@article{ajidm2021934,
author={{Munny, Nazmun Nahar and Shamsuzzaman, SM and Hossain, Tamzeed},
title={In Vitro and in Vivo Evaluation of Antibiotic Combination against Multidrug Resistant <i>Enterobacter Species</i> Isolated From Patients of a Tertiary Care Hospital, Bangladesh},
journal={American Journal of Infectious Diseases and Microbiology},
volume={9},
number={3},
pages={98--105},
year={2021},
url={http://pubs.sciepub.com/ajidm/9/3/4},
issn={2328-4064},
abstract={The emergence of multidrug-resistant (MDR<i>) Enterobacter</i> as a worrying resistant pathogen is an important health concern, especially when there is scarcity of new antibiotics active against Gram-negative bacteria. However, currently no defined therapies available for MDR <i>Enterobacter </i>infections. In this study, in <i>vitro</i> and <i>in vivo</i> efficacy of different antimicrobial combinations were assessed<i>.</i> This cross-sectional study was carried out in the department of Microbiology of Dhaka medical college hospital, Bangladesh from July, 2018 to June, 2019. Multidrug resistance among isolated <i>Enterobacter species</i> were detected phenotypically by disk diffusion method. PCR and sequencing of fosfomycin resistance genes were done. In vitro activity of fosfomycin, amikacin, imipenem, piperacillin-tazobactam and their combinations were evaluated using agar dilution method and synergy was assessed by Fractional inhibitory concentration index. Mice models were made by using the MDR <i>Enterobacter</i> strain. We evaluate the efficacy of fosfomycin, amikacin, imipenem and their combination against multi-drug resistant <i>Enterobacter </i>infection in experimental mice models. Among 28 isolated <i>Enterobacter spp</i>. 53.33% were multidrug-resistant. Among the fosfomycin resistant <i>Enterobacter spp</i>. 70% , 50%, 40% were positive for <i>fosA</i>. <i>foA</i><SUB><i>5</i></SUB><i> </i>and <i>fosB</i><SUB><i>2</i></SUB><SUB><i> </i></SUB><i> </i>respectively. The fractional inhibitory concentration index indicated that combining antibiotics resulted 2 to 8 fold reduction of MIC compared to single therapy. The ratio of synergy observed in imipenem-amikacin, fosfomycin-amikacin, fosfomycin-imipenem 16.67%, 87.33%, 50.0% respectively <i>in vitro</i>. No synergy observed in imipenem-piperacillin tazobactam combination. In mice model, compared to single antibiotic therapy, fosfomycin-amikacin, imipenem-amikacin, fosfomycin-imipenem showed increased sterile blood culture (100%, 60%, 80%). Fosfomycin plus amikacin or fosfomycin plus imipenem may be alternative treatment option against multidrug-resistant <i>Enterobacter</i> infection.},
doi={10.12691/ajidm-9-3-4}
publisher={Science and Education Publishing}
}