Abstract
Background
Methicillin-resistant Staphylococcus aureus (MRSA) and some gram-negative bacilli are very prevalent nosocomial pathogens, commonly causing mixed infections, and are often resistant to multiple drugs. Arbekacin is an aminoglycoside used for the treatment of MRSA infections, but is also active against some gram-negative bacilli. The aim of this study was to determine in vitro activity of arbekacin against recent clinical isolates of staphylococci and gram-negative bacilli.
Materials and Methods
The strains were isolated from clinical specimens of patients at Severance Hospital in 2003. Antimicrobial susceptibility was tested by the Clinical and Laboratory Standards Institute agar dilution method. The following arbekacin breakpoints were used: susceptible, ≤4 μg/mL; and resistant, ≥16 μg/mL.
Results
All isolates of staphylococci tested were inhibited by ≤4 μg/mL of arbekacin, regardless of their methicillin susceptibility. The MIC90s of arbekacin, 1–4 μg/mL, were 8->32-fold and >32–128-fold lower than those of amikacin and gentamicin, respectively. The resistance rates of MRSA, methicillin-susceptible S. aureus, methicillin-resistant coagulase-negative staphylococci (CNS) and methicillin-susceptible CNS were 0% to arbekacin, 0–54% to amikacin, and 24–79% to gentamicin. The MIC90s of arbekacin for Escherichia coli and Citrobacter freundii, 1 μg/mL and 16 μg/mL, were 2–4-fold and 8–16-fold lower than those of amikacin and gentamicin, respectively. However, The MIC90s of arbekacin for other species of gram-negative bacilli, 64->128 μg/mL, were similar to those of other aminoglycosides.
Conclusions
Arbekacin may be a useful alternative to glycopeptides for the treatment of monomicrobial methicillin-resistant staphylococcal infections, as well as mixed infections with gram-negative bacilli, as most isolates of E. coli, C. freundii and some other gram-negative bacilli were also susceptible to arbekacin.
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Table 1.
Activities of antimicrobial agents against Staphylococcus species
Organism (N tested) | Antimicrobial agent* |
MIC (μg/mL) |
Susceptibility (%) |
||||
---|---|---|---|---|---|---|---|
Range | 50% | 90% | S | I | R | ||
Methicillin-resistant | Oxacillin | 32->128 | >128 | >128 | 0 | −† | 100 |
S. aureus | Vancomycin | 0.5–2 | 1 | 1 | 100 | 0 | 0 |
(52) | Amikacin | 4->128 | 64 | >128 | 39 | 8 | 54 |
Gentamicin | 0.25->128 | 64 | >128 | 21 | 0 | 79 | |
Arbekacin | 0.5–4 | 1 | 4 | 100 | 0 | 0 | |
Methicillin-susceptible | Oxacillin | 0.06–1 | 0.5 | 0.5 | 100 | − | 0 |
S. aureus | Vancomycin | 0.5–1 | 0.5 | 1 | 100 | 0 | 0 |
(33) | Amikacin | 0.5–32 | 2 | 8 | 97 | 3 | 0 |
Gentamicin | 0.06->128 | 0.5 | 128 | 73 | 3 | 24 | |
Arbekacin | 0.06–2 | 0.5 | 1 | 100 | 0 | 0 | |
Methicillin-resistant CNS | Oxacillin | 0.5->128 | 4 | 64 | 0 | − | 100 |
(26) | Vancomycin | 0.25–2 | 1 | 2 | 100 | 0 | 0 |
Amikacin | 0.12–64 | 2 | 32 | 81 | 12 | 8 | |
Gentamicin | 0.06–128 | 16 | 64 | 27 | 15 | 58 | |
Arbekacin | 0.06–2 | 0.25 | 1 | 100 | 0 | 0 | |
Methicillin-susceptible CNS | Oxacillin | 0.06–0.25 | 0.12 | 0.25 | 100 | − | 0 |
(29) | Vancomycin | 0.5–2 | 1 | 2 | 100 | 0 | 0 |
Amikacin | 0.5–16 | 1 | 8 | 100 | 0 | 0 | |
Gentamicin | 0.06–128 | 0.12 | 128 | 69 | 7 | 24 | |
Arbekacin | 0.06–2 | 0.12 | 1 | 100 | 0 | 0 |
Table 2.
Activities of antimicrobial agents against gram-negative bacilli
Organism (N tested) | Antimicrobial agent* |
MIC (μg/mL) |
Susceptibility (%) |
||||
---|---|---|---|---|---|---|---|
Range | 50% | 90% | S | I | R | ||
E. coli | Cefotaxime | ≤0.03–128 | 0.06 | 0.25 | 93 | 0 | 7 |
(30) | Gentamicin | ≤0.12–64 | 0.5 | 16 | 87 | 0 | 13 |
Amikacin | 0.5–32 | 2 | 4 | 97 | 3 | 0 | |
Arbekacin | 0.25–16 | 1 | 1 | 93 | 0 | 7 | |
Ciprofloxacin | ≤0.03–64 | ≤0.03 | 32 | 73 | 0 | 27 | |
K. pneumoniae | Cefotaxime | ≤0.03->128 | 0.5 | 128 | 57 | 27 | 17 |
(30) | Gentamicin | 0.5->128 | 1 | >128 | 63 | 0 | 37 |
Amikacin | 1->128 | 4 | >128 | 53 | 13 | 33 | |
Arbekacin | 0.5->128 | 2 | >128 | 50 | 3 | 47 | |
Ciprofloxacin | ≤0.03–128 | 0.06 | 32 | 53 | 0 | 47 | |
C. freundii | Cefotaxime | ≤0.03->128 | 0.25 | 64 | 73 | 0 | 27 |
(15) | Gentamicin | 0.5->128 | 1 | 128 | 80 | 7 | 13 |
Amikacin | 1->128 | 2 | 32 | 87 | 7 | 7 | |
Arbekacin | 0.5->128 | 1 | 16 | 80 | 0 | 20 | |
Ciprofloxacin | ≤0.03–8 | 0.12 | 4 | 80 | 7 | 13 | |
E. cloacae | Cefotaxime | ≤0.03->128 | 0.25 | 128 | 60 | 7 | 33 |
(15) | Gentamicin | 0.25->128 | 0.5 | >128 | 67 | 0 | 33 |
Amikacin | 1->128 | 2 | >128 | 80 | 7 | 13 | |
Arbekacin | 0.5->128 | 1 | >128 | 67 | 7 | 27 | |
Ciprofloxacin | ≤0.03–4 | 0.5 | 4 | 73 | 0 | 27 | |
S. marcescens | Cefotaxime | 0.12->128 | 0.5 | >128 | 57 | 0 | 43 |
(14) | Gentamicin | 0.5->128 | 1 | >128 | 64 | 0 | 36 |
Amikacin | 2->128 | 4 | >128 | 64 | 0 | 36 | |
Arbekacin | 1->128 | 4 | >128 | 57 | 0 | 43 | |
Ciprofloxacin | 0.06–32 | 0.12 | 32 | 64 | 7 | 29 | |
A. baumannii | Cefotaxime | 4->128 | 16 | >128 | 40 | 20 | 40 |
(15) | Gentamicin | 0.5->128 | 2 | >128 | 60 | 0 | 40 |
Amikacin | 0.5->128 | 8 | >128 | 73 | 7 | 20 | |
Arbekacin | 0.5->128 | 1 | >128 | 60 | 13 | 27 | |
Ciprofloxacin | 0.06->128 | 0.25 | 128 | 53 | 7 | 40 | |
P. aeruginosa | Cefotaxime | 8->128 | 32 | >128 | 3 | 62 | 35 |
(29) | Gentamicin | 0.5->128 | 2 | >128 | 59 | 3 | 38 |
Amikacin | 1->128 | 8 | >128 | 72 | 14 | 14 | |
Arbekacin | 0.5–64 | 2 | 64 | 59 | 10 | 31 | |
Ciprofloxacin | 0.06->128 | 0.25 | 32 | 69 | 0 | 31 |