In vitro efficacy of various antibiotic combinations against Pseudomonas aeruginosa isolates

Objective: Pseudomonas aeruginosa is one of the leading causes of nosocomial infection. The present study tested the in vitro efficacy of ceftazidime or imipenem combined with amikacin, levofloxacin and colistin in P. aeruginosa isolates. Methods: P. aeruginosa strains, isolated from clinical samples, were assessed for antibiotic susceptibility using the disc diffusion method. Antibiotic combination tests were performed using minimum inhibitory concentration (MIC) test strips and the sum of the Fractional Inhibitory Concentration (Sigma FIC) index was used to assess synergy. Results: Out of 60 isolated P. aeruginosa strains, 100% were susceptible to colistin and 26.7% (16 strains) were multidrug resistant. MIC50 and MIC90 values were 2 and 32 mu g/ml for imipenem; 1.5 and 24 mu g/ml for ceftazidime; 3 and 8 mu g/ml for amikacin; 0.38 and 32 mu g/ml for levofloxacin; 1 and 1.5 mu g/ml for colistin, respectively. Antagonism was not found in any of the antibiotic combinations tested. The amikacin-ceftazidime combination was found to have a synergistic effect in 15% of the strains, but no synergistic effect was detected for other combinations. Conclusions: In Pseudomonas infection, alternative treatment options using different antibiotic combinations should be tested in vitro and findings should be confirmed by clinical studies.