Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Branch for Bioresources, Giessen, Germany.
Justus-Liebig-University of Giessen, Giessen, Germany.
Microbiol Spectr. 2023 Feb 14;11(1):e0443722. doi: 10.1128/spectrum.04437-22. Epub 2023 Jan 24.
The emergence and spread of antimicrobial resistance (AMR) in Gram-negative pathogens, such as carbapenem-resistant Pseudomonas aeruginosa, pose an increasing threat to health care. Patients with immunodeficiencies or chronic pulmonary disease, like cystic fibrosis (CF), are particularly vulnerable to Pseudomonas infections and depend heavily on antibiotic therapy. To broaden limited treatment options, this study evaluated the potency of the recently licensed drugs ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), and cefiderocol (FDC) as well as two novel preclinical antibiotics, darobactins B (DAR B) and B9 (DAR B9), against clinical P. aeruginosa isolates derived from respiratory samples of CF patients. We observed high levels of resistance to all three newly licensed drugs, with cefiderocol exhibiting the best activity. From the 66 investigated P. aeruginosa isolates, a total of 53% were resistant to CZA, 49% to C/T, and 30% to FDC. Strikingly, 52 of the evaluated isolates were obtained from CF patients prior to market introduction of the drugs. Thus, our results suggest that resistance to CZA, C/T, and FDC may be due to preexisting resistance mechanisms. On the other hand, our two novel preclinical compounds performed better than (CZA and C/T) or close to (FDC) the licensed drugs-most likely due to the novel mode of action. Thus, our results highlight the necessity of global consistency in the area of antibiotic stewardship to prevent AMR from further impairing the potency of antibiotics in clinical practice. Ultimately, this study demonstrates the urgency to support the development of novel antimicrobials, preferably with a new mode of action such as darobactins B and B9, two very promising antimicrobial compounds for the treatment of critically ill patients suffering from multidrug-resistant Gram-negative (MRGN) infections. Antimicrobial resistance (AMR) represents an ever increasing threat to the health care system. Even recently licensed drugs are often not efficient for the treatment of infections caused by Gram-negative bacteria, like Pseudomonas aeruginosa, a causative agent of lung infections. To address this unmet medical need, innovative antibiotics, which possess a new mode of action, need to be developed. Here, the antibiogram of clinical isolates derived from cystic fibrosis patients was generated and new bicyclic heptapeptides, which inhibit the outer membrane protein BamA, exhibited strong activity, also against multidrug-resistant isolates.
革兰氏阴性病原体(如耐碳青霉烯铜绿假单胞菌)中出现和传播的抗生素耐药性(AMR)对医疗保健构成了日益严重的威胁。免疫缺陷或患有慢性肺部疾病(如囊性纤维化(CF))的患者特别容易感染铜绿假单胞菌,并且严重依赖抗生素治疗。为了扩大有限的治疗选择,本研究评估了最近获得许可的药物头孢他啶-阿维巴坦(CZA)、头孢洛扎-他唑巴坦(C/T)和头孢地尔(FDC)以及两种新型临床前抗生素达罗巴丁 B(DAR B)和 B9(DAR B9)对来自 CF 患者呼吸道样本的临床铜绿假单胞菌分离株的效力。我们观察到所有三种新获得许可的药物都具有高度耐药性,而头孢地尔的活性最好。在所研究的 66 株铜绿假单胞菌分离株中,共有 53%对 CZA 耐药,49%对 C/T 耐药,30%对 FDC 耐药。引人注目的是,评估的 52 株分离株来自 CF 患者,而这些药物在市场推出之前就已经存在。因此,我们的结果表明,对 CZA、C/T 和 FDC 的耐药性可能是由于预先存在的耐药机制。另一方面,我们的两种新型临床前化合物的表现优于(CZA 和 C/T)或接近(FDC)许可药物——这很可能是由于它们具有新颖的作用方式。因此,我们的结果强调了在抗生素管理领域保持全球一致性的必要性,以防止抗生素耐药性进一步削弱抗生素在临床实践中的效力。最终,本研究表明迫切需要支持新型抗菌药物的开发,最好是具有新作用方式的抗菌药物,如达罗巴丁 B 和 B9,这两种非常有前途的治疗患有多重耐药革兰氏阴性(MRGN)感染的重症患者的抗菌化合物。抗生素耐药性(AMR)对医疗保健系统构成的威胁日益严重。即使是最近获得许可的药物,也往往不能有效地治疗由铜绿假单胞菌引起的感染,铜绿假单胞菌是肺部感染的病原体。为了解决这一未满足的医疗需求,需要开发具有新作用方式的创新抗生素。在这里,从囊性纤维化患者中生成了临床分离株的药敏谱,并发现新的双环庚肽,抑制外膜蛋白 BamA,表现出很强的活性,对多药耐药分离株也有效。
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