Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant Acinetobacter baumannii

Antimicrobial combinations are at the moment the only potential treatment option for pandrug-resistant A. baumannii. A systematic review was conducted in PubMed and Scopus for studies reporting the activity of antimicrobial combinations against A. baumannii resi...

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Autores principales:	Stamatis Karakonstantis, Petros Ioannou, George Samonis, Diamantis P. Kofteridis
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	<i>Acinetobacter</i> pandrug-resistant antimicrobial combinations synergy Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/4ecb6916b7fd4a9d9b648d1d5bdb5551
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spelling	oai:doaj.org-article:4ecb6916b7fd4a9d9b648d1d5bdb55512021-11-25T16:23:14ZSystematic Review of Antimicrobial Combination Options for Pandrug-Resistant <i>Acinetobacter baumannii</i>10.3390/antibiotics101113442079-6382https://doaj.org/article/4ecb6916b7fd4a9d9b648d1d5bdb55512021-11-01T00:00:00Zhttps://www.mdpi.com/2079-6382/10/11/1344https://doaj.org/toc/2079-6382Antimicrobial combinations are at the moment the only potential treatment option for pandrug-resistant <i>A. baumannii</i>. A systematic review was conducted in PubMed and Scopus for studies reporting the activity of antimicrobial combinations against <i>A. baumannii</i> resistant to all components of the combination. The clinical relevance of synergistic combinations was assessed based on concentrations achieving synergy and PK/PD models. Eighty-four studies were retrieved including 818 eligible isolates. A variety of combinations (<i>n</i> = 141 double, <i>n</i> = 9 triple) were tested, with a variety of methods. Polymyxin-based combinations were the most studied, either as double or triple combinations with cell-wall acting agents (including sulbactam, carbapenems, glycopeptides), rifamycins and fosfomycin. Non-polymyxin combinations were predominantly based on rifampicin, fosfomycin, sulbactam and avibactam. Several combinations were synergistic at clinically relevant concentrations, while triple combinations appeared more active than the double ones. However, no combination was consistently synergistic against all strains tested. Notably, several studies reported synergy but at concentrations unlikely to be clinically relevant, or the concentration that synergy was observed was unclear. Selecting the most appropriate combinations is likely strain-specific and should be guided by in vitro synergy evaluation. Furthermore, there is an urgent need for clinical studies on the efficacy and safety of such combinations.Stamatis KarakonstantisPetros IoannouGeorge SamonisDiamantis P. KofteridisMDPI AGarticle<i>Acinetobacter</i>pandrug-resistantantimicrobial combinationssynergyTherapeutics. PharmacologyRM1-950ENAntibiotics, Vol 10, Iss 1344, p 1344 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	<i>Acinetobacter</i> pandrug-resistant antimicrobial combinations synergy Therapeutics. Pharmacology RM1-950
spellingShingle	<i>Acinetobacter</i> pandrug-resistant antimicrobial combinations synergy Therapeutics. Pharmacology RM1-950 Stamatis Karakonstantis Petros Ioannou George Samonis Diamantis P. Kofteridis Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant <i>Acinetobacter baumannii</i>
description	Antimicrobial combinations are at the moment the only potential treatment option for pandrug-resistant <i>A. baumannii</i>. A systematic review was conducted in PubMed and Scopus for studies reporting the activity of antimicrobial combinations against <i>A. baumannii</i> resistant to all components of the combination. The clinical relevance of synergistic combinations was assessed based on concentrations achieving synergy and PK/PD models. Eighty-four studies were retrieved including 818 eligible isolates. A variety of combinations (<i>n</i> = 141 double, <i>n</i> = 9 triple) were tested, with a variety of methods. Polymyxin-based combinations were the most studied, either as double or triple combinations with cell-wall acting agents (including sulbactam, carbapenems, glycopeptides), rifamycins and fosfomycin. Non-polymyxin combinations were predominantly based on rifampicin, fosfomycin, sulbactam and avibactam. Several combinations were synergistic at clinically relevant concentrations, while triple combinations appeared more active than the double ones. However, no combination was consistently synergistic against all strains tested. Notably, several studies reported synergy but at concentrations unlikely to be clinically relevant, or the concentration that synergy was observed was unclear. Selecting the most appropriate combinations is likely strain-specific and should be guided by in vitro synergy evaluation. Furthermore, there is an urgent need for clinical studies on the efficacy and safety of such combinations.
format	article
author	Stamatis Karakonstantis Petros Ioannou George Samonis Diamantis P. Kofteridis
author_facet	Stamatis Karakonstantis Petros Ioannou George Samonis Diamantis P. Kofteridis
author_sort	Stamatis Karakonstantis
title	Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant <i>Acinetobacter baumannii</i>
title_short	Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant <i>Acinetobacter baumannii</i>
title_full	Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant <i>Acinetobacter baumannii</i>
title_fullStr	Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant <i>Acinetobacter baumannii</i>
title_full_unstemmed	Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant <i>Acinetobacter baumannii</i>
title_sort	systematic review of antimicrobial combination options for pandrug-resistant <i>acinetobacter baumannii</i>
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/4ecb6916b7fd4a9d9b648d1d5bdb5551
work_keys_str_mv	AT stamatiskarakonstantis systematicreviewofantimicrobialcombinationoptionsforpandrugresistantiacinetobacterbaumanniii AT petrosioannou systematicreviewofantimicrobialcombinationoptionsforpandrugresistantiacinetobacterbaumanniii AT georgesamonis systematicreviewofantimicrobialcombinationoptionsforpandrugresistantiacinetobacterbaumanniii AT diamantispkofteridis systematicreviewofantimicrobialcombinationoptionsforpandrugresistantiacinetobacterbaumanniii
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Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant <i>Acinetobacter baumannii</i>

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