{
    "abstract": "Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are one of the most common causes of nosocomial infections and have high mortality rates due to difficulties in treatment. In this study, the in vitro synergistic interactions of the colistin (CT)-meropenem (MEM) combination and patient clinical outcomes were compared in CRAB-infected patients that receive CT-MEM antimicrobial combination therapy. In addition, in vitro synergistic interactions of MEM-ertapenem (ETP), MEM-fosfomycin (FF) and CT-FF antimicrobial combinations were investigated. Finally, the epsilometer (E) test and checkerboard test results were compared and the compatibility of these two tests was evaluated.\nTwenty-one patients were included in the study. Bacterial identification was performed with MALDI-TOF, and antimicrobial susceptibility was assessed with an automated system. Synergy studies were performed using the E test and checkerboard method.\nFor the checkerboard method, the synergy rates for CT-MEM, MEM-FF, MEM-ETP and CT-FF were 100%, 52.3%, 23.8% and 28.5%, respectively. In the E test synergy tests, synergistic effects were detected for two isolates each in the CT-MEM and CT-FF combinations. Microbial eradication was achieved in nine (52.9%) of the 17 patients that received CT-MEM combination therapy. The agreement between the E test and the checkerboard test was 6.5%.\nA synergistic effect was found with the checkerboard method for the CT-MEM combination in all isolates in our study, and approximately 70% of the patients benefited from treatment with this combination. In addition, more than half of the isolates showed a synergistic effect for the MEM-FF combination. Combinations of CT-MEM and MEM-FF may be options for the treatment of CRAB infections. However, a comprehensive understanding of the potential of the microorganism to develop resistant mutants under applied exposures, as well as factors that directly affect antimicrobial activity, such as pharmacokinetics/pharmacodynamics, is essential for providing treatment advice. We found a low rate of agreement between the E test method and the checkerboard test method in our study, in contrast to the literature. Comprehensive studies that compare clinical results with methods are needed to determine the ideal synergy test and interpretation method.",
    "authors": [
        {
            "affiliation": "Faculty of Medicine, Department of Medical Microbiology, \u0130zmir Katip \u00c7elebi University, \u0130zmir, T\u00fcrkiye. tubamuderris@yahoo.com.",
            "firstname": "Tuba",
            "initials": "T",
            "lastname": "M\u00fcderris"
        },
        {
            "affiliation": "Cizre Dr. Selahattin Cizrelio\u011flu Public Hospital, Department of Medical Microbiology, \u015e\u0131rnak, T\u00fcrkiye.",
            "firstname": "G\u00fclden",
            "initials": "G",
            "lastname": "Dursun Manyasl\u0131"
        },
        {
            "affiliation": "Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, \u0130zmir Demokrasi University, \u0130zmir, T\u00fcrkiye.",
            "firstname": "Nurbanu",
            "initials": "N",
            "lastname": "Sezak"
        },
        {
            "affiliation": "Faculty of Medicine, Department of Medical Microbiology, \u0130zmir Katip \u00c7elebi University, \u0130zmir, T\u00fcrkiye.",
            "firstname": "Sel\u00e7uk",
            "initials": "S",
            "lastname": "Kaya"
        },
        {
            "affiliation": "Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, \u0130zmir Katip \u00c7elebi University, \u0130zmir, T\u00fcrkiye.",
            "firstname": "Tuna",
            "initials": "T",
            "lastname": "Demirdal"
        },
        {
            "affiliation": "Faculty of Medicine, Department of Medical Microbiology, \u0130zmir Katip \u00c7elebi University, \u0130zmir, T\u00fcrkiye.",
            "firstname": "S\u00fcreyya",
            "initials": "S",
            "lastname": "G\u00fcl Yurtsever"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024. The Author(s).",
    "doi": "10.1186/s40001-024-01885-6\n10.1093/cid/ciad094\n10.1016/S1473-3099(20)30796-9\n10.1016/S1473-3099(18)30099-9\n10.1093/cid/ciab1013\n10.1016/j.cmi.2021.11.025\n10.1016/j.jgar.2022.08.002\n10.1128/aac.00781-22\n10.1128/mbio.02759-21\n10.1128/AAC.01968-17\n10.1128/AAC.01154-19\n10.1002/phar.2209\n10.1128/AAC.01779-13\n10.1016/j.cmi.2020.03.035\n10.1093/jac/dkw377\n10.1016/j.ajic.2008.03.002\n10.2147/IDR.S148185\n10.1128/AAC.03035-14\n10.1038/s41598-019-53714-0\n10.1093/jac/dkac142\n10.3390/antibiotics9100647\n10.3390/antibiotics10070880\n10.2147/IDR.S172137\n10.3906/sag-1408-14\n10.1016/j.diagmicrobio.2016.07.017\n10.5578/mb.61903\n10.1128/AAC.00839-16\n10.1016/j.ijantimicag.2015.02.005\n10.1179/1973947815Y.0000000062\n10.3389/fcimb.2017.00209\n10.1056/evidoa2200131\n10.1016/j.idc.2009.01.004\n10.1093/cid/civ048\n10.1016/j.ijantimicag.2015.04.002\n10.1097/MCC.0000000000000534\n10.1007/s00134-015-4079-4\n10.1016/j.jsps.2022.03.007\n10.1371/journal.pone.0157757\n10.5578/mb.20239930\n10.1111/bcp.14456\n10.1016/S0732-8893(00)00163-2",
    "journal": "European journal of medical research",
    "keywords": [
        "Carbapenem resistance Acinetobacter baumannii",
        "Checkerboard assays",
        "Combined antibiotic therapy",
        "Epsilometer test synergy assays",
        "In vitro antimicrobial interactions"
    ],
    "methods": null,
    "publication_date": "2024-06-17",
    "pubmed_id": "38880888\n37125467\n33058795\n29456043\n34864936\n34923128\n35948242\n36005804\n35311529\n29158270\n31427295\n30710469\n24247139\n32251844\n27624572\n18538699\n29200878\n25049251\n31748527\n35512342\n32998187\n34356801\n30122965\n27513270\n27475960\n29933736\n27600048\n25795317\n22951653\n26319682\n28596943\n37538951\n19393909\n25632010\n26070662\n30156569\n26438224\n35812137\n27315107\n37462301\n32638408\n11025183",
    "results": "For the checkerboard method, the synergy rates for CT-MEM, MEM-FF, MEM-ETP and CT-FF were 100%, 52.3%, 23.8% and 28.5%, respectively. In the E test synergy tests, synergistic effects were detected for two isolates each in the CT-MEM and CT-FF combinations. Microbial eradication was achieved in nine (52.9%) of the 17 patients that received CT-MEM combination therapy. The agreement between the E test and the checkerboard test was 6.5%.",
    "title": "In-vitro evaluation of different antimicrobial combinations with and without colistin against carbapenem-resistant Acinetobacter baumannii clinical isolates.",
    "xml": "<Element 'PubmedArticle' at 0x78850300eb10>"
}