比较 X 型头孢洛巴坦与其他β-内酰胺/β-内酰胺酶抑制剂(BLI)组合对碳青霉烯类耐药和产超广谱β-内酰胺酶的抗菌活性。
potency of xeruborbactam in combination with multiple β-lactam antibiotics in comparison with other β-lactam/β-lactamase inhibitor (BLI) combinations against carbapenem-resistant and extended-spectrum β-lactamase-producing .
机构信息
Qpex Biopharma , San Diego, California, USA.
JMI Laboratories , North Liberty, lowa, USA.
出版信息
Antimicrob Agents Chemother. 2023 Nov 15;67(11):e0044023. doi: 10.1128/aac.00440-23. Epub 2023 Oct 6.
Recently, several β-lactam (BL)/β-lactamase inhibitor (BLI) combinations have entered clinical testing or have been marketed for use, but limited direct comparative studies of their activity exist. Xeruborbactam (XER, also known as QPX7728), which is undergoing clinical development, is a cyclic boronate BLI with potent inhibitory activity against serine (serine β-lactamase) and metallo-β-lactamases (MBLs). The objectives of this study were (i) to compare the potency and spectrum of β-lactamase inhibition by various BLIs in biochemical assays using purified β-lactamases and in microbiological assays using the panel of laboratory strains expressing diverse serine and metallo-β-lactamases and (ii) to compare the potency of XER in combination with multiple β-lactam antibiotics to that of other BL/BLI combinations in head-to-head testing against recent isolates of carbapenem-resistant (CRE). Minimal inhibitory concentrations (MICs) of XER combinations were tested with XER at fixed 4 or 8 µg/mL, and MIC testing was conducted in a blinded fashion using Clinical and Laboratory Standards Institute reference methods. Xeruborbactam and taniborbactam (TAN) were the only BLIs that inhibited clinically important MBLs. The spectrum of activity of xeruborbactam included several MBLs identified in e.g., and various IMP enzymes and NDM-9 that were not inhibited by taniborbactam. Xeruborbactam potency against the majority of purified β-lactamases was the highest in comparison with other BLIs. Meropenem-xeruborbactam (MEM-XER, fixed 8 µg/mL) was the most potent combination against MBL-negative CRE with MIC values of 0.125 µg/mL. MEM-XER and cefepime-taniborbactam (FEP-TAN) were the only BL/BLIs with activity against MBL-producing CREs; with MEM-XER (MIC of 1 µg/mL) being at least 16-fold more potent than FEP-TAN (MIC of 16 µg/mL). MEM-XER MIC values were ≤8 µg/mL for >90% of CRE, including both MBL-negative and MBL-positive isolates, with FEP-TAN MIC of >8 µg/mL. Xeruborbactam also significantly enhanced potency of other β-lactam antibiotics, including cefepime, ceftolozane, ceftriaxone, aztreonam, piperacillin, and ertapenem, against clinical isolates of that carried various class A, class C, and class D extended-spectrum β-lactamases and carbapenem-resistant , including metallo-β-lactamase-producing isolates. These results strongly support further clinical development of xeruborbactam combinations.
最近,有几种β-内酰胺(BL)/β-内酰胺酶抑制剂(BLI)组合已经进入临床测试或上市使用,但它们的活性的直接比较研究有限。Xeruborbactam(XER,也称为 QPX7728)正在进行临床开发,是一种具有强大抑制活性的环状硼酸 BL,对丝氨酸(丝氨酸β-内酰胺酶)和金属β-内酰胺酶(MBLs)均有抑制作用。本研究的目的是:(i)比较不同 BLIs 在使用纯化的β-内酰胺酶的生化测定中和使用表达不同丝氨酸和金属β-内酰胺酶的实验室菌株的微生物测定中对β-内酰胺酶抑制的效力和谱;(ii)比较 XER 与多种β-内酰胺抗生素联合使用的效力与其他 BL/BLI 组合在针对最近分离的碳青霉烯耐药(CRE)的头对头测试中的效力。使用 XER 以固定的 4 或 8 µg/mL 进行 XER 组合的最小抑菌浓度(MIC)测试,使用临床和实验室标准协会参考方法以盲法进行 MIC 测试。Xeruborbactam 和 taniborbactam(TAN)是唯一抑制临床重要 MBL 的 BLIs。Xeruborbactam 的作用谱包括在 e.g.中发现的几种 MBL,以及各种 IMP 酶和 NDM-9,这些酶不受 taniborbactam 的抑制。与其他 BLIs 相比,Xeruborbactam 对大多数纯化的β-内酰胺酶的效力最高。美罗培南-xeruborbactam(MEM-XER,固定 8 µg/mL)是对 MBL 阴性 CRE 最有效的组合,MIC 值为 0.125 µg/mL。MEM-XER 和头孢吡肟-taniborbactam(FEP-TAN)是唯一对产 MBL CRE 有活性的 BL/BLIs;MEM-XER(MIC 为 1 µg/mL)的效力至少是 FEP-TAN(MIC 为 16 µg/mL)的 16 倍。对于 >90%的 CRE,包括 MBL 阴性和 MBL 阳性分离株,MEM-XER 的 MIC 值为 ≤8 µg/mL,而 FEP-TAN 的 MIC 值为 >8 µg/mL。Xeruborbactam 还显著增强了其他β-内酰胺抗生素的效力,包括头孢吡肟、头孢他啶、头孢曲松、氨曲南、哌拉西林和厄他培南,对携带各种 A 类、C 类和 D 类扩展β-内酰胺酶和碳青霉烯耐药的临床分离株的活性,包括产金属β-内酰胺酶的分离株。这些结果强烈支持进一步开发 Xeruborbactam 组合。