Three Dimensional Checkerboard Synergy Analysis of Colistin, Meropenem, Tigecycline against Multidrug-Resistant Clinical Klebsiella pneumonia Isolates

PLoS One. 2015 Jun 11;10(6):e0126479. doi: 10.1371/journal.pone.0126479. eCollection 2015.

Abstract

The spread of carbapenem-non-susceptible Klebsiella pneumoniae strains bearing different resistance determinants is a rising problem worldwide. Especially infections with KPC (Klebsiella pneumoniae carbapenemase) - producers are associated with high mortality rates due to limited treatment options. Recent clinical studies of KPC-blood stream infections revealed that colistin-based combination therapy with a carbapenem and/or tigecycline was associated with significantly decreased mortality rates when compared to colistin monotherapy. However, it remains unclear if these observations can be transferred to K. pneumoniae harboring other mechanisms of carbapenem resistance. A three-dimensional synergy analysis was performed to evaluate the benefits of a triple combination with meropenem, tigecycline and colistin against 20 K. pneumoniae isolates harboring different β-lactamases. To examine the mechanism behind the clinically observed synergistic effect, efflux properties and outer membrane porin (Omp) genes (ompK35 and ompK36) were also analyzed. Synergism was found for colistin-based double combinations for strains exhibiting high minimal inhibition concentrations against all of the three antibiotics. Adding a third antibiotic did not result in further increased synergistic effect in these strains. Antagonism did not occur. These results support the idea that colistin-based double combinations might be sufficient and the most effective combination partner for colistin should be chosen according to its MIC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Bacterial Proteins / metabolism
  • Colistin / pharmacology*
  • Drug Resistance, Multiple, Bacterial / drug effects
  • Drug Synergism
  • Gene Expression Regulation, Bacterial / drug effects
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / enzymology
  • Klebsiella pneumoniae / isolation & purification
  • Meropenem
  • Microbial Sensitivity Tests
  • Minocycline / analogs & derivatives*
  • Minocycline / pharmacology
  • Porins / metabolism
  • Thienamycins / pharmacology*
  • Tigecycline

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • OmpK35 porin, Klebsiella pneumoniae
  • OmpK36 protein, Klebsiella pneumoniae
  • Porins
  • Thienamycins
  • Tigecycline
  • Meropenem
  • Minocycline
  • Colistin

Grants and funding

This work was supported by grants from the German Ministry of Education and Research (grant numbers 01KI1204 and 01EO1002) and from ARGUS-Stiftung. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.