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. 2020 Dec:23:33-37.
doi: 10.1016/j.jgar.2020.07.025. Epub 2020 Aug 18.

Alternative drugs against multiresistant Gram-negative bacteria

Lauro Vieira Perdigão Neto  1 , Maura Salaroli Oliveira  2 , Tatiana D'Annibale Orsi  3 , Gladys Villas Boas do Prado  3 , Roberta Cristina Ruedas Martins  3 , Gleice Cristina Leite  3 , Ana Paula Marchi  3 , Esther Sant'Ana de Lira  3 , Marina Farrel Côrtes  2 , Evelyn Patricia Sanchez Espinoza  2 , Cláudia Maria Dantas de Maio Carrilho  4 , Ícaro Boszczowski  2 , Thais Guimarães  2 , Silvia Figueiredo Costa  3 , Anna S Levin  5
Affiliations
Free article

Alternative drugs against multiresistant Gram-negative bacteria

Lauro Vieira Perdigão Neto et al. J Glob Antimicrob Resist. 2020 Dec.
Free article

Abstract

Objectives: Enterobacterales and other non-fermenting Gram-negative bacteria have become a threat worldwide owing to the frequency of multidrug resistance in these pathogens. On the other hand, efficacious therapeutic options are quickly diminishing. The aims of this study were to describe the susceptibility of 50 multiresistant Gram-negative bacteria, mostly pan-resistant, against old and less-used antimicrobial drugs and to investigate the presence of antimicrobial resistance genes.

Methods: A total of 50 genetically distinct isolates were included in this study, including 14 Acinetobacter baumannii (belonging to ST79, ST317, ST835 and ST836), 1 Pseudomonas aeruginosa (ST245), 8 Serratia marcescens and 27 Klebsiella pneumoniae (belonging to ST11, ST340, ST258, ST16, ST23, ST25, ST101, ST234, ST437 and ST442). The isolates were submitted to antimicrobial susceptibility testing and whole-genome sequencing to evaluate lineages and resistance genes.

Results: Our results showed that some strains harboured carbapenemase genes, e.g. blaKPC-2 (28/50; 56%) and blaOXA-23 (11/50; 22%), and other resistance genes encoding aminoglycoside-modifying enzymes (49/50; 98%). Susceptibility rates to tigecycline (96%) in all species (except P. aeruginosa), to minocycline (100%) and doxycycline (93%) in A. baumannii, to ceftazidime/avibactam in S. marcescens (100%) and K. pneumoniae (96%), and to fosfomycin in S. marcescens (88%) were high. Chloramphenicol and quinolones (6% susceptibility each) did not perform well, making their use in an empirical scenario unlikely.

Conclusions: This study involving genetically distinct bacteria showed promising results for tigecycline for all Gram-negative bacteria (except P. aeruginosa), and there was good activity of minocycline against A. baumannii, ceftazidime/avibactam against Enterobacterales, and fosfomycin against S. marcescens.

Keywords: Alternative antimicrobials; Carbapenem resistance; Gram-negative; Multiresistance; Polymyxin resistance; Whole-genome sequencing.

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