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In vitro activity of ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam alone or in combination with polymyxin B against carbapenem resistant Acinetobacter baumannii

The Journal of Antibiotics volume 76, pages 540–547 (2023)Cite this article

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Abstract

Nosocomial infection caused by Carbapenem-Resistant Acinetobacter baumannii (CR-A. baumannii) has become a challenge in clinical practice. Acting as the last resort antibacterial agents for the treatment of CR-A. baumannii infection, polymyxins have high risk of nephrotoxicity and poor clinical efficacy. Ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam are three β-lactam/β-lactamase inhibitor combination complexes that newly approved by the Food and Drug Administration for the treatment of carbapenem-resistant Gram-negative bacterial infection. In this study, we analyzed the in vitro activity of those novel antibacterial agents alone or in combination with polymyxin B against the CR-A. baumannii obtained from a Chinese tertiary hospital. Our results suggest that those novel antibacterial agents should not be used alone for the treatment of CR-A. baumannii infection, as they cannot prevent the regrowth of bacteria at the clinical achievable blood concentration. Imipenem/relebactam and meropenem/vaborbactam should not be used as the substitutes of imipenem and meropenem for polymyxin B based combination therapy against CR-A. baumannii, since they have no edge over imipenem and meropenem on antibacterial activity when in combination with polymyxin B. Ceftazidime/avibactam may be more suitable than ceftazidime for polymyxin B based combination therapy against CR-A. baumannii, as it has a higher synergistic rate with polymyxin B, and the antibacterial activity of ceftazidime/avibactam is much higher than that of ceftazidime when tested in combination with polymyxin B. Ceftazidime/avibactam may also be the better choice than imipenem and meropenem for polymyxin B based combination therapy against CR-A. baumannii, as it has a higher synergistic rate with polymyxin B.

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Acknowledgements

The authors are grateful to the Shiyan Renmin Hospital of Hubei University of Medicine and the Ningbo Yinzhou No.2 Hospital of Ningbo University. This work was supported by Shiyan Science and Technology Bureau (Grant No: 20Y46).

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  1. These authors contributed equally: Rongxin Liang, Dongxing Wang

Authors and Affiliations

  1. Department of Clinical Laboratory, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, P. R. China

    Rongxin Liang, Dongxing Wang, Yuxia Gu, Meijun Wang, Dan Hu & Mingan Zhu

  2. Department of Gynecology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, P. R. China

    Mingjin Hu

  3. Department of ophthalmology, Ningbo Yinzhou No.2 Hospital, Medical School of Ningbo University, Ningbo, Zhejiang, 315000, P. R. China

    Meng Wang

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Contributions

MW designed this research. RX and DX took charge of this study and finished the majority of experiments. RX drafted the manuscript and MA revised the manuscript critically for important intellectual content. MJ, YX, MJ, and DH participated in the collection of CR-A. baumannii isolates and gene information analysis.

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Correspondence to Mingan Zhu or Meng Wang.

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Liang, R., Wang, D., Hu, M. et al. In vitro activity of ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam alone or in combination with polymyxin B against carbapenem resistant Acinetobacter baumannii. J Antibiot 76, 540–547 (2023). https://doi.org/10.1038/s41429-023-00631-0

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