram-negative and Grampositive anaerobic bacteria, [17], [18] and against aerobic bacteria, both alone [19] and in combination with other agents against MDR pathogens. [20] fosfomycin, which is not marketed in India, is an ‘‘old’’ antibiotic, discovered in the late 60’s which has been re-evaluated the last years and re-introduced successfully into clinical practice in many countries of the world. [21,22,23] Fosfomycin has broad antimicrobial spectrum against MDR pathogens, both Gram-negative [24] and Gram-positive ones [25]
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