title: In vitro activity of fosfomycin in combination with imipenem, meropenem, colistin and tigecycline against OXA 48-positive Klebsiella pneumoniae strains.
abstract: Carbapenem resistance due to OXA-48 enzymes in Klebsiella pneumoniae is increasing particularly in the Middle Eastern and European regions. Treatment options are limited. The aim of this study was to evaluate the in vitro synergistic activity of fosfomycin in combination with imipenem, meropenem, colistin and tigecycline against OXA-48 producing K. pneumoniae strains. Twelve carbapenem-resistant OXA-48 producing K. pneumoniae isolates were enrolled in this study. Synergistic activity of fosfomycin combined with imipenem, meropenem, colistin, and tigecycline was assessed by chequerboard method. The combination of fosfomycin was synergistic with imipenem, meropenem and tigecycline with the ratios of 42%, 33%, and 33%, respectively. Whilst the combination of fosfomycin with colistin was fully antagonistic against all of the strains, there was no statistically significant difference between the in vitro synergistic activities of fosfomycin in combination with imipenem, meropenem and tigecycline combinations (P > 0.05). Fosfomycin in combination with other agents can be preferred against multidrug resistant K. pneumoniae strains.
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, Baskent University, Ankara, Turkey. ebrubos@baskent.edu.tr
authors.forename: Ebru
authors.initials: E
authors.lastname: Evren
authors.forename: Ozlem Kurt
authors.initials: OK
authors.lastname: Azap
authors.forename: Şule
authors.initials: Ş
authors.lastname: Çolakoğlu
authors.forename: Hande
authors.initials: H
authors.lastname: Arslan
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003091:Colistin / Q000494:pharmacology; D052978:Disk Diffusion Antimicrobial Tests; D004357:Drug Synergism; D005578:Fosfomycin / Q000494:pharmacology; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007710:Klebsiella Infections / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D000077731:Meropenem; D008911:Minocycline / Q000031:analogs & derivatives / Q000494:pharmacology; D058889:Molecular Typing; D060888:Real-Time Polymerase Chain Reaction; D013845:Thienamycins / Q000494:pharmacology; D000078304:Tigecycline; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D005578:Fosfomycin; D000078304:Tigecycline; D015378:Imipenem; D001618:beta-Lactamases; C108449:oxacillinase; D000077731:Meropenem; D008911:Minocycline; D003091:Colistin