Novel partners with colistin to increase its in vivo therapeutic effectiveness and prevent the occurrence of colistin resistance in NDM- and MCR-co-producing Escherichia coli in a murine infection model

Yang Yu, Timothy R Walsh, Run-Shi Yang, Mei Zheng, Meng-Chao Wei, Jonathan M Tyrrell, Yang Wang, Xiao-Ping Liao, Jian Sun, Ya-Hong Liu

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objectives: The emergence of NDM- and MCR-1-co-producing Escherichia coli has compromised the use of carbapenems and colistin, which are critically important in clinical therapy, and represents a severe threat to public health worldwide. Here, we demonstrate synergism of colistin combined with existing antibiotics as a potential strategy to overcome XDR E. coli co-harbouring NDM and MCR-1 genes.

Methods: To comprehensively evaluate their combined activity, antibiotic combinations were tested against 34 different E. coli strains carrying both NDM and MCR-1 genes. Antibiotic resistance profiles and molecular characteristics were investigated by susceptibility testing, PCR, MLST, S1-PFGE and WGS. Antibiotic synergistic efficacy was evaluated through in vitro chequerboard experiments and dose-response assays. A mouse model was used to confirm active combination therapies. Additionally, combinations were tested for their ability to prevent high-level colistin-resistant mutants (HLCRMs).

Results: Combinations of colistin with rifampicin, rifabutin and minocycline showed synergistic activity against 34 XDR NDM- and MCR-1-co-producing E. coli strains, restoring, in part, susceptibility to both colistin and the partnering antibiotics. The therapeutic effectiveness of colistin combined with rifampicin or minocycline was demonstrated in a mouse model. Furthermore, colistin plus rifampicin showed significant activity in preventing the occurrence of HLCRMs.

Conclusions: The synergism of colistin in combinations with rifampicin, rifabutin or minocycline offers viable therapeutic alternatives against XDR NDM- and MCR-positive E. coli.

Original languageEnglish
Pages (from-to)87-95
Number of pages9
JournalThe Journal of antimicrobial chemotherapy
Volume74
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • Animals
  • Anti-Bacterial Agents/administration & dosage
  • Colistin/administration & dosage
  • Disease Models, Animal
  • Drug Resistance, Bacterial
  • Drug Synergism
  • Drug Therapy, Combination/methods
  • Escherichia coli/drug effects
  • Escherichia coli Infections/drug therapy
  • Escherichia coli Proteins/metabolism
  • Female
  • Genotyping Techniques
  • Mice, Inbred ICR
  • Microbial Sensitivity Tests
  • Treatment Outcome
  • beta-Lactamases/metabolism

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