Synergy of colistin with rifampin and trimethoprim/sulfamethoxazole on multidrug-resistant Stenotrophomonas maltophilia

Diagn Microbiol Infect Dis. 2002 Nov;44(3):259-63. doi: 10.1016/s0732-8893(02)00443-1.

Abstract

Stenotrophomonas maltophilia is characterized by intrinsic resistance to a variety of antimicrobials. Therapeutic options are often limited particularly after the emergence of isolates resistant to trimethoprim/sulfamethoxazole. The application of colistin for infections caused by multidrug-resistant Gram-negative pathogens is limited due to its toxicity. In order to evaluate the activity of the interaction of colistin with rifampin or trimethoprim/sulfamethoxazole on S. maltophilia, 24 different isolates resistant to trimethoprim/sulfamethoxazole were in vitro exposed over-time to the combination of 1x and 4 x MIC of colistin with 2 microg/ml of rifampin or 2/38 microg/ml of trimethoprim/sulfamethoxazole. The applied concentrations for rifampin and trimethoprim/sulfamethoxazole reflect their mean serum levels. Synergy of colistin and rifampin was documented after the first two hours of bacterial growth for approximately 60% of isolates and it occurred with both applied concentrations of colistin. The interaction of colistin and rifampin prevented regrowth observed when single colistin was applied. Synergy of colistin and trimethoprim/sulfamethoxazole was mainly found when colistin was applied at a concentration of 4 x MIC involving 41.7% of isolates after 24 h of growth. In the presence of trimethoprim/sulfamethoxazole bacterial regrowth, observed when single colistin was applied, was prevented. It is concluded that growth of multidrug-resistant S. maltophilia is significantly inhibited by the interaction of colistin and rifampin and to a lesser extent of colistin and trimethoprim/sulfamethoxazole. These results merit further study in both the animal model and the clinical setting.

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Colistin / pharmacology*
  • Colony Count, Microbial
  • Cross Infection / microbiology
  • Drug Resistance, Multiple, Bacterial*
  • Drug Synergism
  • Gram-Negative Bacterial Infections / microbiology
  • Humans
  • Microbial Sensitivity Tests
  • Rifampin / pharmacology*
  • Stenotrophomonas maltophilia / drug effects*
  • Stenotrophomonas maltophilia / growth & development
  • Trimethoprim, Sulfamethoxazole Drug Combination / pharmacology*

Substances

  • Anti-Bacterial Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Rifampin
  • Colistin