title: Cefepime and amikacin synergy against a cefotaxime-susceptible strain of Enterobacter cloacae in vitro and in vivo.
abstract: We developed an experimental model of pneumonia to evaluate the efficacy of new antibiotic regimens against Enterobacter cloacae. Rats were infected by administering 8.5 log10 cfu E. cloacae intratracheally, and therapy was initiated 24 h later. At that time, animals' lungs showed bilateral pneumonia containing more than 7 log10 cfu/g of tissue. Because rats eliminate amikacin and cefepime much more rapidly than humans, renal impairment was induced in all animals to simulate the pharmacokinetic parameters in humans. Using this model, we compared the bactericidal activities of cefepime and amikacin alone or in combination against the same cefotaxime-susceptible E. cloacae strain. The MICs of cefepime and amikacin for this strain were 0.5 and 2 mg/L, respectively. In-vitro killing studies showed that antibiotic combinations were synergic only at intermediate concentrations. At peak concentrations, the combination was only as effective as amikacin alone. At trough concentrations, a non-significant trend towards the superiority of the combination over cefepime alone was found. In-vivo studies showed that each antibiotic alone failed to decrease bacterial counts in the lungs except at 6 h, whereas the combination of both antibiotics induced a significant decrease in the lung bacterial count 6, 12 and 24 h after the onset of therapy when compared with tissue bacterial numbers in untreated animals or animals treated with either antibiotic alone. In-vivo synergy between cefepime and amikacin was observed at the three time points studied. No resistant clones emerged during treatment with any of the antibiotic regimens studied.
authors.affiliation: Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Bicêtre, Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: O
authors.initials: O
authors.lastname: Mimoz
authors.forename: A
authors.initials: A
authors.lastname: Jacolot
authors.forename: C
authors.initials: C
authors.lastname: Padoin
authors.forename: J
authors.initials: J
authors.lastname: Caillon
authors.forename: K
authors.initials: K
authors.lastname: Louchahi
authors.forename: M
authors.initials: M
authors.lastname: Tod
authors.forename: K
authors.initials: K
authors.lastname: Samii
authors.forename: O
authors.initials: O
authors.lastname: Petitjean
mesh_terms: D000583:Amikacin / Q000097:blood / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D000077723:Cefepime; D002439:Cefotaxime / Q000494:pharmacology; D002511:Cephalosporins / Q000097:blood / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004357:Drug Synergism; D016972:Enterobacter cloacae / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008826:Microbial Sensitivity Tests; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D051381:Rats; D017208:Rats, Wistar
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime; D000583:Amikacin; D002439:Cefotaxime