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Gómez-Junyent, Joan; Murillo, Oscar; Yu, Heidi H.; Azad, Mohammad A.K.; Wickremasinghe, Hasini; Rigo-Bonnin, Raul; Benavent, Eva; Ariza, Javier; Li, Jian
International journal of antimicrobial agents, February 2021, 2021-Feb, 2021-02-00, Volume: 57, Issue: 2Journal Article
•Ceftazidime monotherapy and ceftazidime in combination with colistin were tested in a Pseudomonas aeruginosa biofilm model•Continuous infusion (CI; T>MIC=100%) ceftazidime demonstrated concentration-dependent killing•Colistin plus 40 mg/L CI ceftazidime had the greatest activity among combinations•Combination therapies avoided the emergence of resistance to colistin/ceftazidime compared with monotherapies•These results support the use of high-dosage CI ceftazidime with colistin against Pseudomonas aeruginosa biofilms Objectives: The pharmacokinetics/pharmacodynamics of continuous infusion (CI) beta-lactams for Pseudomonas aeruginosa biofilm infections has not been defined. This study evaluated the efficacy of several dosage regimens of CI ceftazidime, with or without colistin, an antibiotic with a potential antibiofilm effect, against biofilm-embedded P. aeruginosa. Methods: Mature biofilms of the reference strain PAO1 and the clinical isolate HUB8 (both ceftazidime- and colistin-susceptible) were investigated over 54h using a dynamic CDC biofilm reactor. CI dosage regimens were ceftazidime monotherapy (4, 10, 20 and 40 mg/L), colistin monotherapy (3.50 mg/L), and combinations of colistin and ceftazidime (4 or 40 mg/L). Efficacy was evaluated by changes in log10colony-forming units (cfu)/mL and confocal microscopy. Results: At 54 h, the antibiofilm activity of ceftazidime monotherapies was slightly higher for ceftazidime 20 mg/L (-2.84 log10cfu/mL) and 40 mg/L (-3.05) against PAO1, but no differences were seen against HUB8. Ceftazidime-resistant colonies emerged with 4 mg/L regimens in both strains and with other regimens in PAO1. Colistin monotherapy had significant antibiofilm activity against HUB8 (-3.07), but lower activity against PAO1 (-1.12), and colistin-resistant strains emerged. Combinations of ceftazidime and colistin had higher antibiofilm activity at 54 h compared with each monotherapy, and prevented the emergence of resistance to both antibiotics; higher antibiofilm activity was observed with ceftazidime 40 mg/L plus colistin compared with ceftazidime 4 mg/L plus colistin (-4.19 vs. -3.10 PAO1; -4.71 vs. -3.44 HUB8). Conclusions: This study demonstrated that, with %T>MIC=100%, CI ceftazidime displayed concentration-dependent antibiofilm activity against P. aeruginosa biofilm, particularly in combination with colistin. These results support the use of high-dosage regimens of CI ceftazidime with colistin against biofilm-associated infections with ceftazidime-susceptible P. aeruginosa.
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