title: In vitro activities of nontraditional antimicrobials against multiresistant Acinetobacter baumannii strains isolated in an intensive care unit outbreak.
abstract: Fifteen multiresistant Acinetobacter baumannii isolates from patients in intensive care units and 14 nonoutbreak strains were tested to determine in vitro activities of nontraditional antimicrobials, including cefepime, meropenem, netilmicin, azithromycin, doxycycline, rifampin, sulbactam, and trovafloxacin. The latter five drugs were further tested against four of the strains for bactericidal or bacteriostatic activity by performing kill-curve studies at 0.5, 1, 2, and 4 times their MICs. In addition, novel combinations of drugs with sulbactam were examined for synergistic interactions by using a checkerboard configuration. MICs at which 90% of the isolates tested were inhibited for antimicrobials showing activity against the multiresistant A. baumannii strains were as follows (in parentheses): doxycycline (1 microg/ml), azithromycin (4 microg/ml), netilmicin (1 microg/ml), rifampin (8 microg/ml), polymyxin (0.8 U/ml), meropenem (4 microg/ml), trovafloxacin (4 microg/ml), and sulbactam (8 microg/ml). In the kill-curve studies, azithromycin and rifampin were rapidly bactericidal while sulbactam was more slowly bactericidal. Trovafloxacin and doxycycline were bacteriostatic. None of the antimicrobials tested were bactericidal against all strains tested. The synergy studies demonstrated that the combinations of sulbactam with azithromycin, rifampin, doxycycline, or trovafloxacin were generally additive or indifferent.
authors.affiliation: Departments of Pathology, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA 90033, USA. mapplema@hsc.usc.edu
authors.forename: M D
authors.initials: MD
authors.lastname: Appleman
authors.forename: H
authors.initials: H
authors.lastname: Belzberg
authors.forename: D M
authors.initials: DM
authors.lastname: Citron
authors.forename: P N
authors.initials: PN
authors.lastname: Heseltine
authors.forename: A E
authors.initials: AE
authors.lastname: Yellin
authors.forename: J
authors.initials: J
authors.lastname: Murray
authors.forename: T V
authors.initials: TV
authors.lastname: Berne
mesh_terms: D000150:Acinetobacter / Q000187:drug effects*; D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002056:Burns / Q000150:complications; D003428:Cross Infection / Q000382:microbiology*; D018432:Drug Resistance, Multiple; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006801:Humans; D007362:Intensive Care Units; D007700:Kinetics; D008826:Microbial Sensitivity Tests
chemical_list: D000900:Anti-Bacterial Agents