Sains Malaysiana 48(5)(2019): 1065–1073

http://dx.doi.org/10.17576/jsm-2019-4805-15

 

In vitro Effects of Various Antimicrobials Alone and in Combinations against Imipenem-Resistant Pseudomonas aeruginosa

(Kesan In vitro Pelbagai Antimikrob Sendiri dan Gabungan terhadap Rintangan-Imipenem Pseudomonas aeruginosa)

 

WANUTSANUN TUNYAPANIT^1*, PORNPIMOL PRUEKPRASERT¹, KAMOLWISH LAOPRASOPWATTANA¹ & SUREERAT CHELAE²

 

¹Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand

 

²Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand

 

Received: 8 October 2018/Accepted: 21 February 2019

 

ABSTRACT

Imipenem-resistant Pseudomonas aeruginosa (IRPA) infection is a serious problem in hospitals. Combination therapy is an alternative treatment for this infection. In this study, the in vitro activities of amikacin, aztreonam, ceftazidime, ciprofloxacin, colistin, imipenem, and piperacillin/tazobactam alone and in various combinations were determined by E-test for 38 imipenem-resistant P. aeruginosa isolates obtained from a Thai hospital. Of the 38 IRPA isolates, 9 (24%) were low-level IRPA (defined as MICs of imipenem 8-32 μg/mL) and 29 (76%) were high-level IRPA (defined as MICs of imipenem >32 μg/mL). The high-level IRPA isolates were susceptible to colistin (90%), piperacillin/tazobactam (72%), and amikacin (52%). The low-level IRPA isolates were susceptible to colistin (100%) and all other antimicrobials tested (78%-89%). The MIC50 value of colistin against both the high-level and low-level IRPA isolates was 1.5 μg/mL. Of all the antimicrobial combinations tested, ceftazidime plus ciprofloxacin displayed the highest percentages of synergistic effects against IRPA isolates (26%, 10/38 isolates) and a high percentages of synergistic effects against high-level IRPA isolates (21, 6/29 isolates), with no antagonistic effects detected. Colistin had the greatest activity against most IRPA isolates among all of the antimicrobials tested, while ceftazidime plus ciprofloxacin showed promise in treating infections caused by IRPA isolates including high-level IRPAs.

 

Keywords: Etest; imipenem resistant; Pseudomonas aeruginosa; synergy

 

ABSTRAK

Jangkitan rintangan-imipenem Pseudomonas aeruginosa (IRPA) merupakan masalah yang serius di hospital. Terapi gabungan adalah rawatan alternatif bagi jangkitan ini. Dalam kajian ini, aktiviti in vitro amikasin, aztreonam, ceftazidime, ciprofloxacin, colistin, imipenem dan piperacillin/tazobactam semata-mata serta pelbagai gabungan ditentukan oleh ujian E-38 rintangan-imipenem pencilan P. aeruginosa yang diperoleh daripada sebuah hospital di Thailand. Dalam pencilan 38 IRPA, 9 (24%) ialah IRPA tahap rendah (ditakrifkan sebagai MICs imipenem 8-32 μg/mL) dan 29 (76%) IRPA tahap tinggi (ditakrifkan sebagai MICs imipenem > 32 μg/mL). Pencilan IRPA tahap tinggi telah menyebabkan ia terdedah kepada colistin (90%), piperacillin/tazobactam (72%) dan amikasin (52%). Pencilan IRPA tahap rendah rentan kepada colistin (100%) dan semua ujian antimikrob (78% - 89%). Nilai colistin MIC50 terhadap kedua-dua pencilan di peringkat tinggi dan IRPA tahap rendah adalah 1.5 μg/mL. Daripada semua gabungan antimikrob yang diuji, ceftazidime dan ciprofloxacin menunjukkan peratusan tertinggi kesan bersinergisma terhadap pencilan IRPA (26%, pencilan 10/38) dan tinggi peratusan daripada kesan bersinergisma terhadap tahap tinggi IRPA terasing (21%, pencilan 6/29) dengan tiada kesan berantagonis dikesan. Colistin menunjukkan aktiviti terbesar berbanding kebanyakan pencilan IRPA antara semua antimikrob yang diuji, manakala ceftazidime dan ciprofloxacin menunjukkan keupayaan dalam merawat jangkitan yang disebabkan oleh pencilan IRPA termasuk IRPAs tahap tinggi.

 

Kata kunci: Etest; Pseudomonas aeruginosa; rintangan imipenem; sinergi

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*Corresponding author; email: wanutsanun.t@psu.ac.th