scholarly journals Humanized Exposures of Cefiderocol, a Siderophore Cephalosporin, Display Sustained in vivo Activity against Siderophore-Resistant Pseudomonas aeruginosa

Pharmacology ◽  
2018 ◽  
Vol 101 (5-6) ◽  
pp. 278-284 ◽  
Author(s):  
Islam M. Ghazi ◽  
Marguerite L. Monogue ◽  
Masakatsu Tsuji ◽  
David P. Nicolau

We evaluated the in vivo efficacy of humanized exposures of cefiderocol, a novel siderophore cephalosporin, against a test panel of P. aeruginosa (PSA) previously shown to develop resistance to 2 preclinical candidate siderophores (MB-1 and SMC-3176). In the thigh infection model, the PSA bacterial density in untreated controls grew from 5.54 ± 0.23 to 8.68 ± 0.57 log10 CFU over 24 h. The humanized cefiderocol exposure resulted in >1 log10 CFU reduction in all 8 isolates, while MB-1 and SMC-3176 exhibited variable activity similar to that previously reported. Humanized exposures of cefepime and levofloxacin, acting as positive antimicrobial controls displayed activity consistent with that of the bacterial phenotypic susceptibility profiles. Cefiderocol manifested in vivo efficacy against all PSA isolates including those resistant to cefepime and levofloxacin in contrast to its predecessor siderophore compounds. These preclinical data are supportive of further evaluation of cefiderocol in the treatment of P. aeruginosa.

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S640-S641
Author(s):  
Christian M Gill ◽  
Kamilia Abdelraouf ◽  
David P Nicolau

Abstract Background Carbapenems are often used for infections due to extended-spectrum-β-lactamase (ESBL) and cephalosporinase (CSase)-producers. As increased carbapenem utilization is associated with the development of carbapenem resistance, antimicrobial stewardship has targeted non-carbapenem options. WCK 4282 (FEP 2 g-TZB 2 g) offers pharmacodynamically optimized TZB exposure and demonstrated potent activity in vitro against ESBL-phenotype isolates. We describe the pharmacodynamics of a WCK 4282 human-simulated regimen (HSR) in the neutropenic murine thigh model. Methods 19 clinical strains harboring ESBLs or CSase (EB; n=8 and PA; n=4) or serine-carbapenemases (EB; KPC n=4 or OXA-48-like n=3) were tested in vivo. Per CLSI, 19, 18, and 17 isolates were cefepime, ceftolozane/tazobactam, and piperacillin/tazobactam (TZP) non-susceptible, respectively. Thighs of neutropenic, female, CD-1 mice (3 per group) were inoculated with ~107 CFU/mL of bacterial suspension 2 h prior to dosing. Mice received WCK 4282 HSR, FEP HSR, or saline (controls) for 24 h. WCK 4282 HSR and FEP HSR provided plasma exposures in mice that were similar in f%T > MIC and fAUC to FEP-TZB 2 g-2 g and FEP 2 g, respectively, as IV infusions over 1.5 h q8h in humans. Bacterial densities and their changes at 24 h relative to 0 h controls were determined to assess efficacy and reported as mean±SD log10 CFU/thigh. Results Bacterial burdens were 5.81±0.36 at 0 h and 9.29±0.88 at 24 h in untreated controls. WCK 4282 produced potent activity against ESBL/CSase producing EB and PA with WCK 4282 MIC ≤ 16 mg/L; mean change in log10 CFU from 0 h was -1.70±0.77, while growth was observed with FEP alone. WCK 4282 produced variable activity against OXA-48-like harboring EB. Against KPC-harboring EB, WCK 4282 produced stasis to growth. Mean Log10 CFU changes are reported in Table 1 and Figure 1. Table 1. Comparative efficacy of FEP HSR and WCK 4282 HSR by genotypic β-lactamase Figure 1. Mean Change in log10CFU/thigh for 24 h controls, FEP HSR, and WCK 4282 HSR across the tested MIC distribution. Conclusion WCK 4282, a novel TZB containing regimen, resulted in enhance in vitro potency against ESBL/CSase and OXA-48-like producers. Humanized exposures of WCK 4282 produced substantial kill in vivo against ESBL/CSase producers with MICs ≤ 16 mg/L including FEP resistant/TZP non-susceptible PA. These data support further evaluations of WCK 4282 as a carbapenem-sparing regimen for ESBL/cephalosporinase harboring strains. Disclosures David P. Nicolau, PharmD, Cepheid (Other Financial or Material Support, Consultant, speaker bureau member or has received research support.)Merck & Co., Inc. (Consultant, Grant/Research Support, Speaker’s Bureau)Wockhardt (Grant/Research Support)


Author(s):  
Maxwell J. LASKO ◽  
Kamilia ABDELRAOUF ◽  
David P. NICOLAU

Abstract (248/250) Introduction: WCK 4282 (cefepime 2g/tazobactam 2g) maximizes systemic exposure of tazobactam and restores cefepime activity against various extended-spectrum β-lactamase (ESBL)- and cephalosporinase-producing strains in vitro. We describe clinical WCK 4282 exposure efficacy against various serine β-lactamase-producing Enterobacterales and Pseudomonas aeruginosa in a murine pneumonia model. Clinical cefepime-resistant isolates (17 Enterobacterales and 2 P. aeruginosa) were utilized. Isolates expressed ESBLs, cephalosporinases, and/or serine carbapenemases (KPC, OXA-48-like). WCK 4282 MICs were 4-32 μg/mL. For in vivo experiments, lungs of neutropenic mice were inoculated using standard inoculum (107 log10 CFU/mL). Serine-carbapenemase-producing isolates were also assessed using a low inoculum (1:5 dilution). Treatment mice received HSR of cefepime, meropenem (control for serine carbapenemase expression with low inoculum experiments), or WCK 4282 human-simulated regimens. Efficacy was assessed as change in log10 CFU/lung at 24h compared with 0h controls. Results: At standard inoculum, mean 0h bacterial burden was 6.65±0.23 log10 CFU/lung and increased at 24h by 2.48 ± 0.60 log10 CFU/lung among untreated controls. Lower inoculums initial bacterial burdens ranged from 5.81±0.12-6.39±0.13 log10 CFU/lung. At standard and/or low inoculums, cefepime and meropenem provided minimal activity. WCK 4282 produced >1-log10 reduction against 9/9 ESBL/cephalosporinase-producing strains. WCK 4282 provided variable activity among mice infected with standard or lower inoculums of OXA-48-like-producers. WCK 4282 exposures provided 0.53±1.07 log10 CFU/lung growth against KPC-producers at standard versus bacteriostasis (-0.15±0.54 change in log10 CFU/lung) at low inoculum. Conclusion: WCK 4282 produced potent in vivo activity against ESBL- and cephalosporinase-producing Enterobacterales and P. aeruginosa, and potential activity against OXA-48-like-producing Enterobacterales in a neutropenic pneumonia model.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S648-S649
Author(s):  
Tomefa E Asempa ◽  
Nicole A DeRosa ◽  
Cara Cassino ◽  
Dario Lehoux ◽  
Raymond Schuch ◽  
...  

Abstract Background CF-296 is a novel lysin in pre-clinical development for the treatment of methicillin-susceptible and methicillin-resistant Staphylococcus aureus infections, used in addition to standard of care antibiotics including VAN and DAP. We evaluated the in vivo efficacy of CF-296 alone and in addition to VAN and DAP against S. aureus. Methods Eight isolates (1 MSSA and 7 MRSA) were studied. Murine ICR MIC (100% serum) and human MIC (100% serum) for CF-296 ranged from 32-256 mg/L to 0.5-1 mg/L respectively. Broth microdilution MICs for DAP ranged from 0.5-1 mg/L while all isolates exhibited a VAN MIC of 1 mg/L. Neutropenic ICR mice were thigh inoculated with bacterial suspensions (107 CFU/mL). Mice were administered three monotherapy regimens subcutaneously (SC) or intravenously (IV): i) sub-therapeutic VAN, SC (i.e., a dose that yielded bacteria stasis or growth in order to evaluate further bacterial killing), ii) sub-therapeutic DAP, SC, or iii) CF-296 50 mg/kg, IV. Combination of sub-therapeutic VAN or DAP in addition to 5 escalating CF-296 doses ranging from 0.5 to 50 mg/kg were also examined. Control mice were vehicle-dosed. Efficacy was measured as the change in mean thigh bacterial density at 24h relative to 0h controls. Results Relative to starting inoculum (5.71 ± 0.27 at 0h), bacterial density in controls increased by +2.49 ± 0.98 log10 CFU/thigh across all 8 strains. On average, VAN, DAP, and CF-296 monotherapy resulted in +0.90 ± 1.21, +1.47 ± 0.80, and +0.87 ± 1.39 log10 CFU/thigh bacteria growth, respectively. In addition to VAN, escalating CF-296 exposures (0.5 – 50 mg/kg) resulted in an augmented dose-response, ranging from bacterial reduction of -0.26 ± 1.10 (with addition of CF-296 0.5 mg/kg) to -1.01 ± 0.41 log10 CFU/thigh (with addition of CF-296 50 mg/kg). Similarly, escalating CF-296 exposures in addition to DAP resulted in an augmented dose-response, ranging from bacterial density of +0.80 ± 1.19 to -0.72 ± 0.59 log10 CFU/thigh. Conclusion Compared with 24h control, VAN, DAP, and CF-296 alone displayed modest CFU reduction while CF-296 synergized with VAN and DAP to cause further bacterial killing highlighting a potential role for CF-296 adjunctive therapy against MSSA and MRSA isolates. Disclosures Cara Cassino, MD, ContraFect Corporation (Employee)ContraFect Corporation (Employee) Dario Lehoux, PhD, ContraFect Corporation (Consultant) Raymond Schuch, PhD, ContraFect Corporation (Employee) David P. Nicolau, PharmD, Cepheid (Other Financial or Material Support, Consultant, speaker bureau member or has received research support.)Merck & Co., Inc. (Consultant, Grant/Research Support, Speaker’s Bureau)Wockhardt (Grant/Research Support)


2011 ◽  
Vol 17 (3) ◽  
pp. 318-321 ◽  
Author(s):  
Nobuko Araki ◽  
Katsunori Yanagihara ◽  
Yoshitomo Morinaga ◽  
Koichi Yamada ◽  
Yasuaki Yamada ◽  
...  

2019 ◽  
Vol 63 (7) ◽  
Author(s):  
Marguerite L. Monogue ◽  
Jennifer Tabor-Rennie ◽  
Kamilia Abdelraouf ◽  
David P. Nicolau

ABSTRACT We describe the in vivo efficacy of human-simulated WCK 5222 (cefepime-zidebactam) exposure against multidrug-resistant Pseudomonas aeruginosa (meropenem MICs 8 to >256 μg/ml) in a neutropenic murine thigh infection model. WCK 5222 MICs ranged from 4 to 32 μg/ml. Substantial in vivo WCK 5222 activity was observed against all isolates, further enhancing the efficacy of zidebactam alone in 11/16 isolates (WCK 5222 mean reduction, –1.62 ± 0.58 log10 CFU/thigh), and a lack of activity was observed with cefepime monotherapy.


Molecules ◽  
2021 ◽  
Vol 26 (6) ◽  
pp. 1497
Author(s):  
Pansong Zhang ◽  
Qiao Guo ◽  
Zhihua Wei ◽  
Qin Yang ◽  
Zisheng Guo ◽  
...  

Therapeutics that target the virulence of pathogens rather than their viability offer a promising alternative for treating infectious diseases and circumventing antibiotic resistance. In this study, we searched for anti-virulence compounds against Pseudomonas aeruginosa from Chinese herbs and investigated baicalin from Scutellariae radix as such an active anti-virulence compound. The effect of baicalin on a range of important virulence factors in P. aeruginosa was assessed using luxCDABE-based reporters and by phenotypical assays. The molecular mechanism of the virulence inhibition by baicalin was investigated using genetic approaches. The impact of baicalin on P. aeruginosa pathogenicity was evaluated by both in vitro assays and in vivo animal models. The results show that baicalin diminished a plenty of important virulence factors in P. aeruginosa, including the Type III secretion system (T3SS). Baicalin treatment reduced the cellular toxicity of P. aeruginosa on the mammalian cells and attenuated in vivo pathogenicity in a Drosophila melanogaster infection model. In a rat pulmonary infection model, baicalin significantly reduced the severity of lung pathology and accelerated lung bacterial clearance. The PqsR of the Pseudomonas quinolone signal (PQS) system was found to be required for baicalin’s impact on T3SS. These findings indicate that baicalin is a promising therapeutic candidate for treating P. aeruginosa infections.


2018 ◽  
Vol 63 (2) ◽  
pp. e01040-18 ◽  
Author(s):  
Sean M. Stainton ◽  
Marguerite L. Monogue ◽  
Masakatsu Tsuji ◽  
Yoshinori Yamano ◽  
Roger Echols ◽  
...  

ABSTRACT Herein, we evaluated sustainability of humanized exposures of cefiderocol in vivo over 72 h against pathogens with cefiderocol MICs of 0.5 to 16 μg/ml in the neutropenic murine thigh model. In Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae displaying MICs of 0.5 to 8 μg/ml (n = 11), sustained kill was observed at 72 h among 9 isolates. Postexposure MICs revealed a single 2-dilution increase in one animal compared with controls (1/54 samples, 1.8%) at 72 h. Adaptive resistance during therapy was not observed.


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