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An Approach to Measuring Colistin Plasma Levels Regarding the Treatment of Multidrug-Resistant Bacterial Infection

In Vitro Synergism of Colistin and N-acetylcysteine against Stenotrophomonas maltophilia

Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Microbiology Laboratory, 20122 Milan, Italy
Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, 20122 Milan, Italy
Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
Author to whom correspondence should be addressed.
Received: 5 July 2019 / Revised: 20 July 2019 / Accepted: 23 July 2019 / Published: 25 July 2019
Stenotrophomonas maltophilia is an emerging global opportunistic pathogen, responsible for a wide range of human infections, including respiratory tract infections. Intrinsic multidrug resistance and propensity to form biofilms make S. maltophilia infections recalcitrant to treatment. Colistin is among the second-line options in case of difficult-to-treat S. maltophilia infections, with the advantage of being also administrable by nebulization. We investigated the potential synergism of colistin in combination with N-acetylcysteine (NAC) (a mucolytic agent with antioxidant and anti-inflammatory properties) against S. maltophilia grown in planktonic phase and biofilm. Eighteen S. maltophilia clinical isolates (comprising three isolates from cystic fibrosis (CF) and two trimethoprim-sulfamethoxazole (SXT)-resistant strains) were included. Checkerboard assays showed a synergism of colistin/NAC combinations against the strains with colistin Minimum Inhibitory Concentration (MIC) >2 µg/mL (n = 13), suggesting that NAC could antagonize the mechanisms involved in colistin resistance. Nonetheless, time–kill assays revealed that NAC might potentiate colistin activity also in case of lower colistin MICs. A dose-dependent potentiation of colistin activity by NAC was also clearly observed against S. maltophilia biofilms, also at sub-MIC concentrations. Colistin/NAC combinations, at concentrations likely achievable by topical administration, might represent a valid option for the treatment of S. maltophilia respiratory infections and should be examined further. View Full-Text
Keywords: colistin; N-acetylcysteine; Stenotrophomonas maltophilia; biofilm colistin; N-acetylcysteine; Stenotrophomonas maltophilia; biofilm
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MDPI and ACS Style

Ciacci, N.; Boncompagni, S.; Valzano, F.; Cariani, L.; Aliberti, S.; Blasi, F.; Pollini, S.; Rossolini, G.M.; Pallecchi, L. In Vitro Synergism of Colistin and N-acetylcysteine against Stenotrophomonas maltophilia. Antibiotics 2019, 8, 101.

AMA Style

Ciacci N, Boncompagni S, Valzano F, Cariani L, Aliberti S, Blasi F, Pollini S, Rossolini GM, Pallecchi L. In Vitro Synergism of Colistin and N-acetylcysteine against Stenotrophomonas maltophilia. Antibiotics. 2019; 8(3):101.

Chicago/Turabian Style

Ciacci, Nagaia; Boncompagni, Selene; Valzano, Felice; Cariani, Lisa; Aliberti, Stefano; Blasi, Francesco; Pollini, Simona; Rossolini, Gian M.; Pallecchi, Lucia. 2019. "In Vitro Synergism of Colistin and N-acetylcysteine against Stenotrophomonas maltophilia" Antibiotics 8, no. 3: 101.

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