Minocycline Activity against Unusual Clinically Significant Gram-Negative Pathogens

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ABSTRACT

The minocycline susceptibility of 3,856 isolates including Burkholderia, Achromobacter, Alcaligenes, Aeromonas, and Stenotrophomonas maltophilia from the SENTRY surveillance (2014 to 2019) were analyzed. The susceptibilities of these species (%S) were Achromobacter spp. ( n = 411; 92.6%), Burkholderia cepacia species complex ( n = 199; 85.9%), Aeromonas spp. ( n = 127; 99.2%), Chryseobacterium spp. ( n = 59; 94.9%), Alcaligenes faecalis ( n = 42; 88.1%), and S. maltophilia ( n = 2,287; 99.5%). These data suggest that minocycline is a useful treatment option for infections caused by unusual Gram-negative pathogens.

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Antimicrobial Susceptibility of Acinetobacter calcoaceticus–Acinetobacter baumannii Complex and Stenotrophomonas maltophilia Clinical Isolates: Results From the SENTRY Antimicrobial Surveillance Program (1997–2016)

Ana C. Gales, Harald Seifert, Deniz Gür … (2019)

Abstract Background Acinetobacter calcoaceticus–A. baumannii (Acb) complex and Stenotrophomonas maltophilia represent frequent causes of hospital-acquired infections. We evaluated the frequency and resistance rates of Acb complex and S. maltophilia isolates from medical centers enrolled in the SENTRY Program. Methods A total of 13 752 Acb complex and 6467 S. maltophilia isolates were forwarded to a monitoring laboratory by 259 participating sites from the Asia-Pacific region, Latin America, Europe, and North America between 1997 and 2016. Confirmation of species identification and antimicrobial susceptibility testing were performed using conventional methods and/or matrix-assisted laser desorption ionization–time of flight mass spectrometry and the broth microdilution method, respectively. Antimicrobial susceptibility results were interpreted by CLSI and EUCAST 2018 criteria. Results Acb complex and S. maltophilia were most frequently isolated from patients hospitalized with pneumonia (42.9% and 55.8%, respectively) and bloodstream infections (37.3% and 33.8%, respectively). Colistin and minocycline were the most active agents against Acb complex (colistin MIC50/90, ≤0.5/2 mg/L; 95.9% susceptible) and S. maltophilia (minocycline MIC50/90, ≤1/2 mg/L; 99.5% susceptible) isolates, respectively. Important temporal decreases in susceptibility rates among Acb complex isolates were observed for all antimicrobial agents in all regions. Rates of extensively drug-resistant Acb complex rates were highest in Europe (66.4%), followed by Latin America (61.5%), Asia-Pacific (56.9%), and North America (38.8%). Among S. maltophilia isolates, overall trimethoprim-sulfamethoxazole (TMP-SMX) susceptibility rates decreased from 97.2% in 2001–2004 to 95.7% in 2013–2016, but varied according to the geographic region. Conclusions We observed important reductions of susceptibility rates to all antimicrobial agents among Acb complex isolates obtained from all geographic regions. In contrast, resistance rates to TMP-SMX among S. maltophilia isolates remained low and relatively stable during the study period.

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Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) position statements on polymyxin B and colistin clinical breakpoints

Michael Satlin, James S. Lewis, Melvin P. Weinstein … (2020)

Recent data on polymyxin pharmacokinetics (PK), pharmacodynamics (PD), toxicity and clinical outcomes suggest these agents have limited clinical utility. PK-PD data show a steady state concentration of 2 ug/mL is required for killing bacteria with colistin minimum inhibitory concentrations (MICs) of 2 ug/mL. Less than 50% of patients with normal renal function achieve this exposure and it is associated with high risk of nephrotoxicity. This exposure does not achieve bacterial stasis in pneumonia models. Randomized and observational studies consistently demonstrate increased mortality for polymyxins compared to alternative agents. CLSI and EUCAST are two global organizations that establish interpretive criteria for in vitro susceptibility data. CLSI has recently taken the step to eliminate the “susceptible” interpretive category for the polymyxins, whereas EUCAST maintains this interpretive category. This viewpoint describes the opinions of the two organizations and the data that were used to inform their perspectives.

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Stenotrophomonas, Achromobacter, and nonmelioid Burkholderia species: antimicrobial resistance and therapeutic strategies.

Iain J. Abbott, Anton Peleg (2015)

Stenotrophomonas maltophilia, Achromobacter xylosoxidans, and nonmelioid Burkholderia species, namely, Burkholderia cepacia complex, collectively are a group of troublesome nonfermenters. Although not inherently virulent organisms, these environmental Gram negatives can complicate treatment in those who are immunocompromised, critically ill in the intensive care unit and those patients with suppurative lung disease, such as cystic fibrosis. Through a range of intrinsic antimicrobial resistance mechanisms, virulence factors, and the ability to survive in biofilms, these opportunistic pathogens are well suited to persist, both in the environment and the host. Treatment recommendations are hindered by the difficulties in laboratory identification, the lack of reproducibility of antimicrobial susceptibility testing, the lack of clinical breakpoints, and the absence of clinical outcome data. Despite trimethoprim-sulfamethoxazole often being the mainstay of treatment, resistance is widely encountered, and alternative regimens, including combination therapy, are often used. This review will highlight the important aspects and unique challenges that these three nonfermenters pose, and, in the absence of clinical outcome data, our therapeutic recommendations will be based on reported antimicrobial susceptibility and pharmacokinetic/pharmacodynamic profiles.

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Author and article information

Contributors

Dee Shortridge:

ORCID: https://orcid.org/0000-0002-1215-5216

Journal

Journal ID (nlm-ta): Antimicrob Agents Chemother

Journal ID (iso-abbrev): Antimicrob Agents Chemother

Journal ID (publisher-id): aac

Title: Antimicrobial Agents and Chemotherapy

Publisher: American Society for Microbiology (1752 N St., N.W., Washington, DC )

ISSN (Print): 0066-4804

ISSN (Electronic): 1098-6596

Publication date (Electronic, preprint): 7 September 2021

Publication date (Electronic, pub): 18 October 2021

Publication date (Electronic, collection): November 2021

Publication date PMC-release: 18 October 2021

Volume: 65

Issue: 11

Electronic Location Identifier: e01264-21

Affiliations

[a ] JMI Laboratoriesgrid.419652.d, , North Liberty, Iowa, USA

Author notes

Citation Shortridge D, Arends SJR, Streit JM, Castanheira M. 2021. Minocycline activity against unusual clinically significant Gram-negative pathogens. Antimicrob Agents Chemother 65:e01264-21. https://doi.org/10.1128/AAC.01264-21.