Sanders Madeline, Kim Sun Woo, Shinde Aditi, Fletcher-Williams Danielle, Quach Eric, Beringer Paul
Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA.
Antibiotics (Basel). 2025 May 10;14(5):486. doi: 10.3390/antibiotics14050486.
BACKGROUND: (MABS) is an opportunistic pathogen that causes chronic, difficult-to-treat pulmonary infections, particularly in people with cystic fibrosis (PwCF), leading to rapid lung function decline and increased morbidity and mortality. Treatment is particularly challenging due to the pathogen's resistance mechanisms and the need for prolonged multidrug therapy, which is characterized by poor clinical outcomes and highlights the urgent need for novel therapeutic strategies. Imipenem/relebactam, a novel β-lactam-β-lactamase inhibitor combination, demonstrates in vitro activity against resistant MABS strains and effective pulmonary penetration. Prior research indicates synergistic activity of imipenem with various antibiotics against . OBJECTIVES: This study aims to evaluate the in vitro activity of imipenem/relebactam, alone and in combination with various antibiotics, against MABS clinical isolates from PwCF ( = 28). METHODS: Susceptibility and synergy were assessed using broth microdilution and checkerboard assays. Extracellular time-kill assays were performed to evaluate the bactericidal activity of synergistic three-drug combinations containing imipenem/relebactam. RESULTS: Imipenem/relebactam demonstrated potent in vitro activity against clinical MABS isolates, exhibiting substantial synergy with cefuroxime, cefdinir, amoxicillin, and cefoxitin. Rifabutin, azithromycin, moxifloxacin, clofazimine, and minocycline also demonstrated additive effects with imipenem/relebactam. Extracellular time-kill assays identified imipenem/relebactam + cefoxitin + rifabutin and imipenem/relebactam + cefoxitin + moxifloxacin as the most effective combinations. CONCLUSIONS: These findings suggest that imipenem/relebactam may offer a significant advancement in the management of MABS infections in PwCF. The promising efficacy of multidrug regimens combining imipenem/relebactam with agents like cefoxitin, azithromycin, moxifloxacin, clofazimine, and rifabutin highlights potential therapeutic strategies.
背景:(马红球菌)是一种机会致病菌,可引起慢性、难以治疗的肺部感染,尤其是在囊性纤维化患者(PwCF)中,导致肺功能迅速下降,发病率和死亡率增加。由于该病原体的耐药机制以及需要长期使用多药治疗,治疗极具挑战性,多药治疗临床效果不佳,凸显了对新型治疗策略的迫切需求。亚胺培南/瑞来巴坦是一种新型的β-内酰胺-β-内酰胺酶抑制剂组合药物,对耐药马红球菌菌株具有体外活性,且肺部渗透效果良好。先前的研究表明亚胺培南与多种抗生素对……具有协同活性。 目的:本研究旨在评估亚胺培南/瑞来巴坦单独及与多种抗生素联合对来自PwCF的马红球菌临床分离株(n = 28)的体外活性。 方法:采用肉汤微量稀释法和棋盘法评估敏感性和协同作用。进行细胞外时间杀菌试验以评估含亚胺培南/瑞来巴坦的三联药物协同组合的杀菌活性。 结果:亚胺培南/瑞来巴坦对临床马红球菌分离株显示出强大的体外活性,与头孢呋辛、头孢地尼、阿莫西林和头孢西丁表现出显著协同作用。利福布汀、阿奇霉素、莫西沙星、氯法齐明和米诺环素与亚胺培南/瑞来巴坦也显示出相加作用。细胞外时间杀菌试验确定亚胺培南/瑞来巴坦 + 头孢西丁 + 利福布汀和亚胺培南/瑞来巴坦 + 头孢西丁 + 莫西沙星为最有效的组合。 结论:这些发现表明亚胺培南/瑞来巴坦可能在PwCF的马红球菌感染管理方面带来重大进展。亚胺培南/瑞来巴坦与头孢西丁、阿奇霉素、莫西沙星、氯法齐明和利福布汀等药物联合的多药方案的良好疗效凸显了潜在的治疗策略。
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