Comparison of synergistic effects of multiple combinations of anti-pseudomonas antibiotics against Pseudomonas aeruginosa pan drug resistance in in vitro test with AZDAST Method
Main Article Content
Keywords
Pseudomonas aeruginosa, Pan Drug-Resistant, Combination antibiotic, the AZDAST method
Abstract
Background: Antimicrobial resistance is a global threat to public health. Pseudomonas aeruginosa Pan Drug-Resistant requires the latest antimicrobials. This limitation of therapy requires a breakthrough in the treatment of this infection. Combining antimicrobials with a synergistic effect is thought to increase the cure rate in clinical use. This study aimed to determine the synergistic effect of several combinations of anti-pseudomonas antibiotics against Pan Drug-Resistant Pseudomonas aeruginosa in an in vitro test using the AZDAST method.
Method: An Antibiotic combination test was carried out using the AZDAST method to assess in vitro synergistic activity. The antibiotic single disk used was Amikacin 30 µg, Ceftazidime 30 µg, Meropenem 10 µg, Ciprofloxacin 5 µg; double disk antibiotic is Amikacin 30 µg, Ceftazidime 30 µg, Meropenem 10 µg, Ciprofloxacin 5 µg and combination antibiotic disks Amikacin 30 µg-Ceftazidime 30 µg, Amikacin 30 µg-Meropenem 10 µg, Amikacin 30 µg-Ciprofloxacin 5 µg in which two antibiotic paper disks are combined stacked together, with a 24 mm gap between the other antibiotic combinations.
Result: The results showed that combining the four antibiotics had a synergistic effect. The zone of inhibition resulting from testing the combination of several antibiotics against Pan Drug Resistant Pseudomonas aeruginosa showed no statistical significance (p > 0.05) compared to all antibiotics and comparisons in the combination group of antibiotics only.
Conclusion: The combination of anti-pseudomonas antibiotics synergizes with Pan Drug-Resistant Pseudomonas aeruginosa in the AZDAST method in vitro test.
References
1. World Health Organization. 2014 (WHO). Antimicrobial Resistance: Global Report on Surveillance 2014. https://www.who.int/antimicrobial-resistance/publications/surveillancereport/en/.
2. Centers for Disease Control and Prevention (CDC). 2019. https://www.cdc.gov/. 24/7
3. Dahesihdewi A, Sugiani AK, Parwati I. 2018. Data Surveilans Mikroba Dan Kepekaannya Terhadap Antibiotik Berdasarkan Tipe Rumah Sakit Di Indonesia Tahun 2017. http://forlabinfeksi.or.id/wp-content/uploads/2018/08/Final-Buku-DATA-SURVEILANS-MIKROBA-2018-PatKLIn-20180814-1.pdf.
4. Santoso, S., Noorhamdani A.S., Sumarno, Dewi S., Nurima D.P.H., Dwi Y.N.H., Siwipeni I.R.,&..., Andrew W.T. 2021. Pola Patogen dan Kepekaan Terhadap Antibiotik (Antibiogram Kumulatif) RSUD Dr. Saiful Anwar Malang Periode 2021. Instalasi Mikrobiologi Klinik RSUD Dr. Saiful Anwar Malang.
5. Lambert, P. 2002. Mechanisms of Antibiotic Resistance in Pseudomonas aeruginosa. Journal of The Royal Society of Medicine, 95 (Suppl 41), 22.
6. Yamamoto, M., & Pop-Vicas, A. E. 2014. Treatment for Infections with Carbapenem-Resistant Enterobacteriaceae: What Options do We Still Have?. Critical Care, 18(3), 1-8.
7. Prasetyo, D. S., Herna, H., Mursinah, M., Ibrahim, F., & Bela, B. 2022. Uji In Vitro Beberapa Kombinasi Antibiotik Antipseudomonas terhadap Pseudomonas aeruginosa yang Resisten terhadap Karbapenem. Jurnal Kefarmasian Indonesia, 31-38.
8. Clinical and Laboratory Standards Institute M100-S25 (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; 25th Informational Supplement.
9. Ziaei-Darounkalaei, N., Zahraei-Salehi, T., Mohajer-Tabrizi, T., Ameri, M., & Ziaei-Darounkalaei, O., Bornaei, L. 2016. AZDAST The New Horizon in Antimicrobial Synergism Detection. MethodsX, 3, 43–52. https://doi.org/10.1016/j.mex.2016.01.002.
10. Hudzicki, J. 2009. Kirby-Bauer Disk Diffusion Susceptibility Test Protocol. American Society for Microbiology, 15, 55-63.
11. Schwalbe, R., Steele-Moore, L., & Goodwin, A. C. 2007. Antimicrobial Susceptibility Testing Protocols. Crc Press.
12. Pai M.P., Jennifer J. Kiser, Paul O. Gubbins, Keith A.R. 2018. Drug Interaction in Infectious Disease : Antimicrobial Drug Interaction. Fourth Edition. 3-26.
13. Tängdén, T. 2014. Combination Antibiotic Therapy for Multidrug-Resistant Gram-negative Bacteria. Upsala Journal of Medical Sciences, 119(2), 149-153.
14. Tang, S. Y., Zhang, S. W., Wu, J. D., Wu, F., Zhang, J., Dong, J. T., ... & Zhang, W. J. (2018). Comparison of Mono-and Combination Antibiotic Therapy For the Treatment of Pseudomonas aeruginosa Bacteraemia: A Cumulative Meta-Analysis of Cohort Studies. Experimental and Therapeutic Medicine, 15(3), 2418-2428.
15. Chávez-Jacobo, V. M., Hernández-Ramírez, K. C., Romo-Rodríguez, P., Pérez-Galardo, R. V., Campos-García, J., Gutiérrez-Corona, J. F., ... & Ramírez-Díaz, M. I. 2018. CrpP is a Novel Ciprofloxacin-Modifying Enzyme Encoded By The Pseudomonas aeruginosa pUM505 Plasmid. Antimicrobial Agents and Chemotherapy, 62(6), e02629-17.
16. Chambers HF. 2001. Antimicrobial Agents. In : Hardman JG. Goodman and Gilman’s The Pharmacological Basis of Theurapeutics. 10th ed. New York: McGraw Hills; 2001. p. 1143-70.