Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Apr 28:11:63-71.
doi: 10.2174/1874285801711010063. eCollection 2017.

Synergistic Effect of Colistin and Rifampin Against Multidrug Resistant Acinetobacter baumannii: A Systematic Review and Meta-Analysis

Maryam Mohammadi  1 , Hatef Khayat  1 , Koroush Sayehmiri  2 , Setareh Soroush  3 , Fatemeh Sayehmiri  4 , Somayeh Delfani  3 , Lidija Bogdanovic  5 , Morovat Taherikalani  3
Affiliations
Review

Synergistic Effect of Colistin and Rifampin Against Multidrug Resistant Acinetobacter baumannii: A Systematic Review and Meta-Analysis

Maryam Mohammadi et al. Open Microbiol J. .

Abstract

The existence of infections caused by multidrug resistant (MDR) Acinetobacter baumannii is a growing problem because of the difficulty to treat them. We examined the published literature and focused our analysis on the investigation of the synergism of colistin and rifampin against MDR A. baumannii isolates via systematic review and meta-analysis. A systematic literature search was performed using the following 4 databases (PubMed, Scopus, EMBASE and ISI Web of Sciences). The related articles were evaluated during the period from December 2014 to January 2015. Information based on resistance and sensitivity to antibiotics, the minimum inhibitory concentration and the effects of two antibiotics on each other including synergism, antagonism, relative synergism and additive antagonism were extracted. A meta-analysis of 17 studies including 448 samples was brought into process and 2% (95% CI 0-4%) and 72% (95% CI 56-89%) resistance to colistin and rifampin were observed, respectively. 42% of all isolates showed MIC = 4 µg/ml (95% CI 14-69%) to rifampin and 30% MIC= 2 µg/ml to colistin (95% CI 3.8-78%). MIC50 and MIC90 for both rifampin and colistin were 2 µg/ml and 4 µg/ml, respectively. 63% of the strains demonstrated synergy (95% CI 37-90%), 7% were highlighted as relative synergism (95% CI 0.0- 13%), 3% showed an additive effect (95% CI -0.0-7%) and 14% were indifferent (95% CI 6-23%). The antagonistic effect was not observed in this combination. Synergy rates of time-kill assay in rifampin and colistin combinations were generally higher than those of check bored microdilution and E-test method. The results demonstrated that the combination therapy could be more useful when compared to monotherapy and that this strategy might reduce the resistance rate to rifampin in MDR A. baumannii isolates.

Keywords: A. baumannii; Colistin; Rifampin; Synergism.

PubMed Disclaimer

Figures

Chart (1)
Chart (1)
In-vitro susceptibility rate of colistin alone against A. baumannii. Meta-analysis show that 2% of the isolates were resistant to colistin alone.
Fig. (1)
Fig. (1)
In-vitro susceptibility rate of colistin alone against A. baumannii. Meta-analysis show that 2% of the isolates were resistant to colistin alone.
Fig (2)
Fig (2)
In-vitro susceptibility rate of rifampin alone against A. baumannii. meta-analysis show that 72% of the isolates were resistant to rifampin when it uses alone.
Fig (3)
Fig (3)
In-vitro synergistic rate of colistin with rifampin against A. baumannii. according to meta-analysis 63% of the isolates show synergy.
Fig (4)
Fig (4)
In-vitro partially synergistic rate of colistin with rifampin against A. baumannii is 7%.
Fig (5)
Fig (5)
In-vitro additive rate of colistin with rifampin against A. baumannii is 3%.
Fig (6)
Fig (6)
In-vitro antagonism rate of colistin with rifampin against A. baumannii. The result show that there is not antagonism between colistin and rifampin against A. baumannii isolates.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Karlowsky J.A., Draghi D.C., Jones M.E., Thornsberry C., Friedland I.R., Sahm D.F. Surveillance for antimicrobial susceptibility among clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii from hospitalized patients in the United States, 1998 to 2001. Antimicrob. Agents Chemother. 2003;47(5):1681–1688. doi: 10.1128/AAC.47.5.1681-1688.2003. - DOI - PMC - PubMed
    1. Gales A.C., Jones R.N., Forward K.R., Liñares J., Sader H.S., Verhoef J. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program (19971999). Clin. Infect. Dis. 2001;32(2) Suppl. 2:S104–S113. doi: 10.1086/320183. - DOI - PubMed
    1. Levin A.S., Barone A.A., Penço J., Santos M.V., Marinho I.S., Arruda E.A., Manrique E.I., Costa S.F. Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin. Infect. Dis. 1999;28(5):1008–1011. doi: 10.1086/514732. - DOI - PubMed
    1. Wood G.C., Hanes S.D., Boucher B.A., Croce M.A., Fabian T.C. Tetracyclines for treating multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia. Intensive Care Med. 2003;29(11):2072–2076. doi: 10.1007/s00134-003-1811-2. - DOI - PubMed
    1. Montero A., Ariza J., Corbella X., Doménech A., Cabellos C., Ayats J., Tubau F., Borraz C., Gudiol F. Antibiotic combinations for serious infections caused by carbapenem-resistant Acinetobacter baumannii in a mouse pneumonia model. J. Antimicrob. Chemother. 2004;54(6):1085–1091. doi: 10.1093/jac/dkh485. - DOI - PubMed

LinkOut - more resources