Impact of Efflux Pump Inhibitor CarbonylCyanide M-Chlorophenylhydrazone in Multidrug Resistant Acinetobacter Species Isolates from Sterile Body Fluids

• Main Authors: Shahid Raza, Hitender Gautam, Bhavna Maheshwari, Sarita Mohapatra, Seema Sood, Benu Dhawan, Arti Kapil, Bimal Kumar Das
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2020-11-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: acinetobacter baumannii; broth micro-dilution; efflux pump inhibitors; minimum inhibitory concentration; multidrug resistance
• Online Access: https://jcdr.net/articles/PDF/14206/45997_CE[Ra1]_F(KM)_PF1(AG_KM)_PFA-PB(AG_KM)_PN(SL).pdf

Introduction: Antimicrobial resistance of Acinetobacter baumannii (A. baumannii) are rapidly emerging, becoming non-responsive to most of the commonly prescribed antibiotics and leaving us with few treatment options and galloping treatment costs. Aim: To study the effect of Efflux Pump Inhibitor (EPI) Carbonyl Cyanide 3-Chlorophenylhydrazone (CCCP) on Multidrug Resistance (MDR) A. baumannii isolates from different sterile body fluids. Materials and Methods: A total of 40 Acinetobacter species isolates from different sterile body fluids i.e., Cerebrospinal Fluid (CSF), ascitic fluid, pleural fluid, and peritoneal fluid were collected and identified by Matrix Assisted Laser Desorption/ Ionisation-Time Of Flight (MALDI-TOF), Biomerieux, France. Minimum Inhibitory Concentration (MIC) of A. baumannii was determined by automated VITEK-2 Antimicrobial Susceptibility Testing (AST) system (Biomerieux, France). In addition, MIC of the isolates, grown on Mueller-Hinton Agar (MHA) plate with 15 μg/mL with EPI CCCP (Sigma Aldrich, US) was determined. For Tigecycline, MIC was determined by Broth Microdilution (BMD) method. Results: Out of 40 isolates, 34 (85%) were A. baumannii and 6 (15%) were Acinetobacter junii. Most of the Acinetobacter spps were MDR and only susceptible to few antibiotics. Most effective antibiotic was Tigecycline 25 (73.52%) followed by Co-trimoxazole 10 (29.41%). Similarly, Out of 40 isolates, 2 to 64 folds reductions in MIC was observed due to CCCP in 10 (25%) isolates for various antibiotics. Likewise, for Tigecycline, 2 to 4 folds reductions in MIC value (One strain changed from intermediate to sensitive) was observed by VITEK-2 AST which corroborated with reduction in MIC by BMD after addition of CCCP. Conclusion: MDR A. baumannii are spreading rapidly. There is the need to overcome the antimicrobial resistance by investigating resistance inhibiting substance that will help to restore antimicrobial susceptibility and bringing back the existing antibiotics in prescription.