An improved PKPD modeling approach to characterize the pharmacodynamic interaction over time between ceftazidime/avibactam and colistin from in vitro time-kill experiments against multidrug-resistant Klebsiella pneumoniae isolates.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_9F2F78850D8C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
An improved PKPD modeling approach to characterize the pharmacodynamic interaction over time between ceftazidime/avibactam and colistin from in vitro time-kill experiments against multidrug-resistant Klebsiella pneumoniae isolates.
Journal
Antimicrobial agents and chemotherapy
Author(s)
Aubry R., Buyck J., Prouvensier L., Decousser J-W, Nordmann P., Wicha S.G., Marchand S., Grégoire N.
ISSN
1098-6596 (Electronic)
ISSN-L
0066-4804
Publication state
Published
Issued date
18/10/2023
Peer-reviewed
Oui
Volume
67
Number
10
Pages
e0030123
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
In contrast to the checkerboard method, bactericidal experiments [time-kill curves (TKCs)] allow an assessment of pharmacodynamic (PD) interactions over time. However, TKCs in combination pose interpretation problems. The objective of this study was to characterize the PD interaction over time between ceftazidime/avibactam (CZA) and colistin (CST) using TKC against four multidrug-resistant Klebsiella pneumoniae susceptible to both antibiotics and expressing a widespread carbapenemase determinant KPC-3. In vitro TKCs were performed and analyzed using pharmacokinetic/pharmacodynamic (PKPD) modeling. The general pharmacodynamic interaction model was used to characterize PD interactions between drugs. The 95% confidence intervals (95%CIs) of the expected additivity and of the observed interaction were built using parametric bootstraps and compared to evaluate the in vitro PD interaction over time. Further simulations were conducted to investigate the effect of the combination at varying concentrations typically observed in patients. Regrowth was observed in TKCs at high concentrations of drugs alone [from 4 to 32× minimum inhibitory concentrations (MIC)], while the combination systematically prevented the regrowth at concentrations close to the MIC. Significant synergy or antagonism were observed under specific conditions but overall 95%CIs overlapped widely over time indicating an additive interaction between antibiotics. Moreover, simulations of typical PK profile at standard dosages indicated that the interaction should be additive in clinical conditions. The nature of the PD interaction varied with time and concentration in TKC. Against the four K. pneumoniae isolates, the bactericidal effect of CZA + CST combination was predicted to be additive and to prevent the emergence of resistance at clinical concentrations.
Keywords
Humans, Ceftazidime/pharmacology, Colistin/pharmacology, Klebsiella pneumoniae, Anti-Bacterial Agents/therapeutic use, Azabicyclo Compounds/pharmacology, Drug Combinations, beta-Lactamases/pharmacology, Microbial Sensitivity Tests, Klebsiella Infections/drug therapy, PKPD modeling, antimicrobial combination, ceftazidime/avibactam, colistin
Pubmed
Web of science
Open Access
Yes
Create date
25/09/2023 16:11
Last modification date
25/01/2024 8:41
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