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    Please use this identifier to cite or link to this item: http://ir.cnu.edu.tw/handle/310902800/31650


    標題: Cephalosporin-Glycopeptide Combinations for Use against Clinical Methicillin-Resistant Staphylococcus aureus Isolates: Enhanced In vitro Antibacterial Activity
    作者: Tang, Hung-Jen
    Lai, Chih-Cheng
    Chen, Chi-Chung
    Zhang, Chun-Cheng
    Weng, Tzu-Chieh
    Yu, Wen-Liang
    Chen, Hung-Jui
    Chiu, Yu-Hsin
    Ko, Wen-Chien
    Chuang, Yin-Ching
    貢獻者: Chi Mei Med Ctr, Dept Med
    Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr
    Chi Mei Hosp Liou Ying, Dept Intens Care Med
    Chi Mei Med Ctr, Med Res
    Chi Mei Hosp Liou Ying, Med
    Natl Cheng Kung Univ Hosp, Dept Internal Med
    Natl Cheng Kung Univ Hosp, Ctr Infect Control
    Natl Cheng Kung Univ, Coll Med, Dept Med
    關鍵字: glycopeptides
    cefazolin
    cefmetazole
    cefotaxime
    cefepime
    combination therapy
    synergism
    MRSA
    日期: 2017-05-18
    上傳時間: 2018-11-30 15:51:34 (UTC+8)
    出版者: Frontiers Media Sa
    摘要: The empirical combination of both a beta-lactam and glycopeptide to counter potential staphylococcal pathogens may improve the clinical outcomes for cases of Staphylococcus aureus bacteremia. We reported comparative in vitro studies of combination effects of different cephalosporins (i.e., cefazolin, cefmetazole, cefotaxime, and cefepime) combined with glycopeptides for 34 randomly selected methicillin-resistant S. aureus (MRSA) isolates by three methods, including the checkerboard, time-killing, and combination MIC measurement methods. Thirteen SCCmec type III isolates with a cefazolin MIC of >= 128 mu g/mL were classified as the high-cefazolin MIC (HCM) group, whereas 13 SCCmec type IV and 8 SCCmec type V isolates were classified as the low-cefazolin MIC (LCM) group. With the checkerboard method, synergism was present for vancomycin-based combinations at 30.8-69.2 and 13.6-66.7%, as well as teicoplanin-based combinations of 38.5-84.6 and 0-47.6%, of the HCM and LCM isolates, respectively. No antagonism was noted. The in vitro inhibitory activity was evident even at a low concentration of 1/512x MIC of cephalosporin combined with sub-inhibitory concentrations (1/2x MIC) of a glycopeptide. With time-killing assays, synergism was noted at 1/2x or lx susceptible breakpoint concentrations (SBCs) of a cephalosporin combined with 1/4 or 1/2 MIC of a glycopeptide. In the presence of 1/2 SBC of a cephalosporin, vancomycin or teicoplanin MICs decreased an average of 2.0- to 6.6- or 1.6- to 5.5-fold, respectively. With 8 mu g/mL cephalosporin, the decline of glycopeptide MICs was most obvious in the presence of cefmetazole. In conclusion, cephalosporin-glycopeptide combinations at clinically achievable concentrations can exhibit in vitro synergistic antibacterial activity against clinical MRSA isolates. Such combinations require more clinical data to support their application for use in human MRSA infections.
    Appears in Collections:[保健營養系(所) ] 期刊論文

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