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Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa

Objective: For meropenem 40%T > MIC is associated with optimal killing of P. aeruginosa and E. coli. However, it is unknown how the distribution of %T > MIC through a treatment day impacts the antimicrobial effect in vitro. Therefore, we investigated the in vitro antibiotic activity of meropen...

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Autores principales: Nussbaumer-Pröll, A., Eberl, S., Kurdina, E., Schmidt, L., Zeitlinger, M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010652/
https://www.ncbi.nlm.nih.gov/pubmed/35431957
http://dx.doi.org/10.3389/fphar.2022.840692
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author Nussbaumer-Pröll, A.
Eberl, S.
Kurdina, E.
Schmidt, L.
Zeitlinger, M.
author_facet Nussbaumer-Pröll, A.
Eberl, S.
Kurdina, E.
Schmidt, L.
Zeitlinger, M.
author_sort Nussbaumer-Pröll, A.
collection PubMed
description Objective: For meropenem 40%T > MIC is associated with optimal killing of P. aeruginosa and E. coli. However, it is unknown how the distribution of %T > MIC through a treatment day impacts the antimicrobial effect in vitro. Therefore, we investigated the in vitro antibiotic activity of meropenem, precisely if 40%T > MIC is achieved in one single long period (single dose), 2 × 20% periods (dosing-bid), or 3 × 13.3% (dosing t.i.d.) thereby keeping the overall period of T > MIC constant. Material/Methods: Time kill curves (TKC) with P. aeruginosa-ATCC-27853 and E. coli-ATCC-25922 and five clinical isolates each were implemented over 24 h in CAMHB with concentrations from 0.25×MIC-32×MIC. Periods over and under MIC were simulated by centrifugation steps (discarding supernatant and refilling with fresh CAMHB). Double and triple dosing involved further addition and removal of antibiotic. Complementary growth controls (GC) with and without centrifugation steps were done and the emergence of phenotypical resistance was evaluated (repeated MIC-testing after antibiotic administration). Results: No impact of centrifugation on bacterial growth was seen. TKC with P. aeruginosa showed the best killing in the triple dosage, followed by the double and single dose. In multiple regimens at least a concentration of 4×MIC was needed to achieve a recommended 2-3 log10 killing. Likewise, a reduction of E. coli was best within the three short periods. Contrary to the TKCs with P. aeruginosa we could observe that after the inoculum reached a certain CFU/mL (≥10^8), no further addition of antibiotic could achieve bacterial killing (identified as the inoculum effect). For P. aeruginosa isolates resistance appeared within all regimens, the most pronounced was found in the 40%T > MIC experiments indicating that a single long period might accelerate the emergence of resistance. Contrary, for E. coli no emergence of resistance was found. Conclusion/Outlook: We could show that not solely the %T > MIC is decisive for an efficient bacterial eradication in vitro, but also the distribution of the selected %T > MIC. Thus, dividing the 40%T > MIC in three short periods requested lowers antibiotic concentrations to achieve efficient bacterial killing and reduces the emergence of resistance in P. aeruginosa isolates. The distribution of the %T > MIC did impact the bacterial eradication of susceptible pathogens in vitro and might play an even bigger role in infections with intermediate or resistant pathogens.
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spelling pubmed-90106522022-04-16 Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa Nussbaumer-Pröll, A. Eberl, S. Kurdina, E. Schmidt, L. Zeitlinger, M. Front Pharmacol Pharmacology Objective: For meropenem 40%T > MIC is associated with optimal killing of P. aeruginosa and E. coli. However, it is unknown how the distribution of %T > MIC through a treatment day impacts the antimicrobial effect in vitro. Therefore, we investigated the in vitro antibiotic activity of meropenem, precisely if 40%T > MIC is achieved in one single long period (single dose), 2 × 20% periods (dosing-bid), or 3 × 13.3% (dosing t.i.d.) thereby keeping the overall period of T > MIC constant. Material/Methods: Time kill curves (TKC) with P. aeruginosa-ATCC-27853 and E. coli-ATCC-25922 and five clinical isolates each were implemented over 24 h in CAMHB with concentrations from 0.25×MIC-32×MIC. Periods over and under MIC were simulated by centrifugation steps (discarding supernatant and refilling with fresh CAMHB). Double and triple dosing involved further addition and removal of antibiotic. Complementary growth controls (GC) with and without centrifugation steps were done and the emergence of phenotypical resistance was evaluated (repeated MIC-testing after antibiotic administration). Results: No impact of centrifugation on bacterial growth was seen. TKC with P. aeruginosa showed the best killing in the triple dosage, followed by the double and single dose. In multiple regimens at least a concentration of 4×MIC was needed to achieve a recommended 2-3 log10 killing. Likewise, a reduction of E. coli was best within the three short periods. Contrary to the TKCs with P. aeruginosa we could observe that after the inoculum reached a certain CFU/mL (≥10^8), no further addition of antibiotic could achieve bacterial killing (identified as the inoculum effect). For P. aeruginosa isolates resistance appeared within all regimens, the most pronounced was found in the 40%T > MIC experiments indicating that a single long period might accelerate the emergence of resistance. Contrary, for E. coli no emergence of resistance was found. Conclusion/Outlook: We could show that not solely the %T > MIC is decisive for an efficient bacterial eradication in vitro, but also the distribution of the selected %T > MIC. Thus, dividing the 40%T > MIC in three short periods requested lowers antibiotic concentrations to achieve efficient bacterial killing and reduces the emergence of resistance in P. aeruginosa isolates. The distribution of the %T > MIC did impact the bacterial eradication of susceptible pathogens in vitro and might play an even bigger role in infections with intermediate or resistant pathogens. Frontiers Media S.A. 2022-04-01 /pmc/articles/PMC9010652/ /pubmed/35431957 http://dx.doi.org/10.3389/fphar.2022.840692 Text en Copyright © 2022 Nussbaumer-Pröll, Eberl, Kurdina, Schmidt and Zeitlinger. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Nussbaumer-Pröll, A.
Eberl, S.
Kurdina, E.
Schmidt, L.
Zeitlinger, M.
Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa
title Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa
title_full Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa
title_fullStr Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa
title_full_unstemmed Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa
title_short Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa
title_sort challenging t > mic using meropenem vs. escherichia coli and pseudomonas aeruginosa
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010652/
https://www.ncbi.nlm.nih.gov/pubmed/35431957
http://dx.doi.org/10.3389/fphar.2022.840692
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