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Evaluation of the E test for the assessment of synergy of antibiotic combinations against multiresistant Pseudomonas aeruginosa isolates from cystic fibrosis patients

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Abstract

The determination of synergistic effects of antimicrobial drug combinations can lead to improved therapeutic options in the antibiotic treatment of cystic fibrosis patients who are chronically infected with multiresistant Pseudomonas aeruginosa isolates. The aim of this study was to evaluate the performance of the E test versus the standard agar dilution checkerboard susceptibility test in the assessment of synergy and, in addition, to determine the activity of two antimicrobial combinations against 163 multiresistant P. aeruginosa isolates from cystic fibrosis patients. The agreement between the checkerboard method and the E test was excellent (>90%) for nonmucoid as well as mucoid isolates from cystic fibrosis patients. The rate of synergy was higher for the antibiotic combination of ceftazidime and tobramycin (28.8% of the cystic fibrosis strains) than for the combination of meropenem and tobramycin (19.0%). However, the probability of synergy for the second antibiotic combination increased significantly when the synergy of the first antibiotic combination had already been demonstrated (Fischer’s exact test, p=0.049). The results show that the E test is a valuable and practical method for routine microbiological diagnostics and can aid in the selection of improved antibiotic options in the treatment of cystic fibrosis patients chronically infected with P. aeruginosa.

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Acknowledgements

We thank Dieter Bitter-Suermann and Sebastian Suerbaum for valuable discussions and strong encouragement. The Bundesministerium für Bildung und Forschung (BMBF, Germany), project no. 01KI0216, provided financial support.

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Authors and Affiliations

  1. Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany

    B. Balke & H. Weissbrodt

  2. Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Ludwig-Maximilians Universität, Pettenkoferstraße 9a, 80336, Munich, Germany

    M. Hogardt & S. Schmoldt

  3. Institut für Biometrie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany

    L. Hoy

  4. Gesellschaft für Biotechnologische Forschung (GBF), Abteilung Zellbiologie, Mascheroder Weg 1, 38124, Braunschweig, Germany

    S. Häussler

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  1. B. Balke
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  2. M. Hogardt
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  3. S. Schmoldt
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  4. L. Hoy
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  5. H. Weissbrodt
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  6. S. Häussler
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Correspondence to S. Häussler.

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Balke, B., Hogardt, M., Schmoldt, S. et al. Evaluation of the E test for the assessment of synergy of antibiotic combinations against multiresistant Pseudomonas aeruginosa isolates from cystic fibrosis patients. Eur J Clin Microbiol Infect Dis 25, 25–30 (2006). https://doi.org/10.1007/s10096-005-0076-9

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