# Pharmacokinetics/pharmacodynamics of KSP-1007 in combination with meropenem against carbapenemase-producing gram-negative bacteria in a neutropenic murine thigh infection model

## TL;DR

A new drug combination improves treatment of antibiotic-resistant bacteria in a mouse model.

## Contribution

KSP-1007 enhances meropenem efficacy against carbapenemase-producing bacteria in a neutropenic mouse model.

## Key findings

- The %fT>CT parameter best predicts KSP-1007/MEM efficacy against carbapenemase-producing bacteria.
- Frequent dosing of KSP-1007 maximizes its effect on meropenem activity against resistant strains.
- Efficacy is not dependent on peak drug concentration but on time above threshold.

## Abstract

KSP-1007 is a novel bicyclic boronate-based broad-spectrum β-lactamase inhibitor that improves meropenem (MEM) efficacy against gram-negative bacteria (GNB) producing serine- and metallo-type carbapenemases. We investigated which pharmacokinetics (PK)/pharmacodynamics (PD) parameters of KSP-1007 correlated with MEM/KSP-1007 efficacy against carbapenemase-producing (CP) Enterobacterales (CPE) and Acinetobacter baumannii (CPAB) in a neutropenic murine thigh infection model. Infected neutropenic mice were subcutaneously treated with MEM every 3 h for 24 h alone or in combination with KSP-1007 administered at 3-, 6-, 12-, or 24-h dosing intervals. The bacterial burden in the thigh was assessed 2 h and 26 h after infection. The percentage of the dosing interval at which the free drug concentration exceeded the threshold concentration (%fT>CT) was a good predictor of activity against serine- and metallo-CPE and CPAB based on coefficients of determinations (R2 = 0.5–0.8) and a visual inspection of the plots showing %fT>CT against the change in log10 CFU/thigh, although the area under the 24-h free drug concentration time-curve yielded similar R2 values. The required values for %fT>CT at 0.25–4 μg/mL were 20.4%–4.2% (stasis) and 45.1%–14.1% (1-log10 kill) for serine-CPE and 48.6%–13.3% (stasis) and 97.9%–42.3% (1-log10 kill) for metallo-CPE. The corresponding values for CPAB at thresholds of 0.5–8 μg/mL were 15.3%–4.3% and 33.9%–8.7%. Frequent dosing of KSP 1007 maximized its potentiation of MEM activity against most of the tested CP-GNB strains. Therefore, the in vivo efficacy of KSP-1007 with MEM against CP-GNB was not dependent on the peak free drug concentration of KSP-1007, making KSP-1007 an optimal partner for MEM, which exhibits time-dependent activity.