Efficacy of meropenem extended infusion vs intermittent bolus monotherapy and in combination with colistin against Pseudomonas aeruginosa biofilm

Abstract

Device-related infections are difficult-to-treat due to biofilms. In this setting, optimizing the antibiotic efficacy is difficult since most PK/PD studies have been performed on planktonic cells, and therapies are limited when multidrug-resistant bacteria are involved. We aimed to analyze the PK/PD indices of meropenem predicting anti-biofilm efficacy againstmeropenem-susceptible and -resistantP. aeruginosastrains. Pharmacodynamics of meropenem dosages mimicking those of clinical practice (intermittent bolus of 2g every 8h; extended infusion of 2g over 4h every 8h), with and without colistin, were evaluated with the CDC Biofilm Reactor in vitro model for susceptible (PAO1) and extensively drug resistant (XDR-HUB3) P. aeruginosa. Efficacy was correlated with the pharmacokinetic/pharmacodynamic indices for meropenem. Concerning PAO1, both meropenem regimens were bactericidal, with higher killing for the extended infusion (∆log10 CFU/mL 54-0h=-4.66±0.93 and ∆log10 CFU/mL 54-0h=-3.4±0.41 for intermittent bolus; p<0.001). Concerning XDR-HUB3, meropenem by intermittent bolus was non-active whereas it showed bactericidal effect by extended infusion (∆log10 CFU/mL 54-0h=-3.65±0.29; p<0.001). Time above minimum inhibitory concentration (f%T>MIC) had the best correlation with efficacy for both strains. Adding colistin always improved meropenem activity and resistant-strains did not emerge. Thef%T>MIC was the PK/PD index that best correlated with the anti-biofilm efficacy of meropenem; it was better optimized when using extended infusion, allowing to recover bactericidal activity in monotherapy also against meropenem-resistantP. aeruginosa.Combining meropenemby extended infusionwith colistin offered the most effective therapy for both strains. Optimizing meropenem dosing by extended infusion should be encouraged when treating biofilm-related infections.