Activity of three b-lactams (ertapenem, meropenem and ampicillin) against intraphagocytic Listeria monocytogenes and Staphylococcus aureus

Objectives: Assessment of the activity of three b-lactams [ertapenem (a carbapenem with a prolonged half-life), meropenem and ampicillin] against intraphagocytic Listeria monocytogenes and Staphylo-coccus aureus. Methods: Quantitative measurements of cfu changes in broth and in THP-1 macrophages (post-phagocytosis) over time (5 and 24h) at concentrations spanning from sub-MICs to Cmax (maximal concentration typically observed in patients ’ serum upon administration of conventional doses); morphological studies using an electron microscope; evaluation of drug stability (HPLC), protein bind-ing (equilibrium dialysis) and measurement of drug cellular accumulation (microbiological assay). Results: Ertapenem was unable to control L. monocytogenes growth in THP-1 macrophages at all con-centrations and times tested, even under conditions where ampicillin and meropenem were bacteri-cidal. This behaviour could not be ascribed to drug instability, protein binding or lack of cell accumulation in comparison with ampicillin or meropenem. Ertapenem, ampicillin and meropenem were equally effective at reducing the post-phagocytosis inoculum of S. aureus ( 1 log cfu), and caused conspicuous changes in the morphology of intracellular bacteria consistent with their lysis. These effects were obtained, however, only at large multiples (100-fold or more) of the MIC maintained over 24h. Because of the high intrinsic antimicrobial potency of the b-lactams studied, these concen-trations were below the Cmax. Conclusions: Ertapenem will probably be ineffective against intraphagocytic forms of L. monocyto-genes for reasons that remain to be discovered. Conversely, ertapenem could be an alternative to ampicillin and meropenem against intraphagocytic S. aureus since its longer half-life may allow high concentrations to be maintained for more prolonged times