In Vitro Efficacy of Imipenem/Relebactam Against Imipenem Resistant Gram-Negative Strains Isolated from a Tertiary Care Hospital

Authors

  • Saima Ishtiaq Department of Microbiology, Foundation University School of Health, Islamabad Pakistan
  • Sonia Tahir Department of Microbiology, Lahore Medical & Dental College, Lahore Pakistan
  • Muhammad Waqas Abbas Department of Microbiology, Fauji Foundation Hospital, Rawalpindi Pakistan
  • Haider Ali Department of Microbiology, Foundation University School of Health, Islamabad Pakistan
  • Saima Syed Department of Microbiology, Foundation University School of Health, Islamabad Pakistan
  • Fatima Kareem Department of Microbiology, Foundation University School of Health, Islamabad Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i1.9901

Keywords:

Carbapenems, Imipenem, Anti-bacterial agents, Drug resistance, Bacterial drug resistance, Multiple drug resistance

Abstract

Objective: To determine in vitro efficacy of Imipenem/Relebactam against multi-drug resistant strains.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Microbiology, Fauji Foundation Hospital (FFH) Rawalpindi, Pakistan from Jul to Dec 2022.

Methodology: All specimens from indoor and outdoor patients with infection due to Gram-negative organisms showing
resistance to Imipenem disc (10μg) were included. Cultures were inoculated on Blood and MacConkey’s agar. Imipenemresistant Gram-negative species identification was made by Gram stain, Oxidase test and commercially available identification strips Analytical profile index 10S (API-10S) (from bioMerieux, Inc.).Imipenem-resistant species were identified, showing a zone diameter of less than 23mm against10µg Imipenem disc for Enterobacterale and Non-Enterobacterales, and for Pseudomonas species, zone size is ≤19mm. These resistant organisms were tested for sensitivity against
Imipenem/Relebactam by E-strip (MTSTM –MIC Test Strip) (Liofilchem, Inc., Waltham, MA).

Results: Out of 160 Carbapenem-resistant Enterobacterale and Non-Enterobacterales specimens, only 14 isolates (including 02 Pseudomonas spp.) showed susceptibility to Imipenem/Relebactam combination of drug. US-FDA Imipenem/Relebactam
susceptibility interpretive criteria (STIC) was used.

Conclusion: In our setup, only 8.75% isolates showed sensitivity to this newer drug combination Imipenem/Relebactum. This highlights the importance of evaluating newer drugs in our population before using them empirically.

Downloads

Download data is not yet available.

References

Vivas R, Barbosa AAT, Dolabela SS, Jain S. Multidrug-Resistant

Bacteria and Alternative Methods to Control Them: An

Overview. Microb Drug Resist 2019; 25(6): 890-908.

https://doi.org/10.1089/mdr.2018.0319.

Lozano C, Torres C. Actualización en la resistencia antibiótica en

Gram positivos [Update on antibiotic resistance in Gram-positive

bacteria]. Enferm Infecc Microbiol Clin 2017; 35 Suppl 1:2-8.

https://doi.org/10.1016/S0213-005X(17)30028-9.

Titov I, Wunderink RG, Roquilly A, Rodríguez Gonzalez D,

David-Wang A, Boucher HW, et al. A Randomized, Doubleblind, Multicenter Trial Comparing Efficacy and Safety of

Imipenem/Cilastatin/Relebactam Versus

Piperacillin/Tazobactam in Adults With Hospital-acquired or

Ventilator-associated Bacterial Pneumonia (RESTORE-IMI 2

Study). Clin Infect Dis 2021; 73(11): e4539-e4548.

https://doi.org/10.1093/cid/ciaa803.

Campanella TA, Gallagher JC. A Clinical Review and Critical

Evaluation of Imipenem-Relebactam: Evidence to Date. Infect

Drug Resist 2020; 13: 4297-4308.

https://doi.org/10.2147/IDR.S224228.

Mushtaq S, Meunier D, Vickers A, Woodford N, Livermore DM.

Activity of imipenem/relebactam against Pseudomonas

aeruginosa producing ESBLs and carbapenemases. J Antimicrob

Chemother 2021; 76(2): 434-442.

https://doi.org/10.1093/jac/dkaa456.

Cruz-López F, Martínez-Meléndez A, Morfin-Otero R,

Rodriguez-Noriega E, Maldonado-Garza HJ, Garza-González E.

Efficacy and In Vitro Activity of Novel Antibiotics for Infections

With Carbapenem-Resistant Gram-Negative Pathogens. Front

Cell Infect Microbiol 2022; 12: 884365.

https://doi.org/10.3389/fcimb.2022.884365.

Lapuebla A, Abdallah M, Olafisoye O, Cortes C, Urban C,

Landman D, et al. Activity of Imipenem with Relebactam against

Gram-Negative Pathogens from New York City. Antimicrob

Agents Chemother 2015; 59(8): 5029-31.

https://doi.org/ 10.1128/AAC.00830-15.

Yang T-Y, Hsieh Y-J, Kao L-T, Liu GH, Lian S-H, Wang L-C, et al.

Activities of imipenem-relebactam combination against

carbapenem-nonsusceptible Enterobacteriaceae in Taiwan. J

Microbiol Immunol Infect 2022; 55(1): 86-94.

https://doi.org/ 10.1016/j.jmii.2021.02.001.

Heo YA. Imipenem/Cilastatin/Relebactam: A Review in GramNegative Bacterial Infections. Drugs 2021; 81(3): 377-388.

https://doi.org/10.1007/s40265-021-01471-8.

Kurihara D, Matsumoto S, Kishi N, Ishii Y, Mori M. In Vitro

Antibacterial Activity of Imipenem/Relebactam against Clinical

Isolates in Japan. Microbiol Spectr 2022; 10(2): e0223521.

https://doi.org/10.1128/spectrum.02235-21.

Gebre AB, Begashaw TA, Ormago MD. Bacterial profile and

drug susceptibility among adult patients with community

acquired lower respiratory tract infection at tertiary hospital,

Southern Ethiopia. BMC Infect Dis 2021; 21(1):

https://doi.org/10.1186/s12879-021-06151-2.

Lob SH, Karlowsky JA, Young K, Motyl MR, Hawser S, Kothari

ND, et al. In vitro activity of imipenem-relebactam against

resistant phenotypes of Enterobacteriaceae and Pseudomonas

aeruginosa isolated from intraabdominal and urinary tract

infection samples - SMART Surveillance Europe 2015-2017. J

Med Microbiol 2020; 69(2): 207-217.

https://doi.org/10.1099/jmm.0.001142.

Mansour H, Ouweini AEL, Chahine EB, Karaoui LR.

Imipenem/cilastatin/relebactam: A new carbapenem βlactamase inhibitor combination. Am J Health Syst Pharm 2021;

(8): 674-683. https://doi.org/10.1093/ajhp/zxab012.

Dhingra S, Rahman NAA, Peile E, Rahman M, Sartelli M, Hassali

MA, et al. Microbial Resistance Movements: An Overview of

Global Public Health Threats Posed by Antimicrobial Resistance,

and How Best to Counter. Front Public Health 2020; 8: 535668.

https://doi.org/10.3389/fpubh.2020.535668.

Papp-Wallace KM, Barnes MD, Alsop J, Taracila MA, Bethel CR,

Becka SA, et al. Relebactam Is a Potent Inhibitor of the KPC-2 βLactamase and Restores Imipenem Susceptibility in KPCProducing Enterobacteriaceae. Antimicrob Agents Chemother

; 62(6): e00174-18. https://doi.org/10.1128/AAC.00174-18.

O'Donnell JN, Lodise TP. New Perspectives on Antimicrobial

Agents: Imipenem-Relebactam. Antimicrob Agents Chemother

; 66(7): e0025622. https://doi.org/10.1128/aac.00256-22.

Downloads

Published

28-02-2024

Issue

Section

Original Articles

How to Cite

1.
Ishtiaq S, Sonia Tahir, Muhammad Waqas Abbas, Haider Ali, Saima Syed, Fatima Kareem. In Vitro Efficacy of Imipenem/Relebactam Against Imipenem Resistant Gram-Negative Strains Isolated from a Tertiary Care Hospital. Pak Armed Forces Med J [Internet]. 2024 Feb. 28 [cited 2024 Nov. 21];74(1):94-8. Available from: https://pafmj.org/PAFMJ/article/view/9901