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Journal of Antimicrobial Chemotherapy
Article . 2024 . Peer-reviewed
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Synergistic effects of ceftazidime/avibactam combined with meropenem in a murine model of infection with KPC-producing Klebsiella pneumoniae

Authors: Zheng, Mei; Li, Fu-Hao; Liu, Juan; Li, Wen-Jie; Yin, Ruo-Xi; Cai, Da-Tong; Andrey, Diego Olivier; +6 Authors

Synergistic effects of ceftazidime/avibactam combined with meropenem in a murine model of infection with KPC-producing Klebsiella pneumoniae

Abstract

Abstract Objectives The emergence and expansion of carbapenem-resistant Klebsiella pneumoniae infections is a concern due to the lack of ‘first-line’ antibiotic treatment options. The ceftazidime/avibactam is an important clinical treatment for carbapenem-resistant K. pneumoniae infections but there is an increasing number of cases of treatment failure and drug resistance. Therefore, a potential solution is combination therapies that result in synergistic activity against K. pneumoniae carbapenemase: producing K. pneumoniae (KPC-Kp) isolates and preventing the emergence of KPC mutants resistant to ceftazidime/avibactam are needed in lieu of novel antibiotics. Methods To evaluate their synergistic activity, antibiotic combinations were tested against 26 KPC-Kp strains. Antibiotic resistance profiles, molecular characteristics and virulence genes were investigated by susceptibility testing and whole-genome sequencing. Antibiotic synergy was evaluated by in vitro chequerboard experiments, time-killing curves and dose–response assays. The mouse thigh model was used to confirm antibiotic combination activities in vivo. Additionally, antibiotic combinations were evaluated for their ability to prevent the emergence of ceftazidime/avibactam resistant mutations of blaKPC. Results The combination of ceftazidime/avibactam plus meropenem showed remarkable synergistic activity against 26 strains and restored susceptibility to both the partnering antibiotics. The significant therapeutic effect of ceftazidime/avibactam combined with meropenem was also confirmed in the mouse model and bacterial loads in the thigh muscle of the combination groups were significantly reduced. Furthermore, ceftazidime/avibactam plus meropenem showed significant activity in preventing the occurrence of resistance mutations. Conclusions Our results indicated that the combination of ceftazidime/avibactam plus meropenem offers viable therapeutic alternatives in treating serious infections due to KPC-Kp.

Keywords

Bacterial Proteins / genetics, Klebsiella pneumoniae / drug effects, Azabicyclo Compounds / therapeutic use, Microbial Sensitivity Tests, Ceftazidime, beta-Lactamases, Carbapenem-Resistant Enterobacteriaceae / genetics, Mice, Bacterial Proteins, Ceftazidime / pharmacology, 616, Animals, Klebsiella Infections / microbiology, Anti-Bacterial Agents / therapeutic use, Ceftazidime / therapeutic use, Azabicyclo Compounds / pharmacology, Whole Genome Sequencing, Klebsiella Infections / drug therapy, Drug Synergism, Meropenem, Anti-Bacterial Agents / pharmacology, Klebsiella Infections, Anti-Bacterial Agents, Klebsiella pneumoniae, Drug Combinations, Disease Models, Animal, Carbapenem-Resistant Enterobacteriaceae, Female, Drug Therapy, Combination, Meropenem / administration & dosage, Beta-Lactamases / genetics, Klebsiella pneumoniae / genetics, Azabicyclo Compounds, Meropenem / pharmacology, Carbapenem-Resistant Enterobacteriaceae / drug effects

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
1
Average
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