Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA.
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA
Antimicrob Agents Chemother. 2018 May 25;62(6). doi: 10.1128/AAC.00157-18. Print 2018 Jun.
Increasing utilization of vancomycin due to the high prevalence of methicillin-resistant (MRSA) infections has led to the emergence of vancomycin-intermediate (VISA) and heterogeneous VISA (hVISA) strains. data suggest the potential for potent synergy between several beta-lactams and vancomycin. The objective of this study is to evaluate the synergy between beta-lactams and vancomycin against MRSA that is vancomycin susceptible, vancomycin-susceptible (VSSA), hVISA, and VISA. Fifty randomly selected clinical MRSA strains with various susceptibility levels to vancomycin were evaluated for vancomycin alone and vancomycin in combination with various concentrations of cefazolin (CFZ), cefepime (FEP), ceftaroline (CPT), and nafcillin (NAF). The potential for synergy was assessed by 24-h time-kill studies. Beta-lactams reduced vancomycin MIC values against all strains (4- to 16-fold reduction). In time-kill studies against MRSA, CFZ, FEP, CPT, and NAF all demonstrated similar degrees of killing at 24 h, and all showed synergistic activity with vancomycin against VSSA, hVISA, and VISA. Each of these combinations was also superior to any single agent against isolates of all three phenotypes, and each was bactericidal ( < 0.001 for all comparisons). All single-agent exposures demonstrated no activity at 24 h. The combination of vancomycin and beta-lactams significantly improved antibacterial activity against VSSA, hVISA, and VISA strains compared to the activity of any agent alone, supporting the potential use of vancomycin-beta-lactam combination therapy in infections caused by MRSA. Further clinical research is warranted to investigate the synergy of vancomycin against these strains.
由于耐甲氧西林金黄色葡萄球菌 (MRSA) 感染的高发率,万古霉素的使用率不断增加,导致出现了万古霉素中介 (VISA) 和异质性 VISA (hVISA) 菌株。数据表明,几种β-内酰胺类药物与万古霉素之间可能具有潜在的协同作用。本研究旨在评估β-内酰胺类药物与万古霉素对 MRSA 的协同作用,这些 MRSA 菌株对万古霉素的敏感性不同,包括万古霉素敏感(VSSA)、hVISA 和 VISA。对 50 株随机选择的临床 MRSA 菌株进行了评估,这些菌株对万古霉素的敏感性各不相同,评估内容包括万古霉素单独使用以及与不同浓度头孢唑林 (CFZ)、头孢吡肟 (FEP)、头孢洛林 (CPT) 和萘夫西林 (NAF) 联合使用的情况。通过 24 小时时间杀伤研究评估协同作用的潜力。β-内酰胺类药物降低了所有菌株对万古霉素的 MIC 值(降低了 4-16 倍)。在针对 MRSA 的时间杀伤研究中,CFZ、FEP、CPT 和 NAF 在 24 小时时均显示出相似的杀菌效果,并且对 VSSA、hVISA 和 VISA 均表现出协同活性。这些组合中的每一种与所有三种表型的分离株相比,都优于任何单一药物,并且对所有比较均具有杀菌作用(<0.001)。所有单药暴露在 24 小时时均无活性。与β-内酰胺类药物联合使用,显著提高了对 VSSA、hVISA 和 VISA 菌株的抗菌活性,优于任何单一药物的活性,支持万古霉素-β-内酰胺类药物联合治疗在由 MRSA 引起的感染中的应用。需要进一步的临床研究来调查万古霉素对这些菌株的协同作用。
Antimicrob Agents Chemother. 2016-3-25
J Antimicrob Chemother. 2020-10-1
Microbiol Spectr. 2024-8-6
Antimicrob Agents Chemother. 2013-4-1
Antimicrob Agents Chemother. 2011-10-17
Ther Adv Infect Dis. 2025-6-14
Infect Dis Clin Microbiol. 2024-6-28
Gels. 2022-5-19
Open Forum Infect Dis. 2021-5-23
Antimicrob Agents Chemother. 2018-1-25
Intensive Care Med. 2017-1-18
Antimicrob Agents Chemother. 2013-10-21
Antimicrob Agents Chemother. 2013-7-29
Antimicrob Agents Chemother. 2011-10-17