Cephalosporin-Glycopeptide Combinations for Use against Clinical Methicillin-Resistant Staphylococcus aureus Isolates: Enhanced In vitro Antibacterial Activity

doi:10.3389/fmicb.2017.00884

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Title:	Cephalosporin-Glycopeptide Combinations for Use against Clinical Methicillin-Resistant Staphylococcus aureus Isolates: Enhanced In vitro Antibacterial Activity
Authors:	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
Contributors:	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
Keywords:	glycopeptides cefazolin cefmetazole cefotaxime cefepime combination therapy synergism MRSA
Date:	2017-05-18
Issue Date:	2018-11-30 15:51:34 (UTC+8)
Publisher:	Frontiers Media Sa
Abstract:	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.
Relation:	Frontiers In Microbiology, v.8, pp.884
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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