In VivoEfficacy of Glycopeptide-Colistin Combination Therapies in aGalleria mellonellaModel ofAcinetobacter baumanniiInfection
ABSTRACTThe treatment ofAcinetobacter baumanniiinfections poses a significant clinical challenge, with isolates resistant to all commonly used agents increasingly being reported. With few new agents in the pipeline, clinicians are increasingly turning to combinations of antimicrobials in the hope that they may act synergistically together. In this study we assessed the activities of two glycopeptide-colistin combinations bothin vitroand using aGalleria mellonellacaterpillar model ofA. baumanniiinfection. In checkerboard assays both vancomycin and teicoplanin were highly active against susceptible and multidrug-resistant strains ofA. baumanniiwhen combined with colistin (fractional inhibitory concentration [FIC] of <0.25). Treatment ofG. mellonellacaterpillars infected with lethal doses ofA. baumanniiresulted in significantly enhanced survival rates when either vancomycin or teicoplanin was given with colistin compared to colistin treatment alone (P< 0.05). This effect was most marked when vancomycin was the glycopeptide administered, although this agent was also highly effective as monotherapy, possibly through an immunomodulatory action on theG. mellonellaresponse toA. baumanniiinfection. This work suggests that glycopeptide-colistin combinations are highly active againstA. baumanniibothin vitroand in a simple animal model of infection. They should be considered further as potential treatments for difficult-to-treatA. baumanniiinfections.