Dual β-lactam combination therapy for multi-drug resistant Pseudomonas aeruginosa infection : enhanced efficacy in vivo and comparison with monotherapies of penicillin-binding protein inhibition
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The aim of the study was to determine the efficacy of dual β-lactam combination treatments derived from eight approved drugs against Galleria mellonella larvae infected with MDR strains of P. aeruginosa. Carbapenem-resistant P. aeruginosa NCTC 13437 and an unrelated clinical isolate were used to infect G. mellonella larvae and the efficacy of twenty-eight dual β-lactam combination therapies were compared to their constituent monotherapies. For the most potent combinations identified, penicillin-binding protein (PBP) inhibition profiles were measured and compared with each constituent antibiotic. Five of the dual β-lactam combinations resulted in greater than 70% survival of infected G. mellonella. Two combinations showed potent, enhanced efficacy versus both strains − ceftazidime + meropenem and aztreonam + meropenem. Comparison of PBP inhibition profiles revealed that the enhanced efficacy of these two dual β-lactam combinations could not be explained by more potent inhibition of PBPs or inhibition of a broader range of PBPs. A possible contribution to the enhanced efficacy of the combinations could be stimulation of innate immunity via increased haemocyte numbers compared to their constituent monotherapies. Combinations of β-lactam antibiotics show promise in overcoming MDR P. aeruginosa and are worthy of additional study and development.
Siriyong , T , Murray , R M , Bidgood , L E , Young , S A , Wright , F , Parcell , B J , Voravuthikunchai , S P & Coote , P J 2019 , ' Dual β-lactam combination therapy for multi-drug resistant Pseudomonas aeruginosa infection : enhanced efficacy in vivo and comparison with monotherapies of penicillin-binding protein inhibition ' Scientific Reports , vol. 9 , 9098 . https://doi.org/10.1038/s41598-019-45550-z
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DescriptionS.V. and T.S. were supported by Thailand Research Fund Senior Research Scholar (Grant Number RTA6180006). R.M. and P.C. were funded by University of St Andrews.
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