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Phage Therapy as an Alternative Treatment Modality for Resistant Staphylococcus aureus Infections. Antibiotics (Basel) 2023; 12:antibiotics12020286. [PMID: 36830196 PMCID: PMC9952150 DOI: 10.3390/antibiotics12020286] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
The production and use of antibiotics increased significantly after the Second World War due to their effectiveness against bacterial infections. However, bacterial resistance also emerged and has now become an important global issue. Those most in need are typically high-risk and include individuals who experience burns and other wounds, as well as those with pulmonary infections caused by antibiotic-resistant bacteria, such as Pseudomonas aeruginosa, Acinetobacter sp, and Staphylococci. With investment to develop new antibiotics waning, finding and developing alternative therapeutic strategies to tackle this issue is imperative. One option remerging in popularity is bacteriophage (phage) therapy. This review focuses on Staphylococcus aureus and how it has developed resistance to antibiotics. It also discusses the potential of phage therapy in this setting and its appropriateness in high-risk people, such as those with cystic fibrosis, where it typically forms a biofilm.
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Miyazaki T, Yanagihara K, Kakeya H, Izumikawa K, Mukae H, Shindo Y, Yamamoto Y, Tateda K, Tomono K, Ishida T, Hasegawa Y, Niki Y, Watanabe A, Soma K, Kohno S. Daily practice and prognostic factors for pneumonia caused by methicillin-resistant Staphylococcus aureus in Japan: A multicenter prospective observational cohort study. J Infect Chemother 2019; 26:242-251. [PMID: 31575499 DOI: 10.1016/j.jiac.2019.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/07/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
Pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) is associated with poor clinical outcomes. We surveyed clinical outcomes of MRSA pneumonia in daily practice to identify risk factors for the clinical failure and mortality in patients with MRSA pneumonia. This multicenter prospective observational study was performed across 48 Japanese medical institutions. Adult patients with culture-positive MRSA pneumonia were recruited and treated with anti-MRSA antibiotics. The relationships between clinical and microbiological characteristics and clinical outcomes at test of cure (TOC) or 30-day all-cause mortality were analyzed. In total, 199 eligible patients, including nursing and healthcare-associated pneumonia (n = 95), hospital-acquired pneumonia (n = 76), and community-acquired pneumonia (n = 25), received initial treatment with anti-MRSA agents such as vancomycin (n = 135), linezolid (n = 36), or teicoplanin (n = 22). Overall clinical failure rate at TOC and the 30-day mortality rate were 51.1% (48/94 patients) and 33.7% (66/196 patients), respectively. Multivariable logistic regression analyses for vancomycin-treated populations revealed that abnormal white blood cell count (odds ratio [OR] 4.34, 95% confidence interval [CI] 1.31-14.39) was a risk factor for clinical failure and that no therapeutic drug monitoring (OR 3.10, 95% CI 1.35-7.12) and abnormally high C-reactive protein level (OR 3.54, 95% CI 1.26-9.92) were risk factors for mortality. In conclusion, this study provides evidence that majority of MRSA pneumonia patients are initially treated with vancomycin in Japan, and the absence of therapeutic drug monitoring for vancomycin is significantly associated with the mortality in patients with MRSA pneumonia.
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Affiliation(s)
- Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshihito Niki
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Akira Watanabe
- Research Division for Development of Anti-Infective Agents, Institute of Development, Aging and Cancer, Tohoku University, Miyagi, Japan
| | - Kazui Soma
- Emergency Medical Center, Kitasato University Hospital, Kanagawa, Japan
| | - Shigeru Kohno
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
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Anstead GM, Cadena J, Javeri H. Treatment of infections due to resistant Staphylococcus aureus. Methods Mol Biol 2014; 1085:259-309. [PMID: 24085702 DOI: 10.1007/978-1-62703-664-1_16] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This chapter reviews data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review covers findings reported in the English language medical literature up to January of 2013. Despite the emergence of resistant and multidrug-resistant S. aureus, we have seven effective drugs in clinical use for which little resistance has been observed: vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, telavancin, ceftaroline, and daptomycin. However, vancomycin is less effective for infections with MRSA isolates that have a higher MIC within the susceptible range. Linezolid is probably the drug of choice for the treatment of complicated MRSA skin and soft tissue infections (SSTIs); whether it is drug of choice in pneumonia remains debatable. Daptomycin has shown to be non-inferior to either vancomycin or β-lactams in the treatment of staphylococcal SSTIs, bacteremia, and right-sided endocarditis. Tigecycline was also non-inferior to comparator drugs in the treatment of SSTIs, but there is controversy about whether it is less effective than other therapeutic options in the treatment of more serious infections. Telavancin has been shown to be non-inferior to vancomycin in the treatment of SSTIs and pneumonia, but has greater nephrotoxicity. Ceftaroline is a broad-spectrum cephalosporin with activity against MRSA; it is non-inferior to vancomycin in the treatment of SSTIs. Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, rifampin, moxifloxacin, and minocycline are oral anti-staphylococcal agents that may have utility in the treatment of SSTIs and osteomyelitis, but the clinical data for their efficacy is limited. There are also several drugs with broad-spectrum activity against Gm-positive organisms that have reached the phase II and III stages of clinical testing that will hopefully be approved for clinical use in the upcoming years: oritavancin, dalbavancin, omadacycline, tedizolid, delafloxacin, and JNJ-Q2. Thus, there are currently many effective drugs to treat resistant S. aureus infections and many promising agents in the pipeline. Nevertheless, S. aureus remains a formidable adversary, and despite our deep bullpen of potential therapies, there are still frequent treatment failures and unfortunate clinical outcomes. The following discussion summarizes the clinical challenges presented by MRSA, the clinical experience with our current anti-MRSA antibiotics, and the gaps in our knowledge on how to use these agents to most effectively combat MRSA infections.
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Affiliation(s)
- Gregory M Anstead
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
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Aston JL, Dortch MJ, Dossett LA, Creech CB, May AK. Risk factors for treatment failure in patients receiving vancomycin for hospital-acquired methicillin-resistant Staphylococcus aureus pneumonia. Surg Infect (Larchmt) 2010; 11:21-8. [PMID: 19689198 DOI: 10.1089/sur.2008.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The rate of vancomycin failure in patients with hospital-acquired pneumonia (HAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) has exceeded 40% in several studies. This observation was attributed initially to the lack of weight-based dosing and targeting of lower trough concentrations. However, a subsequent study demonstrated no additional benefit in patients who achieved trough vancomycin concentrations >15 mg/L compared with patients with concentrations between 5 and 15 mg/L. We sought to identify contributors to vancomycin failure in patients with MRSA HAP. METHODS This was a retrospective study of patients in a surgical intensive care unit with MRSA HAP who received vancomycin between January 1, 2005, and July 31, 2007. Clinical outcomes, microbiological data, prior antibiotic exposure, ventilator days, co-morbidities, and demographics were compared in patients with clinical success and those with treatment failure. Their characteristics were compared using a two-sided Fisher exact test or Mann-Whitney U test, as appropriate for nominal or continuous data. RESULTS More patients in the treatment failure group had received one or more doses of vancomycin within 90 days leading up to MRSA HAP (84% vs. 47%; p = 0.04). In addition, the duration of prior vancomycin exposure was significantly longer among patients in the treatment failure group (6 vs. 0 days; p < 0.05). There were no statistically significant differences in the percentages of patients who achieved a vancomycin trough concentrations > or =15 mg/dL within the first 48 h (28% vs. 17%; p = 0.69), 72 h (44% vs. 39%; p = 1.0), or 96 h (56% vs. 44%; p = 0.74) after starting treatment. Patients in the failure group had a significantly higher overall mortality rate (32% vs. 0; p = 0.02). CONCLUSIONS These data suggest that patients who have recent exposure to vancomycin are at high risk for vancomycin failure and may benefit from an appropriate alternative when a diagnosis of MRSA HAP is made.
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Affiliation(s)
- Jonathan L Aston
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37232-7610, USA.
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Falagas ME, Vardakas KZ. Benefit-Risk Assessment of Linezolid for Serious Gram-Positive Bacterial Infections. Drug Saf 2008; 31:753-68. [DOI: 10.2165/00002018-200831090-00004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Vardakas KZ, Ntziora F, Falagas ME. Linezolid: effectiveness and safety for approved and off-label indications. Expert Opin Pharmacother 2007; 8:2381-400. [DOI: 10.1517/14656566.8.14.2381] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Anstead GM, Quinones-Nazario G, Lewis JS. Treatment of infections caused by resistant Staphylococcus aureus. Methods Mol Biol 2007; 391:227-58. [PMID: 18025681 DOI: 10.1007/978-1-59745-468-1_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We review data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). In this review, we cover findings reported in the English language medical literature up to February 2006. Despite the emergence of resistant and multidrug resistant S. aureus, five effective drugs for which little resistance has been observed are in clinical use: vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, and daptomycin. However, vancomycin is less effective for infections with MRSA isolates that have a high minimum inhibitory concentration in the susceptible range. Linezolid looks promising in the treatment of MRSA pneumonia and skin and soft-tissue infections (SSTIs). Daptomycin displays rapid bactericidal activity in vitro, and it has been shown to be noninferior to comparator agents in the treatment of SSTIs and bacteremia. Tigecycline was also noninferior to comparator drugs in the treatment of SSTIs. Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, and minocycline are oral antistaphylococcal agents that may have utility in the treatment of SSTIs and osteomyelitis, but the clinical data for their efficacy is limited. There are four drugs with broad-spectrum activity against Gram-positive organisms at an advanced stage of clinical testing: ceptobiprole and three new glycopeptides with potent bactericidal activity, oritavancin, dalbavancin, and telavancin. Thus, there are currently many effective drugs to treat resistant S. aureus infections and many promising agents in the pipeline. Nevertheless, S. aureus remains a formidable adversary against which there are frequent treatment failures. The next goals are to determine the most appropriate indications and cost-effectiveness of each of these drugs in the treatment strategy against S. aureus.
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Affiliation(s)
- Gregory M Anstead
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Micek ST, Heuring TJ, Hollands JM, Shah RA, Kollef MH. Optimizing antibiotic treatment for ventilator-associated pneumonia. Pharmacotherapy 2006; 26:204-13. [PMID: 16466325 DOI: 10.1592/phco.26.2.204] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ventilator-associated pneumonia (VAP) is the most common infectious complication in patients receiving mechanical ventilation and accounts for exorbitant use of resources in the intensive care unit. Antimicrobial management of VAP incorporates an initial broad-spectrum, empiric regimen to ensure appropriate coverage with deescalation of therapy after 48-72 hours based on culture results and sensitivities. When VAP clinically responds to treatment, antimicrobials should be discontinued after 7-8 days to reduce overall antibiotic consumption and the selection pressure on flora observed in the intensive care unit and thus minimize the development and spread of antimicrobial resistance.
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Affiliation(s)
- Scott T Micek
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
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Levison ME, Fung S. Community-associated methicillin-resistant Staphylococcus aureus: reconsideration of therapeutic options. Curr Infect Dis Rep 2006; 8:23-30. [PMID: 16448597 DOI: 10.1007/s11908-006-0031-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Methicillin resistance, long recognized as characteristic of nosocomial Staphylococcus aureus, has increasingly been identified in community-acquired strains in the past 15 years. The genotypes of community-associated methicillin-resistant S. aureus (MRSA) are different from nosocomial strains, and unlike nosocomial strains, they have a distinctive methicillin-resistance chromosomal cassette (designated type IV), are usually susceptible to multiple classes of antimicrobials other than beta-lactams, carry a distinctive virulence factor (the Panton-Valentine leukocidin), cause mainly skin and soft tissue infection and less frequently, necrotizing pneumonia, and involve predominantly children and young adults. Outbreaks have been reported in certain segments of the population (eg, football players, wrestlers, prison inmates, and native people) that often do not have the established risk factors for MRSA. However, these strains have also caused infections likely acquired in an institutional health care setting. Delay in starting appropriate antibiotic therapy for severe infections caused by MRSA can be life-threatening. This requires a reconsideration of the empiric choice of an anti-staphylococcal beta-lactam for seriously ill patients with suspected community-associated S. aureus infections.
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Maltezou HC, Giamarellou H. Community-acquired methicillin-resistant Staphylococcus aureus infections. Int J Antimicrob Agents 2006; 27:87-96. [PMID: 16423509 DOI: 10.1016/j.ijantimicag.2005.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) should no longer be regarded as a strictly nosocomial pathogen. During the past decade, community-acquired MRSA (CA-MRSA) infections among young persons without healthcare-associated (HCA) risk factors have emerged in several areas worldwide. These infections are caused by strains that almost exclusively carry the staphylococcal cassette chromosome mec type IV element and the Panton-Valentine leukocidin genes and, unlike HCA-MRSA strains, are not multiresistant. Although the majority of CA-MRSA infections are mild skin and soft tissue infections, severe life-threatening cases of necrotizing pneumonia, necrotizing fasciitis, myonecrosis and sepsis have been reported. Clindamycin is an effective agent for skin and soft tissue infections, however attention should be paid to the possibility of the emergence of resistance during treatment in strains with the macrolide, lincosamide and group B streptogramin (MLS(B))-inducible resistance phenotype. For patients with invasive infections that may be caused be CA-MRSA, vancomycin, teicoplanin and linezolid represent appropriate empirical therapeutic options.
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Affiliation(s)
- Helen C Maltezou
- Office for Nosocomial Infections, Microbe Resistance and Strategy Concerning the Use of Antibiotics, Hellenic Center for Infectious Disease Control, Athens, Greece
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11
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Koulenti D, Myrianthefs P, Dimopoulos G, Baltopoulos G. Neumonía nosocomial causada por Staphylococcus aureus resistente a meticilina. Enferm Infecc Microbiol Clin 2005; 23 Suppl 3:37-45. [PMID: 16854340 DOI: 10.1157/13091219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of hospital acquired pneumonia (HAP) and the second most frequently isolated pathogen from patients who die from HAP. High-risk units for MRSA colonization such as intensive care (ICU's) are the most affected. Multiple risk factors for transmission of MRSA have been identified, including colonization pressure and severity of illness at ICU admission. On the other hand, the most important predisposing factor for MRSA infection is prolonged mechanical ventilation and/or previous antibiotic therapy. Controlling the spread of MRSA remains a major challenge for hospitals. Screening programs, together with contact precautions for cases with MRSA and judicious antimicrobial use are major factors for a successful control. Early appropriate initial therapy is of crucial importance and improves outcome. The standard therapy has been glycopeptides but, in spite of its in vitro activity, mortality in critically ill patients treated with glycopeptides has consistently been reported high, mainly due to their poor lung penetration. Linezolid shows better clinical cure and survival rates, but further studies are needed. As the treatment options for MRSA pneumonia are limited and inadequate, development of more effective drugs is mandatory.
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Affiliation(s)
- Despoina Koulenti
- Athens University School of Nursing ICU, KAT General Hospital, Atenas, Grecia.
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Ziglam HM, Elliott I, Wilson V, Hill K, Nathwani D. Clinical audit of linezolid use in a large teaching hospital. J Antimicrob Chemother 2005; 56:423-6. [PMID: 15946987 DOI: 10.1093/jac/dki185] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Linezolid, the first available agent in the new class of oxazolidinone antibiotics, represents a significant advance in the management options available for combating methicillin-resistant Staphylococcus aureus (MRSA) infections. In the UK it was launched for clinical use in 2001. The aim of this study was to audit the clinical use of linezolid and compliance with the guidelines of the hospital antibiotic committee. METHODS Our hospital antibiotic committee agreed clinical indications for linezolid use. We undertook an audit of compliance with these recommendations and also reviewed its use in terms of the source of infection, microbiology, duration of therapy, side-effects and choice of previous treatment. RESULTS Seventy-seven inpatients prescribed linezolid in Ninewells Hospital in the 3 years between March 2001 and September 2003 were audited. Overall compliance with our local recommendations appears to be very good. The main justification for using linezolid is the presence of existing or worsening renal dysfunction or poor venous access (34%) or lack of tolerance or clinical failure following glycopeptide monotherapy or combination therapy (32%). Skin and soft tissue infections (26%) were the most frequently diagnosed infections, although an increasing number of patients appear to receive linezolid for the treatment of lower respiratory tract infections, primarily in the ICU for nosocomial or ventilator-associated pneumonia. MRSA organisms were the most common cause of microbiologically proven treated infections [n = 43 (56%)]. Disappointingly, only 34 out of 77 patients had case record documentation of prior approval by an infection specialist. CONCLUSIONS The use of linezolid in our hospital appears to follow local guidelines, but the quality of information recorded in the notes could be optimized. Consequently, a linezolid mandatory order form to be completed by the attending prescribing clinician has been introduced, and will be subject to future evaluation. We recommend such specific antibiotic utilization reviews or audits of new agents introduced into clinical infection practice.
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Affiliation(s)
- H M Ziglam
- Department of Infection, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
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Wargo KA, Eiland EH. Appropriate Antimicrobial Therapy for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carrying the Panton-Valentine Leukocidin Genes. Clin Infect Dis 2005; 40:1376-8; author reply 1378-9. [PMID: 15825047 DOI: 10.1086/429509] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Deresinski S. Methicillin-Resistant Staphylococcus aureus: An Evolutionary, Epidemiologic, and Therapeutic Odyssey. Clin Infect Dis 2005; 40:562-73. [PMID: 15712079 DOI: 10.1086/427701] [Citation(s) in RCA: 272] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Accepted: 11/10/2004] [Indexed: 11/03/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus, first identified just over 4 decades ago, has undergone rapid evolutionary changes and epidemiologic expansion. It has spread beyond the confines of health care facilities, emerging anew in the community, where it is rapidly becoming a dominant pathogen. This has led to an important change in the choice of antibiotics in the management of community-acquired infections and has also led to the development of novel antimicrobials.
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Affiliation(s)
- Stan Deresinski
- Division of Infectious Disease and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.
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Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C, Tasker R, Vallet B. Year in review in intensive care medicine, 2004. I. Respiratory failure, infection, and sepsis. Intensive Care Med 2004; 31:28-40. [PMID: 15609018 PMCID: PMC7079835 DOI: 10.1007/s00134-004-2529-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Accepted: 11/26/2004] [Indexed: 01/15/2023]
Affiliation(s)
| | | | | | - Laurent Brochard
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
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16
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Anstead GM, Owens AD. Recent advances in the treatment of infections due to resistant Staphylococcus aureus. Curr Opin Infect Dis 2004; 17:549-55. [PMID: 15640709 DOI: 10.1097/00001432-200412000-00007] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This paper reviews recent data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review will focus on new findings reported in the English-language medical literature from June 2003 to September 2004. RECENT FINDINGS Despite the emergence of resistant and multidrug-resistant S. aureus, we have three effective drugs in clinical use for which little resistance has been observed: quinupristin-dalfopristin, linezolid, and daptomycin. Linezolid looks particularly promising in the treatment of MRSA pneumonia. Daptomycin displays rapid bactericidal activity in vitro, but, so far, clinical trials have only been conducted for the treatment of skin and soft-tissue infections. There are three drugs with broad-spectrum activity against Gram-positive organisms at an advanced stage of testing: two new glycopeptides with potent bacteriocidal activity and long half-lives (oritavancin and dalbavancin), and tigecycline, a minocycline derivative. These drugs have also shown efficacy in the treatment of skin and soft-tissue infections. SUMMARY The promising data that have emerged in the last year indicate that we may have six available drugs to treat resistant S. aureus infections within the next few years. The next goal is to determine the appropriate indications and cost-effectiveness of each of these drugs in our treatment strategy against S. aureus and other Gram-positive pathogens.
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Affiliation(s)
- Gregory M Anstead
- Medical Service, Department of Veterans Affairs Medical Center South Texas Veterans Health Care System, San Antonio, TX 78229-3900, USA.
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Affiliation(s)
- Neil Hall
- Specialist Registrar in Anaesthesia, University Hospitals of Leicester, Leicester, UK
| | - Gareth Williams
- Consultant in Anaesthesia and Critical Care, University Hospitals of Leicester, Leicester, UK
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