Evaluation Of In-vitro Efficacy Of Betalactam/Non Betalactam Antimicrobials Against ESBL Genotypes from Wound Infection
Abstract
Gram-negative isolates with multiple beta-lactamase enzymes often possess gene determinants for resistance to non-beta-lactam antibiotics. The present study evaluates the in-vitro efficacy of β lactam/non-β lactam antimicrobials against extended-spectrum beta-lactamase (ESBL) genotypes from wound infection. The minimum inhibitory concentrations (MICs) of antimicrobials against 38 Enterobacteriaceae isolates from wound infection were determined by Vitek 2 ID/AST cards. ESBL genotypes: SHV, TEM, CTX-M, and OXA-10/11 genes were detected by real-time PCR. A correlation was found between ESBL genotypes and its resistance to imipenem and amoxycillin clavulanate that is statistically significant (p-value < 0.005). No statistically significant finding was noted among ESBL genotypes which showed resistance to meropenem, amikacin, gentamicin, piperacillin-tazobactam, ciprofloxacin and cotrimoxazole (p-value > 0.005). About 85.19% ESBL genotypes showed imipenem and meropenem susceptibility (MIC:- 0.025–1 μg) and to amikacin (MIC:≤ 2–16 μg). In 44.44% of ESBL genotypes showed susceptibility to cefepime (MIC: ≤ 2 μg) and 7.41% showed cefepime MIC of 4 to 8 μg (Susceptible Dose-Dependent). The emergence of carbapenem-resistant Enterobacterales have highlighted the need to assess the in-vitro efficacy of non-carbapenem betalactam and non-betalactam therapeutic alternatives to treat ESBL infections. Depending on the MIC of cefepime and susceptibility data of aminoglycosides, cotrimoxazole and fluoroquinolones, these drugs can be considered as carbapenem sparing drug as well as for non bacteremic ESBL therapy.
Keywords:
Wound infection, ESBL genotypes, Minimum Inhibitory Concentration, Invitro efficacyDOI
https://doi.org/10.25004/IJPSDR.2024.160301References
Therrien C, Levesque RC. Molecular basis of antibiotic resistance and beta-lactamase inhibition by mechanism-based inactivators: perspectives and future directions. FEMS Microbiology Reviews.2000;24:251-262. Available from: doi: 10.1111/j.1574-6976.2000.tb00541.x..
Karaiskos I, Giamarellou H. Carbapenem-Sparing Strategies for ESBL Producers: When and How. Antibiotics (Basel). 2020;9(2):61.Available from: doi: 10.3390/antibiotics9020061
Bethel CR, Taracila M, Shyr T, Thomson JM, Distler AM, Hujer KM et al .Exploring the inhibition of CTX-M-9 by beta-lactamase inhibitors and carbapenems. Antimicrobial Agents and Chemotherapy. 2011;55:3465-3475. Available from: doi: 10.1128/AAC.00089-11.
Akova M. Sulbactam-containing beta-lactamase inhibitor combinations. Clinical Microbiology and Infection. 2008;5:21-24. Available from: doi: 10.1111/j.1469-0691.2007.01847.x.
Ripoll A, Baquero F, Novais A, Rodríguez-Domínguez MJ, Turrientes MC, Cantón R, et al. In vitro selection of variants resistant to beta-lactams plus beta-lactamase inhibitors in CTX-M beta-lactamases: predicting the in vivo scenario? Antimicrobial Agents and Chemotherapy. 2011; 55:4530-4536. Available from: doi: 10.1128/AAC.00178-11
Lee N, Yuen KY, Kumana CR. Clinical role of beta-lactam/beta-lactamase inhibitor combinations. Drugs. 2003;63:1511-1524. Available from: doi: 10.2165/00003495-200363140-00006.
Haidar G, Alkroud A, Cheng S, Churilla TM, Churilla BM, Shields RK, et al. Association between the Presence of Aminoglycoside-Modifying Enzymes and In Vitro Activity of Gentamicin, Tobramycin, Amikacin, and Plazomicin against Klebsiella pneumoniae Carbapenemase and Extended-Spectrum-β-Lactamase-Producing Enterobacter Species. Antimicrobial Agents and Chemotherapy.2016;60:5208-5214. Available from: doi: 10.1128/AAC.00869-16.
Cha MK, Kang CI, Kim SH, Cho SY, Ha YE, Wi YM, et al. Korean Network for Study on Infectious Diseases (KONSID). In vitro activities of 21 antimicrobial agents alone and in combination with aminoglycosides or fluoroquinolones against extended-spectrum-β-lactamase-producing Escherichia coli isolates causing bacteremia. Antimicrobial Agents and Chemotherapy. 2015 ;59:5834-5837. Available from: doi: 10.1128/AAC.01121-15.
Krause KM, Serio AW, Kane TR, Connolly LE. Aminoglycosides: An Overview. Cold Spring Harbor Perspectives in Medicine. 2016;6:a027029. Available from: doi: 10.1101/cshperspect.a027029.
CLSI. Performance Standards for Antimicrobial Susceptibility testing 31st ed.CLSI supplement M100.Clinical and Laboratory standard Institute, 2021.
Manoharan A, Premalatha K, Chatterjee S, Mathai D. SARI Study Group. Correlation of TEM, SHV and CTX-M extended-spectrum beta lactamases among Enterobacteriaceae with their in vitro antimicrobial susceptibility. Indian Journal of Medical Microbiology. 2011;29:161-164. Available from: doi: 10.4103/0255-0857.81799.
Harada Y, Morinaga Y, Kaku N, Nakamura S, Uno N, Hasegawa H. In vitro and in vivo activities of piperacillin-tazobactam and meropenem at different inoculum sizes of ESBL-producing Klebsiella pneumoniae. Clinical Microbiology and Infection. 2014 ;20:O831-9. Available from: doi: 10.1111/1469-0691.12677.
Abdelaziz SM, Aboshanab KM, Yahia IS, Yassien MA, Hassouna NA. Correlation between the Antibiotic Resistance Genes and Susceptibility to Antibiotics among the Carbapenem-Resistant Gram-Negative Pathogens. Antibiotics (Basel). 2021;10:255. Available from: doi: 10.3390/antibiotics10030255.
Rajivgandhi G, Maruthupandy M, Ramachandran G, Priyanga M, Manoharan N. Detection of ESBL genes from ciprofloxacin resistant Gram negative bacteria isolated from urinary tract infections (UTIs), Frontiers in Laboratory. 2018;2: 5-13. Available from: doi.org/10.1016/j.flm.2018.01.001
Haji SH, Jalal ST, Omer SA, Mawlood AH. Molecular detection of SHV-Type ESBL in E. coli and K. pneumoniae and their antimicrobial resistance profile. Zanco Journal of Medical Sciences. 2018; 22:262–272. Available from: doi.org/10.15218/zjms.2018.035
Manandhar S, Zellweger RM, Maharjan N, Dongol S, Prajapati KG, Thwaites G, et al. A high prevalence of multi-drug resistant Gram-negative bacilli in a Nepali tertiary care hospital and associated widespread distribution of Extended-Spectrum Beta-Lactamase (ESBL) and carbapenemase-encoding genes. Annals of Clinical Microbiology and Antimicrobials. 2020;19:48. Available from: doi.org/10.1186/s12941-020-00390-y
Maseda E, Suárez de la Rica A. Controversies in the management of ESBL-producing Enterobacterales. Clinical Implications. Revista Española de Quimioterapia. 2022; 35:41-45. Available from: doi: 10.37201/req/s03.10.2022.
Umemura T, Kato H, Hagihara M, Hirai J, Yamagishi Y, Mikamo H. Efficacy of Combination Therapies for the Treatment of Multi-Drug Resistant Gram-Negative Bacterial Infections Based on Meta-Analyses. Antibiotics (Basel). 2022;11:524. Available from: doi: 10.3390/antibiotics11040524.
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