Fahriye EKŞİ, Mehmet ERİNMEZ

Investigation of the effect of N-Acetylcysteine on colistin mic values in Acinetobacter Baumannii strains isolated from clinical samples

This study aims to investigate the effect of N-acetylcysteine (NAC) on MIC values colistin used in A. baumannii treatment. Acinetobacter baumannii is an opportunistic pathogen that colonizes inpatients and causes severe infections, septic shock, and death. With the emergence of multi-drug resistant A. baumannii infections, colistin becomes a treatment option. NAC is a mucolytic agent used commonly in lower respiratory tract infections especially in patients who have chronic respiratory disorders. Fifty A.baumannii isolates which were collected from a secondary care hospital were included in the study. The isolates were identified by an automatized identification system and antibiograms were also performed by this system. With the broth microdilution method, we investigated and compared the MIC values of the Colistin and NAC+Colistin combination. Samples tested with standard broth microdilution method and results interpreted as Colistin MIC50 value is 0.25 μg/mL and MİK90 value is 1 μg/mL, NAC+Colistin combination MIC50 value is 0.25 μg/mL and MİK90 value is 1 μg/mL. Although there is no difference in MIC50 and MIC90 values, a slight rise is seen in average MIC values for the NAC+Colistin combination. The screening for drugs that are generally prescribed together may provide a strategy to improve treatment outcomes of A. baumannii and reduce hospitalization.

Keywords:

colistin N-acetylcysteine, Acinetobacter baumannii,

PDF

___

1. Garrity GM, Bell JA LT. Taxonomic Outline of The Procaryotes. In: Begery’s Manual of Systematic Bacteriology. 2nd ed. New York: Springer-Verlag; 2004. p. 103. 2. Garrity GM, Bell JA LT. Taxonomic Outline of The Procaryotes. In: Begery’s Manual of Systematic Bacteriology. 2nd ed. New York: Springer-Verlag; 2004. p. 103.
3. Bergogne-Berezin E. Importance of Acinetobacter sp. In: Acinetobacter Biology and Pathogenesis. Paris: Springer; 2008. p. 1–85.
4. Seifert H, Strate A, Pulverer G. Nosocomial bacteremia due to Acinetobacter baumannii. Clinical features, epidemiology, and predictors of mortality. Medicine (Baltimore). 1995 Nov;74(6):340-9.
5. Cai Y, Chai D, Wang R, Liang B, Bai N. Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother. 2012 Jul;67(7):1607-15.
6. Blasi F, Page C, Rossolini GM, Pallecchi L, Matera MG, Rogliani P, Cazzola M. The effect of N-acetylcysteine on biofilms: Implications for the treatment of respiratory tract infections. Respir Med. 2016 Aug;117:190-7.
7. EUCAST reading guide for broth microdilution. 2021. Available from: www.eucast.org
8. Goswami M, Jawali N. N-acetylcysteine-mediated modulation of bacterial antibiotic susceptibility. Antimicrob Agents Chemother. 2010 Aug;54(8):3529-30.
9. Kim HA, Ryu SY, Seo I, Suh SI, Suh MH, Baek WK. Biofilm Formation and Colistin Susceptibility of Acinetobacter baumannii Isolated from Korean Nosocomial Samples. Microb Drug Resist. 2015 Aug;21(4):452-7.
10. Marchese A, Bozzolasco M, Gualco L, Debbia EA, Schito GC, Schito AM. Effect of fosfomycin alone and in combination with N-acetylcysteine on E. coli biofilms. Int J Antimicrob Agents. 2003 Oct;22 Suppl 2:95-100.
11. Pérez-Giraldo C, Rodríguez-Benito A, Morán FJ, Hurtado C, Blanco MT, Gómez-García AC. Influence of N-acetylcysteine on the formation of biofilm by Staphylococcus epidermidis. J Antimicrob Chemother. 1997 May;39(5):643-6.
12. Pollini S, Boncompagni S, Di Maggio T, Di Pilato V, Spanu T, Fiori B, et al. In vitro synergism of colistin in combination with N-acetylcysteine against Acinetobacter baumannii grown in planktonic phase and in biofilms. J Antimicrob Chemother. 2018 Sep 1;73(9):2388-2395.
13. Rodríguez-Beltrán J, Cabot G, Valencia EY, Costas C, Bou G, Oliver A, et al. N-acetylcysteine selectively antagonizes the activity of imipenem in Pseudomonas aeruginosa by an OprD-mediated mechanism. Antimicrob Agents Chemother. 2015;59(6):3246-51.
14. Landini G, Di Maggio T, Sergio F, Docquier JD, Rossolini GM, Pallecchi L. Effect of High N-Acetylcysteine Concentrations on Antibiotic Activity against a Large Collection of Respiratory Pathogens. Antimicrob Agents Chemother. 2016 Nov 21;60(12):7513-7517.
15. Zuin R, Palamidese A, Negrin R, Catozzo L, Scarda A, Balbinot M. High-dose N-acetylcysteine in patients with exacerbations of chronic obstructive pulmonary disease. Clin Drug Investig. 2005;25(6):401-8.