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Efficacy of generic meropenem products in combination with colistin in carbapenemase-producing Klebsiella pneumoniae experimental osteomyelitis.

  • Tattevin, P1
  • Dinh, A2
  • Ghout, I3
  • Mouton, W4
  • Verdier, M-C5
  • Laurent, F4
  • Lemaitre, F5
  • Gatin, L2
  • Saleh-Mghir, A6
  • Crémieux, A-C7
  • 1 Pontchaillou Univ. Hosp., Rennes, France; INSERM U1230, Université Rennes 1, IFR140, F-35033, Rennes, France. Electronic address: [email protected] , (France)
  • 2 UMR 1173, Versailles Saint-Quentin Université, Versailles, France; Raymond Poincaré Univ Hosp., Garches, France. , (France)
  • 3 Ambroise Paré Univ. Hosp., Boulogne, France. , (France)
  • 4 Lyon Univ. Hosp., Lyon, France. , (France)
  • 5 Pontchaillou Univ. Hosp., Rennes, France; INSERM CIC 1414, Université Rennes 1, F-35033, Rennes, France. , (France)
  • 6 UMR 1173, Versailles Saint-Quentin Université, Versailles, France. , (France)
  • 7 UMR 1173, Versailles Saint-Quentin Université, Versailles, France; St Louis Hospital AP-HP, Université, Paris 7, France. , (France)
Published Article
International journal of antimicrobial agents
Publication Date
Sep 05, 2020
DOI: 10.1016/j.ijantimicag.2020.106152
PMID: 32898684


Guidelines for the management of carbapenemase-producing Enterobacterales (CPE) infections recommend a combination of two active agents, including meropenem if MIC ≤ 8 mg/L. The therapeutic equivalence of meropenem generics has been challenged. We compared the bactericidal activity of meropenem princeps (AstraZeneca), and four different generic products (Actavis, Kabi, Mylan, Panpharma), in vitro and in vivo, in association with colistin. In vitro time-kill studies were performed at 4 x MICs. An experimental model of KPC-producing Klebsiella pneumoniae osteomyelitis was induced in rabbits by tibial injection of a sclerosing agent followed by 2 × 108 CFU of KPC-99YC (meropenem MIC, 4 mg/L; colistin MIC, 1 mg/L). Treatment started 14 days after inoculation, for 7 days, in 7 groups of >10 rabbits: control group, colistin, and one group for each meropenem product (i.e., the princeps, and the 4 generics), in combination with colistin. In vitro, meropenem + colistin were bactericidal with no viable bacteria after 6 h, and this effect was similar with all meropenem products. In the osteomyelitis model, there was no significant difference between meropenem generics and the princeps when combined with colistin. Colistin-resistant strains were detected after treatment with colistin + meropenem princeps (n=3), and generics (n=3). In conclusion, the efficacy of four generics of meropenem was not different from the princeps in vitro, and in an experimental model of KPC-producing K. pneumoniae osteomyelitis in rabbits, in terms of bactericidal activity, and emergence of resistance. Copyright © 2020. Published by Elsevier Ltd.

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