• Asian Pacific Journal of Cancer Prevention
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• v.15 no.11
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• pp.4549-4553
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• 2014

Background: Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients. Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia. Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrile neutropenic children with cancer. Materials and Methods: Charts of febrile, neutropenic children hospitalized at our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed. Patients received PIP/TAZ 360 mg/kg/day or meropenem 60 mg/kg/day intravenously in three divided doses. Duration of fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between the two groups. Resolution of fever without antibiotic change was defined as success and resolution of fever with antibiotic change or death of a patient was defined as failure. Modification was defined as changing the empirical antimicrobial agent during a febrile episode. Results: Two hundred eighty four febrile neutropenic episodes were documented in 136 patients with a median age of 5 years. In 198 episodes meropenem and in 86 episodes PIP/TAZ were used. Duration of fever and neutropenia, neutrophil count, sex, and primary disease were not different between two groups. Success rates and modification rate between two groups showed no significant differences (p>0.05). Overall success rate in the meropenem and PIP/TAZ groups were 92.4% and 91.9% respectively. No serious adverse effects occurred in either of the groups. Conclusions: Meropenem and PIP/TAZ monotherapy are equally safe and effective in the initial treatment of febrile neutropenia in children with cancer.

• Tuberculosis and Respiratory Diseases
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• v.85 no.3
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• pp.256-263
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• 2022

Background: Mycobacterium tuberculosis (Mtb) is resistant to the β-lactam antibiotics due to a non-classical transpeptidase in the cell wall with β-lactamase activity. A recent study showed that meropenem combined with clavulanate, a β-lactamase inhibitor, was effective in multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). However, in Korea, clavulanate can only be used as drugs containing amoxicillin. In this study, we investigated the susceptibility and genetic mutations of drug-resistant Mtb isolates to amoxicillin-clavulanate and meropenem-clavulanate to improve the diagnosis and treatment of drug-resistant TB patients. Methods: The minimum inhibitory concentration (MIC) of amoxicillin-clavulanate and meropenem-clavulanate was examined by resazurin microtiter assay. We used 82 MDR and 40 XDR strains isolated in Korea and two reference laboratory strains. Mutations of drug targets blaC, blaI, ldtA, ldtB, dacB2, and crfA were analyzed by polymerase chain reaction and DNA sequencing. Results: The MIC₉₀ values of amoxicillin/clavulanate and meropenem/clavulanate in drug-resistant Mtb isolates were 64/2.5 and 16/2.5 mg/L, respectively. Gene mutations related to amoxicillin/clavulanate and meropenem/clavulanate resistance could not be identified, but T448G mutation was found in the blaC gene related to β-lactam antibiotics' high susceptibility. Conclusion: Our results provide clinical consideration of β-lactams in treating drug-resistant TB and potential molecular markers of amoxicillin-clavulanate and meropenem-clavulanate susceptibility.

• YAKHAK HOEJI
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• v.39 no.3
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• pp.215-222
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• 1995

The in vitro antibacterial activities of new carbapenem. CRB 529, 535, 538, 545 and 550 with meropenem and imipenem were compared. CRB 529. 535, 538, 545 and 550 proved to have a broad an tibacterial spectrum. Its in vitro activity against standard 20 strains was almost the same as that of imipenem and slightly higher than that of meropenem. However. against clinical isolated P. aeruginosa, CRB 529, 535, 538, 545 and 550 showed significantly higher activity than imipenem, and also CRB 529, 535, 538, 545 and 550 showed almost the same activity than imipenem and meropenem against 82 clinical isolated strains including S. aureus (MRSA), S. aureus (MSSA), E. faecalis, E. facium, E. coli, P. aeruginosa, K. pneumonia, P. mirabiris, P. stuartii, M. morganii, C. freundii, E. cloacae, S. marcescens and A. calcoaceticus var. anitratus. The stability of CRB 529, 535, 538, 545 and 550 against porcine renal dehydropeptidase-I(DHP-1) was 10 folds higher than that of imipenem and was 3 folds higher than that of meropenem.

• Microbiology and Biotechnology Letters
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• v.34 no.4
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• pp.352-356
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• 2006

CW-270031, an injectable carbapenem, is a novel synthesized pyrrolidinyl-thio carbapenems. It was evaluated for its in vitro antibacterial activities in comparison with those of imipenem and meropenem against standard strains and clinical isolated strains, CW-270031 was more active than imipenem against gram-negative (E. coli and Klebsiella oxytoca) clinical isolates, but it was slightly active than meropenem. Against Klebsiella aeruginosa CW-118 MIC were 0.048 $\mu$g/ml for CW-270031, 0.19 $\mu$g/ml for imipenem. Against clinical E. coli MIC range were 0.012$\sim$0.195 $\mu$g/ml for CW-270031, 0.097$\sim$0.39 $\mu$g/ml for imipenem. Against clinical Klebsiella oxytoca MIC$_{50}$ were 0.09 $\mu$g/ml for CW-270031, 0.39 $\mu$g/ml for imipenem. Against gram-positive standard strains and clinical CW-270031 was slightly more activity than meropenem, but CW-270033 was less active than imipenem against these tested isolates. The subcutaneous injection of CW-270031 in mice revealed that the half-life of CW-270031 in serum was about 13 min, long than that of meropenem (10.6 min). CW-270031. was stable to hydrolysis by dog renal dehydropeptidase I (DHP-l) enzyme, to an more stabilities shown by meropenem.

• Korean Journal of Microbiology
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• v.52 no.4
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• pp.428-436
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• 2016

The emergence of antibiotic-resistant bacteria has been increased and become a public health concern worldwide. Many bacterial infections can be sequentially treated with different types of antibiotics. Thus, this study was designed to evaluate the changes in survival, antibiotic susceptibility, mutant frequency, ${\beta}$-lactamase activity, biofilm formation, and gene expression in Klebsiella pneumoniae after exposure to sequential antibiotic treatments of ciprofloxacin and meropenem. Treatments include control (CON; no addition), 1/2 MIC ciprofloxacin addition (1/2CIP), 2 MIC ciprofloxacin addition (2CIP), initial 1/2 MIC ciprofloxacin addition followed by 1/2 MIC meropenem (8 h-incubation) and 2 MIC ciprofloxacin (16 h-incubation) (1/2CIP-1/2MER-2CIP), initial 1/2 MIC ciprofloxacin addition followed by 1/2 MIC meropenem (8 h-incubation) and 2 MIC meropenem (16 h-incubation) (1/2CIP-1/2MER-2MER), and initial 1/2 MIC ciprofloxacin addition followed by 2 MIC ciprofloxacin(8 h-incubation) and 2 MIC meropenem(16 h-incubation) (1/2CIP-2CIP-2MER). No growth of K. pneumoniae was observed for the 2CIP throughout the incubation period. The numbers of planktonic cells varied with the treatments (7~10 log CFU/ml), while those of biofilm cells were not significantly different among treatments after 24-h incubation, showing approximately 7 log CFU/ml. Among the sequential treatments, the least mutant frequency was observed at the 1/2CIP-1/2MER-2CIP (14%). Compared to the CON, 1/2CIP-2CIP-2MER decreased the sensitivity of K. pneumoniae to piperacillin, cefotaxime, and nalidixic acid. The highest ${\beta}$-lactamase activity was 22 nmol/min/ml for 1/2CIP-1/2MER-2CIP, while the least ${\beta}$-lactamase activity was 6 nmol/min/ml for 1/2CIP-2CIP-2MER. The relative expression levels of multidrug efflux pump-related genes (acrA, acrB, and ramA) were increased more than 2-fold in K. pneumoniae exposed to 1/2CIP-1/2MER-2MER and 1/2CIP-2CIP-2MER. The results suggest that the sequential antibiotic treatments could change the antibiotic resistance profiles in K. pneumoniae.

• Journal of Veterinary Clinics
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• v.27 no.2
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• pp.125-129
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• 2010

A 2-year-old female Pomeranian dog was referred with multiple pelvic fractures. The surgical correction was performed for the fractures. However, after the surgery, purulent exudation was occurred in the surgical site. Antibiotic susceptibility test revealed that the isolated bacteria are resistant to penicillins, cephalosporins, aminoglycosides, quinolones, and trimethoprim/sulfamethoxazole. Bacterial identification and extended-spectrum $\beta$-lactamase (ESBL) confirming test indicated that the isolated bacteriae is ESBL-producing Klebsiella pneumoniae. Minimum inhibitory concentration (MIC) and maximum bactericidal concentration (MBC) tests revealed that meropenem, one of carbapenems, is the only effective antibiotic. The patient was treated with meropenem for 5 days. After 10 days, the exudation was disappeared and the infection was cured. The molecular typing of the ESBL revealed that TEM-1 ESBL is present in the bacteria isolated from the patient. The bacteria isolated from the owner's palm also revealed that TEM-1 and SHV-1 ESBLs are present.

• Microbiology and Biotechnology Letters
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• v.51 no.2
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• pp.214-216
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• 2023

Meropenem-resistant Pseudomonas peli CJ30 was isolated from the Han River, South Korea. The genome of strain CJ30 comprising 4,919,106 bp with a G + C content of 60.0% was assembled to nine contigs. The draft genome sequence contained 5,411 protein-coding genes, 18 rRNA genes, and 70 tRNA genes. Strain CJ30 contained bla_SFC-3 and ampC β-lactamase gene.

• Biomedical Science Letters
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• v.30 no.2
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• pp.96-99
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• 2024

In vitro antimicrobial activities of hot water extracts of Chamaecyparis obtuse, for clinical metallo-β-lactamase-Producing Pseudomonas aeruginosa (MBLPA.) was compared to commonly used conventional antimicrobial agents. All MBLPA was susceptible to colistin or amikacin, but also to imipenem 88.6%, meropenem 100%, piperacillin 85.7%, ceftazidime 97.1%, gentamicin 97.1%, and ciprofloxacin 100% were non-susceptible. MIC range to imipenem, meropenem, cefotaxime, ceftazidime, gentamicin, and ciprofloxacin for MBLPA were each 1 - >128 ㎍/mL, 4 - >128 ㎍/mL, 4 - >128 ㎍/mL, 8 - >128 ㎍/mL, 4 - >128, and 2- >128 ㎍/mL. MIC range to aztreonam for MBLPA were 1 - 128 ㎍/mL. MIC₉₀ to imipenem, meropenem, cefotaxime, ceftazidime, gentamicin, and ciprofloxacin for MBLPA were each 32 ㎍/mL, >128 ㎍/mL, >128 ㎍/mL, >128 ㎍/mL, >128 ㎍/mL, and 128 ㎍/mL. MIC₉₀ to colistin and amikacin were each 1 ㎍/mL and 64 ㎍/mL. The hot water extracts of C. obtuse leaf had the lowest MIC range (0.25 - >0.5 μL/mL), MIC₅₀ (>0.5 μL/mL), and MIC₉₀ (>0.5 μL/mL) of the clinical MBLPA tested, and it was possible more potent than various conventional antimicrobial agents for MBLPA infection patients. Therefore, it suggested the possibility of using extract components of C. obtuse or their derivatives to treat MBLPA infection patients.

• Korean Journal of Clinical Pharmacy
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• v.22 no.3
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• pp.234-238
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• 2012

Background: Valproic acid is widely used in the treatment of generalized tonic-clonic and partial seizures. The carbapenem class is the most potent and widest spectrum of antimicrobial activity. Concomitant administration of carbapenems and valproic acid has been reported to decrease the serum concentration of valproic acid, which is sometimes associated with seizures. The purpose of this study is to evaluate the changes in valproic acid concentration and half life and the frequency of seizure during concomitant administration of valproic acid and carbapenems. Method: This study was performed retrospectively on total 40 cases with identified valproic acid concentration during concomitant administration of valproic acid and carbapenems at Kangbuk Samsung Hospital from February 1st, 2006 to October 31st, 2011. Patients were classified into 3 groups: ertapenem group (n=14), imipenem group (n=12), meropenem group (n=14). Results: The mean serum concentrations in each group during combined treatment were $9.50{\pm}8.84$, $21.88{\pm}8.17$ and $10.62{\pm}8.67$ mg/L, respectively (p < 0.001). The mean half-lives in each group during concurrent use of valproic acid and carbapenems were $3.18{\pm}0.81$, $4.63{\pm}1.97$ and $2.67{\pm}1.69$ hr, respectively (p < 0.001). The valproic acid serum concentration decreased by 75.5%, 54.1% and 84.1% and the half-life of valporoic acid decreased by 65.6%, 35.7% and 73.5%, respectively. Total cases with seizure were 12(30%) with 5(35.7%) in the ertapenem group, 3 (25.0%) in the imipenem group and 4(28.6%) in the meropenem group (p=0.911). There were no specific factors to influence on seizure development during combined treatment. Conclusion: Concurrent use of carbapenems and valproic acid should be avoided. If concomitant administration is essential, very close serum concentration monitoring and clinical observation are necessary.

• Korean Journal of Clinical Laboratory Science
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• v.51 no.4
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• pp.444-452
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• 2019

Carbapenem resistance, mediated by the major acquired metallo-β-lactamase (MBL) genes, has been increasingly reported, particularly for clinical isolates of Acinetobacter spp. Of the 191 nonduplicate clinical isolates of the carbapenem-nonsusceptible Acinetobacter spp. evaluated, 125 isolates (65.4%) were positive for the modified imipenem or meropenem-Hodge test, and 49 isolates (25.7%) were positive for the imipenem-EDTA+SMA double disk synergy test (DDS). PCR and sequencing of the bla_VIM-2-allele and bla_IMP-1-allele showed that 29 A. baumannii isolates and 1 A. calcoaceticus isolate had bla_VIM-2, whereas 16 A. baumannii isolates and 2 A. calcoaceticus isolates had bla_IMP-6; 1 isolate of the A. genomospecies 3 had bla_VIM-2 and bla_AIM-1. All the above MBL genes belong to class 1 integron. The size of class 1 integron encompassing bla_VIM-2 or bla_IMP-6 ranges from 2.8 kb to 3.2 kb in clinical isolates of A. baumannii, and 3.2 kb to 3.5 kb in clinical isolates of A. genomospecies 3. bla_VIM-2 was most often located first or second in the class 1 integron, and these integrons often included aacA4. Due to dispersion of the MBL-producing Acinetobacter spp. as well as integron, which may encompass various resistance genes, there is an expectation for the increase of multidrug resistant Gram-negative bacteria, including resistance of carbapenems such as imipenem or meropenem. Hence, the development of new antimicrobial agents for treating severe Acinetobacter spp. infections is needed.