Mechanistic insights into synergy between nalidixic acid and tetracycline against clinical isolates of Acinetobacter baumannii and Escherichia coli

Commun Biol. 2021 May 10;4(1):542. doi: 10.1038/s42003-021-02074-5.

Abstract

The increasing prevalence of antimicrobial resistance has become a global health problem. Acinetobacter baumannii is an important nosocomial pathogen due to its capacity to persist in the hospital environment. It has a high mortality rate and few treatment options. Antibiotic combinations can help to fight multi-drug resistant (MDR) bacterial infections, but they are rarely used in the clinics and mostly unexplored. The interaction between bacteriostatic and bactericidal antibiotics are mostly reported as antagonism based on the results obtained in the susceptible model laboratory strain Escherichia coli. However, in the present study, we report a synergistic interaction between nalidixic acid and tetracycline against clinical multi-drug resistant A. baumannii and E. coli. Here we provide mechanistic insight into this dichotomy. The synergistic combination was studied by checkerboard assay and time-kill curve analysis. We also elucidate the mechanism behind this synergy using several techniques such as fluorescence spectroscopy, flow cytometry, fluorescence microscopy, morphometric analysis, and real-time polymerase chain reaction. Nalidixic acid and tetracycline combination displayed synergy against most of the MDR clinical isolates of A. baumannii and E. coli but not against susceptible isolates. Finally, we demonstrate that this combination is also effective in vivo in an A. baumannii/Caenorhabditis elegans infection model (p < 0.001).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acinetobacter Infections / drug therapy*
  • Acinetobacter Infections / microbiology
  • Acinetobacter baumannii / isolation & purification*
  • Animals
  • Anti-Bacterial Agents / pharmacology
  • Caenorhabditis elegans / drug effects
  • Caenorhabditis elegans / growth & development*
  • Caenorhabditis elegans / microbiology
  • Drug Synergism*
  • Escherichia coli / isolation & purification*
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / microbiology
  • Humans
  • Microbial Sensitivity Tests
  • Nalidixic Acid / pharmacology*
  • Tetracyclines / pharmacology*

Substances

  • Anti-Bacterial Agents
  • Tetracyclines
  • Nalidixic Acid