Acinetobacter baumannii transformants expressing oxacillinases and metallo-β-lactamases that confer resistance to meropenem: new tools for anti- Acinetobacter drug development and AMR preparedness.

Antimicrobial resistance (AMR) in Acinetobacter baumannii is an unmet medical need. Multiple drug-resistant/extremely drug-resistant strains of A. baumannii do not display growth well in in vivo models, and consequently, their response to antibacterial therapy is inconsistent. We addressed this issue by engineering carbapenem resistance motifs into the highly virulent genetic background of A. baumannii AB5075. This strain has a chromosomally encoded oxa-23 that was deleted ( Δoxa-23 ), then plasmids expressing oxa-23 , oxa-24/40 , oxa-58 , imp-1 , vim-2 , and ndm-1 were introduced to create the mutant strains. Each transformant was used as a challenge strain in a neutropenic murine thigh infection model and assessed for the extent of growth and response to meropenem 200 mg/kg subcutaneously every 6 h (q6h). Pharmacodynamic analyses were performed by transforming drug exposure from dose (mg/kg) to the fraction of the dosing interval; free meropenem concentrations were >minimum inhibitory concentration (MIC) ( f T > MIC). AB5075 and the AB5075 Δoxa-23 mutant had a MICs of 32 and 4 mg/L, respectively. The transformants harboring oxacillinases oxa-24/40 and oxa-58 had an MIC of 64 mg/L. The metallo-β-lactamases imp-1 , vim-2 , and ndm-1 had MICs of 128, 64, and 64 mg/L, respectively. All vehicle-treated transformants displayed in vivo growth in the range of 0.75-1.4 log. The response to meropenem was consistent with the varying f T > MIC of the transformants and was readily described by an inhibitory sigmoid E max relationship. Stasis was achieved with a f T > MIC of 0.36. These A. baumannii transformants are invaluable new tools for the assessment of anti- Acinetobacter compounds and provide a new pathway for AMR preparedness.