{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T17:27:43Z","timestamp":1775755663395,"version":"3.50.1"},"reference-count":26,"publisher":"Akademiai Kiado Zrt.","issue":"2","content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2025,6,20]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> (CRKP) is one of the major Gram-negative bacteria in human infections, which can cause pneumonia, sepsis, meningitis, and abscess. However, the current therapy for CRKP infection is polymyxin and tigecycline. The aim of this study is to analyze the <jats:italic>in vitro<\/jats:italic> antibacterial effects of cefoperazone\/sulbactam (SCF) combined with ceftazidime (CAZ), imipenem\/cilastatin (IMI), and meropenem (MEM) against CRKP harbouring different antibiotic resistance genes. In this study, fifteen clinical isolates of CRKP from January to December 2023 were taken from our hospital for bacterial identification and confirmation of carbapenemase genotypes, and the minimum inhibitory concentration (MIC) of SCF, CAZ, IMI, and MEM were determined by broth microdilution method. The results of combined drug sensitivity test were determined by checkerboard method and characterized with fractional inhibitory concentration (FIC). The combined antibacterial activity was determined by time-kill curve. The results showed that among the 15 CRKP strains, 9 carried <jats:italic>bla<\/jats:italic><jats:sub>KPC<\/jats:sub> gene, 3 carried <jats:italic>bla<\/jats:italic><jats:sub>NDM<\/jats:sub> gene and 3 carried <jats:italic>bla<\/jats:italic><jats:sub>OXA-48-like<\/jats:sub> gene. The MIC values determined by broth microdilution method showed better sensitivity of KPC-producing CRKP to four antimicrobial drugs including SCF. However, <jats:italic>bla<\/jats:italic><jats:sub>NDM<\/jats:sub> as well as <jats:italic>bla<\/jats:italic><jats:sub>OXA-48-like<\/jats:sub> genotypes showed strong resistance to all four antimicrobial drugs. The FIC values of SCF combined with CAZ, IMI and MEM showed that all tested antibacterial agents had the best effect on KPC-producing CRKP, and had no obvious additive effect on other CRKP. The results of time-kill curve showed that SCF combined with IMI had good antibacterial effect. This study found that SCF combined with IMI has a synergistic antibacterial effect on KPC producing carbapenem-resistant <jats:italic>K. pneumoniae<\/jats:italic>, which could provide reference for clinical practice.<\/jats:p>","DOI":"10.1556\/030.2025.02577","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T11:01:47Z","timestamp":1745406107000},"page":"106-112","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":2,"title":["Antibacterial efficacy of cefoperazone\/sulbactam in combination with various antimicrobials against carbapenem-resistant Klebsiella pneumoniae"],"prefix":"10.1556","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6250-1621","authenticated-orcid":true,"given":"Chunlai","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Jianhu County People's Hospital, Jianhu, Jiangsu 224700, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"B1","series-title":"Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection and in vitro sensitivity analysis to sitafloxacin","author":"Liu C","year":"2022","unstructured":"Liu C. Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection and in vitro sensitivity analysis to sitafloxacin. Chinese People's Liberation Army (PLA) Medical School; 2022."},{"issue":"3","key":"B2","series-title":"Chin J Infect Chemother","first-page":"277","article-title":"Bacterial resistance surveillance in CHINET tertiary hospitals","volume":"24","author":"Hu FP","year":"2022","unstructured":"Hu FP, Guo Y, Zhu DM, Wang F, Jiang XF, Xu YC, et al. Bacterial resistance surveillance in CHINET tertiary hospitals. Chin J Infect Chemother 2022; 24(3): 277\u2013286. https:\/\/doi.org\/10.16718\/j.1009-7708.2024.03.005."},{"issue":"6","key":"B3","series-title":"Microbiol Spectr","article-title":"Clinical risk factors and microbiological and intestinal characteristics of carbapenemase-producing Enterobacteriaceae colonization and subsequent infection","volume":"10","author":"Yuan WL","year":"2022","unstructured":"Yuan WL, Xu JL, Guo L, Chen YH, Gu JY, Zhang H, et al. Clinical risk factors and microbiological and intestinal characteristics of carbapenemase-producing Enterobacteriaceae colonization and subsequent infection. Microbiol Spectr 2022; 10(6). https:\/\/doi.org\/10.1128\/spectrum.01906-21."},{"key":"B4","series-title":"Microb Pathog","article-title":"Efficacy and safety of ceftazidime-avibactam compared to other antimicrobials for the treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae strains, a systematic review and meta-analysis","volume":"179","author":"Karampatakis T","year":"2023","unstructured":"Karampatakis T, Tsergouli K, Lowrie K. Efficacy and safety of ceftazidime-avibactam compared to other antimicrobials for the treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae strains, a systematic review and meta-analysis. Microb Pathog 2023; 179: 106090. https:\/\/doi.org\/10.1016\/j.micpath.2023.106090."},{"issue":"8","key":"B5","series-title":"Clin Microbiol Infect","first-page":"943","article-title":"Management of carbapenem-resistant Enterobacteriaceae infections","volume":"25","author":"Durante-Mangoni E","year":"2019","unstructured":"Durante-Mangoni E, Andini R, Zampino R. Management of carbapenem-resistant Enterobacteriaceae infections. Clin Microbiol Infect 2019; 25(8): 943\u2013950. https:\/\/doi.org\/10.1016\/j.cmi.2019.04.013."},{"issue":"2","key":"B6","series-title":"Int J Antimicrob Agents","article-title":"Carbapenemase-producing Enterobacterales infections: recent advances in diagnosis and treatment","volume":"59","author":"Lee YL","year":"2022","unstructured":"Lee YL, Chen HM, Hii IM, Hsueh PR. Carbapenemase-producing Enterobacterales infections: recent advances in diagnosis and treatment. 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Cefoperazone\/sulbactam: new composites against multiresistant gram negative bacteria? Infect Genet Evol 2021; 88: 104707. https:\/\/doi.org\/10.1016\/j.meegid.2021.104707."},{"issue":"2","key":"B9","series-title":"Antibiotics (Basel)","article-title":"In vitro antimicrobial activity of various Cefoperazone\/sulbactam products","volume":"9","author":"Sheu MJ","year":"2020","unstructured":"Sheu MJ, Chen CC, Lu YC, Su BA, Zhang CC, Wang SS, et al. In vitro antimicrobial activity of various Cefoperazone\/sulbactam products. Antibiotics (Basel) 2020; 9(2). https:\/\/doi.org\/10.3390\/antibiotics9020077."},{"issue":"12","key":"B10","series-title":"J Clin Microbiol","article-title":"Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, M100, 31st edition","volume":"59","author":"Humphries R","year":"2021","unstructured":"Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, M100, 31st edition. J Clin Microbiol 2021; 59(12): e21321. https:\/\/doi.org\/10.1128\/JCM.00213-21."},{"issue":"03","key":"B11","series-title":"Chin J Infect Chemother","first-page":"287","article-title":"In vitro co-sensitization of carbapenem-resistant enterobacteriaceae by 11 combination protocols","volume":"22","author":"Lu GP","year":"2023","unstructured":"Lu GP, Tang H, Xia ZX, Men WQ, Shen JL. In vitro co-sensitization of carbapenem-resistant enterobacteriaceae by 11 combination protocols. Chin J Infect Chemother 2023; 22(03): 287\u2013294. https:\/\/10.12138\/j.issn.1671-9638.20233384."},{"key":"B12","series-title":"Antimicrob Resist Infect Control","first-page":"142","article-title":"In vitro and in vivo bactericidal activity of ceftazidime-avibactam against Carbapenemase-producing Klebsiella pneumoniae","volume":"7","author":"Zhang WX","year":"2018","unstructured":"Zhang WX, Guo Y, Li JY, Zhang YY, Yang Y, Dong D, et al. In vitro and in vivo bactericidal activity of ceftazidime-avibactam against Carbapenemase-producing Klebsiella pneumoniae. 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