Sains Malaysiana 44(7)(2015): 1061–1065

Interaction of Imipenem and Tigecycline against Carbapenem-Resistant Acinetobacter baumanii: The Relativity of Synergism

(Interaksi Imipenem dan Tigecycline terhadap Rintang-Carbapenem Acinetobacter baumanii: Kerelatifan Sinergisme)

H. ALFIZAH¹, O.Z. SITI SARAH² & M.Z. NORAZIAH²*

¹Dept. of Medical Microbiology & Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia

²School of Diagnostic and Applied Health Sciences, Faculty of Health Sciences

Universiti Kebangsaan Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur, Malaysia

Received: 26 July 2013/Accepted: 6 April 2015

ABSTRACT

Acinetobacter baumanii is an opportunistic bacterium that causes widespread nosocomial infections and tends to be multi-resistant to most of antibiotics. Tigecycline is a well-known antibiotic that possesses a wide-range of activities and is very active in vitro towards a variety of resistant pathogens, including A. baumanii. The aim of this study was to evaluate the effects of the imipenem and tigecycline combination against carbapenem-resistant A. baumanii (CRAB). The minimal inhibitory concentration (MIC) was determined using the E-test method. The microbroth checkerboard technique was employed to determine the effects of the imipenem and tigecycline interaction by obtaining the fractional inhibitory concentration (FIC) index value. A time kill (TK) study was performed to identify any synergistic effects when both imipenem and tigecycline were used against CRAB strains. The result demonstrated that all A. baumanni strains exhibited imipenem MIC values of 32 μg/mL. The combination of imipenem and tigecycline demonstrated an additive effect (FIC > 0.5-4) against all of the strains and synergistic activity (decrement of > 2 log10 CFU/mL) towards AC 34/07 and AC 32/06 strains. The use of imipenem in combination with tigecycline resulted in a more efficient activity and an increased capability to control CRAB infections. This effect showed potential combination and may be of importance in the development or modification of antimicrobial agents for the treatment of CRAB infections.

Keywords: Acinetobacter baumanii; carbapenem-resistant; imipenem; tigecycline

ABSTRAK

Acinetobacter baumanii adalah bakteria oportunis yang menyebabkan jangkitan nosokomial secara meluas dan cenderung untuk menjadi multirintang terhadap kebanyakan antibiotik. Tigecycline adalah antibiotik yang mempunyai pelbagai aktiviti dan sangat aktif secara in vitro terhadap pelbagai patogen rintang antibiotik, termasuklah A. baumanii. Tujuan kajian ini adalah untuk menilai kesan dan gabungan antibiotik imipenem dan tigecycline terhadap A. baumanii rintang-karbapenem (CRAB). Kepekatan perencatan minimum (MIC) ditentukan dengan menggunakan kaedah E-test. Teknik papan penyemak mikrokaldu digunakan untuk menentukan kesan imipenem dan interaksinya dengan tigecycline dengan mendapatkan nilai indeks kepekatan rencatan berperingkat (FIC). Ujian masa membunuh (TK) telah dijalankan untuk mengenal pasti kesan sinergi apabila kedua-dua imipenem dan tigecycline digunakan terhadap strain CRAB. Hasil ujian menunjukkan bahawa semua strain A. baumanni memberi nilai imipenem MIC sebanyak 32 μg/mL. Gabungan imipenem dan tigecycline menunjukkan kesan tambahan (FIC> 0,5-4) terhadap semua strain yang diuji dan aktiviti sinergi (pengurangan sebanyak> 2 log10 CFU/mL) terhadap strain AC 34/07 dan AC 32/06. Penggunaan kombinasi imipenem dan tigecycline menghasilkan aktiviti yang lebih cekap dan meningkatkan kemampuan untuk mengawal jangkitan CRAB. Kesan ini menunjukkan kombinasi yang berpotensi dan mungkin penting dalam pembangunan atau pengubahsuaian agen antimikrob untuk rawatan jangkitan CRAB.

Kata kunci: Acinetobacter baumani; imipenem I; rintang-karbapenem; tigecycline

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*Corresponding author; email: nora@medic.ukm.my