さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

Bactericidal and synergistic activity of double-carbapenem regimen for infections caused by carbapenemase-producing Klebsiella pneumoniae.

2016年 CMI に発表された、CP-KPに対するダブルカルバペネム療法のvitro検討。

 

 

 

Abst

 

Available therapeutic options against carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are limited because of the high level of resistance to other antimicrobial classes including polymyxins.

The double-carbapenem regimen has been recently considered a possible therapeutic strategy.

In the present study, we evaluated the in vitro bactericidal and synergistic activity of a double-carbapenem regimen consisting of ertapenem plus high-dose meropenem in a series of patients with healthcare-associated CR-Kp infections in whom the use of colistin was not indicated because of potential nephrotoxicity and/or resistance.

In vitro synergy was evaluated using checkerboard and killing studies.

A total of 15 patients were included in the study, with sepsis, severe sepsis and septic shock found in two (13.3%), five (33.3%) and one (6.7%) patients, respectively.

Overall, the clinical/microbiological response was 12/15 (80%). Synergy was observed in 11/14 (78.6%) isolates using the checkerboard method whereas in killing studies 12/14 (85.7%) and 14/14 (100%) strains were synergistic and bactericidal at 24 h at concentrations of 1 × MIC MEM+1 × MIC ERT and 2 × MEM+1 × MIC ERT, respectively, with a significant decrease of log CFU/mL compared with other combinations (p <0.0001).

The double-carbapenem regimen showed clinical and in vitro effectiveness in patients with CR-Kp infections.

 

Fig and Tab

 

f:id:akinohanayuki:20170712054836p:plain

 

f:id:akinohanayuki:20170712054850p:plain

f:id:akinohanayuki:20170712054901p:plain

 

 感想

 

 ertapenem plus a high dose of meropenemのvitroを示した論文。

 

効果を示す機序として、著者は以下のように述べています。

It could be speculated that, as carbapenemases have higher affinity for ertapenem than for meropenem, these enzymes are consumed by the interaction with ertapenem, so leading meropenem to exert its bactericidal activity。

 

先日書いた記事において、ダブルカルバの有用性が期待できうることを紹介したが、

 


 ダブルカルバは、コリスチンが使用できない患者に対するオプションの1つで有ることを強調しなければならない。