Title
Optimizing aminoglycoside selection for KPC-producing Klebsiella pneumoniae with the aminoglycoside-modifying enzyme (AME) gene aac(6')-Ib
Date Issued
01 March 2021
Access level
open access
Resource Type
journal article
Author(s)
Butler D.A.
Rana A.P.
Patel S.R.
Huang Y.
Ozer E.A.
Hauser A.R.
Bulman Z.P.
Publisher(s)
Oxford University Press
Abstract
Objectives: KPC-producing Klebsiella pneumoniae (KPC-Kp) isolates commonly co-harbour the aminoglycoside-modifying enzyme (AME) gene aac(6')-Ib, which encodes an AME that can confer resistance to some of the commercially available aminoglycosides. We sought to determine the influence of AAC(6')-Ib in KPC-Kp on the pharmacodynamic activity of aminoglycosides. Methods: Six KPC-Kp clinical isolates, three with and three without aac(6')-Ib, were analysed. Using these isolates, the bacterial killing of amikacin, gentamicin and tobramycin was assessed in static time-kill experiments. The pharmacodynamic activity of the aminoglycosides was then assessed in a dynamic one-compartment infection model over 72 h using simulated human pharmacokinetics of once-daily dosing with amikacin (15 mg/kg), gentamicin (5 mg/kg) and tobramycin (5 mg/kg). Results: At clinically relevant aminoglycoside concentrations in time-kill experiments and the dynamic one-compartment model, gentamicin was more active than amikacin or tobramycin against the isolates harbouring aac(6')-Ib. Amikacin, gentamicin and tobramycin all showed progressively reduced bacterial killing with exposure to repeated doses against most isolates in the dynamic one-compartment model. MIC values were generally not a good predictor of gentamicin pharmacodynamic activity against KPC-Kp, but were more reliable for amikacin and tobramycin. Conclusions: Gentamicin may be preferred over amikacin or tobramycin for treatment of KPC-Kp infections. However, gentamicin MICs are not a consistent predictor of its pharmacodynamic activity and unexpected treatment failures are possible.
Start page
671
End page
679
Volume
76
Issue
3
Language
English
OCDE Knowledge area
Farmacología, Farmacia
Scopus EID
2-s2.0-85102098641
PubMed ID
Source
Journal of Antimicrobial Chemotherapy
ISSN of the container
0305-7453
Sponsor(s)
The project was funded by the Chicago Biomedical Consortium with support from the Searle Funds at The Chicago Community Trust (to Z.P.B. and A.R.H.). This project has been funded in part by the National Institutes of Health under Grants R01AI118257, U19AI135964, K24AI04831 and R21AI129167 (all to A.R.H.). Z.P.B. was supported in part by the National Center for Advancing Translational Sciences, National Institutes of Health, under Grant KL2TR002002.
Sources of information: Directorio de Producción Científica Scopus