Screening of MMV pandemic response and pathogen box compounds against pan-drug-resistant Klebsiella pneumoniae to identify potent inhibitory compounds

Background: The recent emergence of pan-drug-resistant (PDR) K. pneumoniae strains hinders the success rate of treatment procedures for patients. High mortality, extended duration of hospitalization with high costs is associated with such infections. Discovery and identification of new drugs are inevitable to combat PDR clinical pathogens. We aim to identify and evaluate new compounds in vitro against a PDR clinical K. pneumoniae isolate using compounds of Pathogen Box and Pandemic Response Box from Medicines for Malaria Venture (MMV).Methods: The PDR strain was initially screened with the 601 compounds from both Boxes at 10 mu M concentration. Formation of dormant cells against the drug activity was assessed using persister assay. MIC was determined for the drugs inhibiting PDR K. pneumoniae during initial screening.Results: Five compounds were identified to inhibit the test strain. MMV1580854 (94.60 %), MMV1579788 (94.65 %), MMV1578574 (eravacycline; 93.13 %), MMV1578566 (epetraborole; 95.29 %) and MMV1578564 (96.32 %) were able to exhibit a higher percentage of growth inhibition. Persisters were found to be growing in a range from 104 to 107 CFU/ml. Minimum inhibitory concentrations (MIC) of all compounds were >= 2 mu M except for MMV1579788, which had a MIC of >= 5 mu M.Conclusion: Five novel compounds were identified against the highly evolved pan-drug-resistant K. pneumoniae. Among the five, epetraborole andMMV1578564 were identified as highly potent based on the persister frequency and MICs. The pan-drug resistant clinical isolate used in this study was found to be acting differently from the reference or wild type strains against the test compounds in a previous study.