Biphasic bactericidal activity of nitroxoline against Acinetobacter baumannii isolates from urinary tract infections

Acinetobacter baumannii is a critical pathogen which can cause hospital-acquired infections, particularly urinary tract infections (UTIs). The antimicrobial resistance (AMR) of A. baumannii is rising which poses a significant challenge to clinical management. Nitroxoline, an old antibiotic for treating uncomplicated UTIs, has gained renewed interest as a potential therapeutic option. Here, we investigates the bactericidal activity of nitroxoline against 34 A. baumannii (17 carbapenem-resistant and 17 carbapenem-sensitive isolates) collected from UTI patients. Nitroxoline exhibited a biphasic bactericidal effect, characterized by enhanced efficacy up to an optimal bactericidal concentration (OBC), followed by declined activity at higher nitroxoline concentrations. The OBCs, minimum bactericidal concentration (MBC), minimum inhibitory concentration (MIC), and time-killing curves were evaluated to elucidate bactericidal activity. Raman deuterium stable isotope probing (Raman-DIP) was employed to validate nitroxolines bactericidal effect and its impact on bacterial metabolic activity and survival rates. These results demonstrate that nitroxoline exhibits excellent inhibitory and bactericidal activity against A. baumannii. While nitroxoline exhibits biphasic bactericidal activity with OBC50/90 values of 4/8 mg/L. Raman spectroscopy identified a decreased C-D ratio as nitroxoline concentration increased, indicating reduced metabolic activity. Notably, an inverse correlation (r = -0.7594, p <0.0001) was observed between bacterial survival and the ccratio at concentrations above the OBC. These findings underscore the necessity of optimizing dosing regimens to enhance nitroxolines therapeutic efficacy and alleviate AMR development. Raman-DIP emerges as a robust tool for assessing nitroxolines effects on bacterial metabolism and determining MIC, offering valuable insights for future clinical applications.