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Gijón D, García-Castillo J, Fernández-López MC, Bou G, Siller M, Calvo-Montes J, Pitart C, Vila J, Torno N, Gimeno C, Cruz H, Ramos H, Mulet X, Oliver A, Ruiz-Garbajosa P, Canton R. In vitro activity of cefiderocol and other newly approved antimicrobials against multi-drug resistant Gram-negative pathogens recovered in intensive care units in Spain and Portugal. Rev Esp Quimioter 2024; 37:69-77. [PMID: 37882320 PMCID: PMC10874671 DOI: 10.37201/req/098.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE The antimicrobial resistance is a significant public health threat, particularly for healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens which are increasingly reported worldwide. The aim of this study was to provide data on the in vitro antimicrobial activity of cefiderocol and that of commercially available comparator antibiotics against a defined collection of recent clinical multi-drug resistant (MDR) microorganisms, including carbapenem resistant Gram-negative bacteria collected from different regions in Spain and Portugal. METHODS A total of 477 clinical isolates of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia were prospectively (n=265) and retrospectively (n=212) included (2016-2019). Susceptibility testing was performed using standard broad microdilution and results were interpreted using CLSI-2021 and EUCAST-2021 criteria. RESULTS Overall, cefiderocol showed a good activity against Enterobacterales isolates, being 99.5% susceptible by CLSI and 94.5% by EUCAST criteria. It also demonstrated excellent activity against P. aeruginosa and S. maltophilia isolates, all being susceptible to this compound considering CLSI breakpoints. Regarding A. baumannii (n=64), only one isolate was resistant to cefiderocol. CONCLUSIONS Our results are in agreement with other studies performed outside Spain and Portugal highlighting its excellent activity against MDR gram-negative bacteria. Cefiderocol is a therapeutic alternative to those available for the treatment of infections caused by these MDR bacteria.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - R Canton
- Rafael Cantón. Servicio de Microbiología, Hospital Universitario Ramón y Cajal. Carretera de Colmenar Km 9,1. 28034-Madrid. Spain.
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2
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Antonelli A, Coppi M, Tellapragada C, Hasan B, Maruri A, Gijón D, Morecchiato F, de Vogel C, Verbon A, van Wamel W, Kragh KN, Frimodt-Møller N, Cantón R, Giske CG, Rossolini GM. Isothermal microcalorimetry versus checkerboard assay to evaluate in vitro synergism of meropenem-amikacin and meropenem-colistin combinations against multidrug-resistant Gram-negative pathogens. Int J Antimicrob Agents 2022; 60:106668. [PMID: 36038097 DOI: 10.1016/j.ijantimicag.2022.106668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/28/2022] [Accepted: 08/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the activity of meropenem-amikacin and meropenem-colistin combinations with checkerboard broth microdilution (CKBM) compared to isothermal microcalorimetry (ITMC) assays against a multicentric collection of multidrug-resistant Gram-negative (MDR-GN) clinical isolates, to compare the Fractional inhibitory concentration index (FICI) and time to results of CKBM and ITMC assays. METHODS A collection of 333 MDR-GNs showing reduced susceptibility to meropenem (121 Klebsiella pneumoniae, 14 Escherichia coli, 130 Pseudomonas aeruginosa and 68 Acinetobacter baumannii) isolated from different centres (Florence, Madrid, Rotterdam, and Stockholm) was included in the study. The antimicrobial activity of selected combinations was evaluated with CKBM and ITMC. FICI results were interpreted as synergistic/additive and indifferent for values ≤0.5/0.5<x≤1 and >1, respectively. WGS data in a subset of strains was used to evaluate their clonality. RESULTS A total of 254 and 286 strains were tested with meropenem-colistin and meropenem-amikacin combinations with ITMC and CKBM, respectively. Synergism/additive effects were observed with 46 strains (20 K. pneumoniae, 4 E. coli, 22 P. aeruginosa) and 20 strains (3 K. pneumoniae, 11 P. aeruginosa and 6 A. baumannii) with meropenem-amikacin and meropenem-colistin combination, respectively, with CKBM. ITMC showed a good concordance with CKBM with 89.5% and 92.2% of cases interpreted within the same FICI category for meropenem-amikacin and meropenem-colistin combinations, respectively. Most of the synergism/additivity effects were detected within 6 hours by ITMC. CONCLUSIONS ITMC showed a very good concordance with CKBM against a large collection of MDR-GN and could be implemented for the rapid evaluation of in vitro activity of antimicrobial combinations.
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Affiliation(s)
- Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Chaitanya Tellapragada
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Badrul Hasan
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ainhize Maruri
- Servicio de Microbiologia, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Desiree Gijón
- Servicio de Microbiologia, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Fabio Morecchiato
- Department of Experimental and Clinical Medicine, University of Florence, Florence Italy
| | - Corné de Vogel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University, Rotterdam, Netherlands
| | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus University, Rotterdam, Netherlands
| | - Willem van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University, Rotterdam, Netherlands
| | - Kasper Nørskov Kragh
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | | | - Rafael Cantón
- Servicio de Microbiologia, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER de Enfermedades Infecciosas. Instituto de Salud Carlos III. Madrid, Spain
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
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3
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Kragh KN, Gijón D, Maruri A, Antonelli A, Coppi M, Kolpen M, Crone S, Tellapragada C, Hasan B, Radmer S, de Vogel C, van Wamel W, Verbon A, Giske CG, Rossolini GM, Cantón R, Frimodt-Møller N. Effective antimicrobial combination in vivo treatment predicted with microcalorimetry screening. J Antimicrob Chemother 2021; 76:1001-1009. [PMID: 33442721 PMCID: PMC7953322 DOI: 10.1093/jac/dkaa543] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/30/2020] [Indexed: 02/01/2023] Open
Abstract
Objectives The worldwide emergence of antibiotic resistance calls for effective exploitation of existing antibiotics. Antibiotic combinations with different modes of action can synergize for successful treatment. In the present study, we used microcalorimetry screening to identify synergistic combination treatments against clinical MDR isolates. The synergistic effects were validated in a murine infection model. Methods The synergy of meropenem combined with colistin, rifampicin or amikacin was tested on 12 isolates (1 Escherichia coli, 5 Klebsiella pneumoniae, 3 Pseudomonas aeruginosa and 3 Acinetobacter baumannii) in an isothermal microcalorimeter measuring metabolic activity. One A. baumannii strain was tested with two individual pairings of antibiotic combinations. The microcalorimetric data were used to predict in vivo efficacy in a murine peritonitis/sepsis model. NMRI mice were inoculated intraperitoneally and after 1 h treated with saline, drug X, drug Y or X+Y. Bacterial load was determined by cfu in peritoneal fluid and blood after 4 h. Results In vitro, of the 13 combinations tested on the 12 strains, 3 of them exhibited a synergistic reduction in MIC (23% n = 3/13), 5 showed an additive effect (38.5% n = 5/13) and 5 had indifferent or antagonistic effects (38.5% n = 5/13). There was a significant correlation (P = 0.024) between microcalorimetry-screening FIC index values and the log reduction in peritoneal fluid from mice that underwent combination treatment compared with the most effective mono treatment. No such correlation could be found between chequerboard and in vivo results (P = 0.16). Conclusions These data support microcalorimetic metabolic readout to predict additive or synergistic effects of combination treatment of MDR infections within hours.
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Affiliation(s)
- Kasper Nørskov Kragh
- Department of Clinical Microbiology, Rigshospitalet, 2200 Copenhagen N, Denmark.,Costerton Biofilm Center, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Desiree Gijón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Ainhize Maruri
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50121 Firenze, Italy
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50121 Firenze, Italy
| | - Mette Kolpen
- Department of Clinical Microbiology, Rigshospitalet, 2200 Copenhagen N, Denmark
| | - Stephanie Crone
- Department of Clinical Microbiology, Rigshospitalet, 2200 Copenhagen N, Denmark
| | | | - Badrul Hasan
- Department of Laboratory Medicine, Karolinska Institutet, 14183 Stockholm, Sweden
| | - Stine Radmer
- Department of Clinical Microbiology, Rigshospitalet, 2200 Copenhagen N, Denmark
| | - Corné de Vogel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University, Erasmus MC, 3000CA Rotterdam, The Netherlands
| | - Willem van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University, Erasmus MC, 3000CA Rotterdam, The Netherlands
| | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus University, Erasmus MC, 3000CA Rotterdam, The Netherlands
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institutet, 14183 Stockholm, Sweden.,Clinical Microbiology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, 50121 Firenze, Italy
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
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4
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Tellapragada C, Hasan B, Antonelli A, Maruri A, de Vogel C, Gijón D, Coppi M, Verbon A, van Wamel W, Rossolini GM, Cantón R, Giske CG. Isothermal microcalorimetry minimal inhibitory concentration testing in extensively drug resistant Gram-negative bacilli: a multicentre study. Clin Microbiol Infect 2020; 26:1413.e1-1413.e7. [PMID: 32006694 DOI: 10.1016/j.cmi.2020.01.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/27/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the performance of an isothermal microcalorimetry (IMC) method for determining the MICs among extensively drug-resistant Gram-negative bacilli. METHODS A collection of 320 clinical isolates (n = 80 of each) of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii from Sweden, Spain, Italy and the Netherlands were tested. The MICs were determined using the IMC device calScreener (Symcel, Stockholm, Sweden) and ISO-broth microdilution as the reference method. Essential agreement, categorical agreement, very major errors (VME), major errors (ME) and minor (mE) errors for each antibiotic were determined. RESULTS Data from 316 isolates were evaluated. Four errors (two ME, one VME, one mE) among 80 K. pneumoniae, six errors (four ME, one VME, one mE) among 79 E. coli, 15 errors (seven VME, three ME, five mE) among 77 P. aeruginosa and 18 errors (12 VME, two ME, four mE) among 80 A. baumannii were observed. Average essential agreement and categorical agreement of the IMC method were 96.6% (95% confidence interval, 94.2-99) and 97.1% (95% confidence interval, 95.4-98.5) respectively when the MICs were determined at the end of 18 hours. Categorical agreement of the IMC method for prediction of MIC by the end of 8 hours for colistin, meropenem, amikacin, ciprofloxacin and piperacillin/tazobactam were 95%, 91.4%, 94%, 95.2% and 93.7% respectively. CONCLUSIONS The IMC method could accurately determine the MICs among extensively drug-resistant clinical isolates of E. coli, K. pneumoniae, P. aeruginosa and A. baumannii isolates.
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Affiliation(s)
- C Tellapragada
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institute, Stockholm, Sweden
| | - B Hasan
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institute, Stockholm, Sweden
| | - A Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - A Maruri
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - C de Vogel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - D Gijón
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - M Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - A Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - W van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - R Cantón
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - C G Giske
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institute, Stockholm, Sweden; Division of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
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5
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Fortún J, Martín-Dávila P, Gómez-Mampaso E, González-García A, Barbolla I, Gómez-García I, Wikman P, Ortíz J, Navas E, Cuartero C, Gijón D, Moreno S. Extra-pulmonary tuberculosis: differential aspects and role of 16S-rRNA in urine. Int J Tuberc Lung Dis 2014; 18:478-85. [PMID: 24670706 DOI: 10.5588/ijtld.13.0555] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early diagnosis of extra-pulmonary tuberculosis (EPTB) is important for successful treatment. METHODS All cases of EPTB diagnosed at Ramon y Cajal Hospital, Madrid, Spain, from 1997 to 2008 were analysed and compared with pulmonary tuberculosis (PTB) patients to identify differential parameters that could serve to predict the presence of EPTB at initial presentation. Different microbiological techniques were analysed, including amplification of 16S-rRNA in urine. RESULTS During the study period, 814 cases of TB were diagnosed at our centre; 330 (40.5%) were EPTB. Concomitant PTB was detected in 45% of EPTB cases. The main clinical forms of EPTB were lymphadenitis (86, 26%), miliary TB (60, 18%), and multifocal TB (43, 13%). Variables independently associated with EPTB were human immunodeficiency virus (HIV) infection (OR 3.6, 95%CI 2.4-5.4), older age (>60 years) (OR 3.7, 95%CI 2.5-5.6) and mortality (OR 2.9, 95%CI 1.3-6.3). 16S-rRNA in urine was performed in 82 EPTB patients (25%), among whom a positive result was obtained in 70%; in the PTB group, a positive result was found in 5 of 28 patients (18%) (P <0.001). CONCLUSIONS HIV infection and older age appear to be the main risk factors associated with EPTB. In this study, mortality was significantly higher in patients with EPTB. A positive 16S-rRNA test result in urine is a useful marker of EPTB.
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Affiliation(s)
- J Fortún
- Infectious Diseases Department Ramon y Cajal Hospital, Madrid, Spain
| | - P Martín-Dávila
- Infectious Diseases Department, Ramon y Cajal Hospital, Madrid, Spain
| | - E Gómez-Mampaso
- Microbiology Department, Ramon y Cajal Hospital, Madrid, Spain
| | - A González-García
- Infectious Diseases Department Ramon y Cajal Hospital, Madrid, Spain
| | - I Barbolla
- Infectious Diseases Department Ramon y Cajal Hospital, Madrid, Spain
| | - I Gómez-García
- Urology Department, Hospital Virgen de la Salud, Toledo, Spain
| | - P Wikman
- Infectious Diseases Department Ramon y Cajal Hospital, Madrid, Spain
| | - J Ortíz
- Infectious Diseases Department Ramon y Cajal Hospital, Madrid, Spain
| | - E Navas
- Infectious Diseases Department Ramon y Cajal Hospital, Madrid, Spain
| | - C Cuartero
- Microbiology Department, Ramon y Cajal Hospital, Madrid, Spain
| | - D Gijón
- Microbiology Department, Ramon y Cajal Hospital, Madrid, Spain
| | - S Moreno
- Infectious Diseases Department Ramon y Cajal Hospital, Madrid, Spain
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