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Dequin PF, Aubron C, Faure H, Garot D, Guillot M, Hamzaoui O, Lemiale V, Maizel J, Mootien JY, Osman D, Simon M, Thille AW, Vinsonneau C, Kuteifan K. The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference. Ann Intensive Care 2023; 13:59. [PMID: 37400647 DOI: 10.1186/s13613-023-01155-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/11/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION New beta-lactams, associated or not with beta-lactamase inhibitors (NBs/BIs), can respond to the spread of carbapenemase-producing enterobacteriales and nonfermenting carbapenem-resistant bacteria. The risk of emergence of resistance to these NBs/BIs makes guidelines necessary. The SRLF organized a consensus conference in December 2022. METHODS An ad hoc committee without any conflict of interest (CoI) with the subject identified the molecules (ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam and cefiderocol); defined 6 generic questions; drew up a list of subquestions according to the population, intervention, comparison and outcomes (PICO) model; and reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Seven experts in the field proposed their own answers to the questions in a public session and answered questions from the jury (a panel of 10 critical-care physicians without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. Due to the frequent lack of powerful studies that have used clinically important criteria of judgment, the recommendations were formulated as expert opinions as often as necessary. RESULTS The jury provided 17 statements answering 6 questions: (1) Is there a place in the ICU for the probabilistic use of new NBs/IBs active against Gram-negative bacteria? (2) In the context of documented infections with sensitivity to several of these molecules, are there pharmacokinetic, pharmacodynamic, ecological or medico-economic elements for prioritization? (3) What are the possible combinations with these molecules and in what context? (4) Should we integrate these new molecules into a carbapenem-sparing strategy? (5) What pharmacokinetic and pharmacodynamic data are available to optimize their mode of administration in critically ill patients? (6) What are the dosage adaptations in cases of renal insufficiency, hepatocellular insufficiency or obesity? CONCLUSION These recommendations should optimize the use of NBs/BIs in ICU patients.
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Affiliation(s)
- Pierre-François Dequin
- Inserm UMR 1100, Centre d'Etudes des Pathologies Respiratoires, Université, Tours, France.
- Médecine Intensive Réanimation, Hôpital Bretonneau, 37044 Tours cedex 9, Tours, CHU, France.
| | - Cécile Aubron
- Médecine Intensive Réanimation CHU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Henri Faure
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal Robert Ballanger, Aulnay Sous-Bois, France
| | - Denis Garot
- Médecine Intensive Réanimation, Hôpital Bretonneau, 37044 Tours cedex 9, Tours, CHU, France
| | - Max Guillot
- Médecine Intensive Réanimation CHU, Hôpital de Hautepierre, Strasbourg, France
| | - Olfa Hamzaoui
- Médecine Intensive Réanimation CHU de Reims, Reims, France
| | - Virginie Lemiale
- Medical ICU, Saint Louis Hospital, APHP, 1 Avenue Claude Vellefaux, Paris, France
| | - Julien Maizel
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Joy Y Mootien
- Medical Intensive Care Unit, GHRMSA, Mulhouse, France
| | - David Osman
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marie Simon
- Maladies Infectieuses Et Tropicales, Hospices Civils de Lyon, Lyon, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation Centre Hospitalier de Bethune, Bethune, France
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Nasomsong W, Nulsopapon P, Changpradub D, Pungcharoenkijkul S, Hanyanunt P, Chatreewattanakul T, Santimaleeworagun W. Optimizing Doses of Ceftolozane/Tazobactam as Monotherapy or in Combination with Amikacin to Treat Carbapenem-Resistant Pseudomonas aeruginosa. Antibiotics (Basel) 2022; 11:antibiotics11040517. [PMID: 35453269 PMCID: PMC9026743 DOI: 10.3390/antibiotics11040517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 12/17/2022] Open
Abstract
Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a hospital-acquired pathogen with a high mortality rate and limited treatment options. We investigated the activity of ceftolozane/tazobactam (C/T) and its synergistic effects with amikacin to extend the range of optimal therapeutic choices with appropriate doses. The E-test method is used to determine in vitro activity. The optimal dosing regimens to achieve a probability of target attainment (PTA) and a cumulative fraction of response (CFR) of ≥90% were simulated using the Monte Carlo method. Of the 66 CRPA isolates, the rate of susceptibility to C/T was 86.36%, with an MIC50 and an MIC90 of 0.75 and 24 µg/mL, respectively. Synergistic and additive effects between C/T and amikacin were observed in 24 (40%) and 18 (30%) of 60 CRPA isolates, respectively. The extended infusion of C/T regimens achieved a ≥90% PTA of 75% and a 100% fT > MIC at C/T MICs of 4 and 2 µg/mL, respectively. Only the combination of either a short or prolonged C/T infusion with a loading dose of amikacin of 20−25 mg/kg, followed by 15−20 mg/kg/day amikacin dosage, achieved ≥90% CFR. The C/T infusion, combined with currently recommended amikacin dose regimens, should be considered to manage CRPA infections.
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Affiliation(s)
- Worapong Nasomsong
- Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok 10400, Thailand; (W.N.); (D.C.)
| | - Parnrada Nulsopapon
- Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand;
- Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group [PIRBIG], Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Dhitiwat Changpradub
- Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok 10400, Thailand; (W.N.); (D.C.)
| | | | - Patomroek Hanyanunt
- Division of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok 10400, Thailand; (P.H.); (T.C.)
| | - Tassanawan Chatreewattanakul
- Division of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok 10400, Thailand; (P.H.); (T.C.)
| | - Wichai Santimaleeworagun
- Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand;
- Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group [PIRBIG], Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
- Correspondence: ; Tel.: +66-34-255-800; Fax: +66-34-255-801
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Ferreira DR, Alves PC, Kirillov AM, Rijo P, André V. Silver(I)-Tazobactam Frameworks with Improved Antimicrobial Activity. Front Chem 2022; 9:815827. [PMID: 35145956 PMCID: PMC8822216 DOI: 10.3389/fchem.2021.815827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Tazobactam (TazoH) is a penicillinate sulfone β-lactamase inhibitor with negligible antimicrobial activity, commonly used with other antibiotics to provide an effective combination against many susceptible organisms expressing β-lactamases. Two novel Ag(I)-tazobactam frameworks ([Ag(I)-Tazo] and [Ag(I)-Tazo2]) prepared by mechanochemistry are presented herein as alternative forms to improve the antimicrobial activity of tazobactam by exploring synergistic effects with silver, being the first crystal structures reported of tazobactam coordinating to a metal site. The topological analysis of the 3D ([Ag(I)-Tazo]) and 2D+1D ([Ag(I)-Tazo2]) frameworks revealed underlying nets with the cbs (CrB self-dual) and decorated sql topologies, respectively. These novel frameworks are stable and show an enhanced antimicrobial activity when compared to tazobactam alone. Amongst the tested microorganisms, Pseudomonas aeruginosa is the most sensitive to tazobactam and the new compounds. This study thus unveils novel facets of tazobactam chemistry and opens up its application as a multifunctional linker for the design of antibiotic coordination frameworks and related materials.
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Affiliation(s)
- Daniela R. Ferreira
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associação do Instituto Superior Técnico para a Investigação e Desenvolvimento (IST-ID), Lisboa, Portugal
| | - Paula C. Alves
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associação do Instituto Superior Técnico para a Investigação e Desenvolvimento (IST-ID), Lisboa, Portugal
| | - Alexander M. Kirillov
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Patrícia Rijo
- Universidade Lusófona’s Research Center for Biosciences and Health Technologies (CBIOS), Lisboa, Portugal
- Faculty of Pharmacy, Research Institute for Medicines (iMed. ULisboa), Universidade de Lisboa, Lisboa, Portugal
| | - Vânia André
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Associação do Instituto Superior Técnico para a Investigação e Desenvolvimento (IST-ID), Lisboa, Portugal
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Cuba GT, Rocha-Santos G, Cayô R, Streling AP, Nodari CS, Gales AC, Pignatari ACC, Nicolau DP, Kiffer CRV. In vitro synergy of ceftolozane/tazobactam in combination with fosfomycin or aztreonam against MDR Pseudomonas aeruginosa. J Antimicrob Chemother 2021; 75:1874-1878. [PMID: 32240299 DOI: 10.1093/jac/dkaa095] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/02/2020] [Accepted: 02/20/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Carbapenem-resistant Pseudomonas aeruginosa (CR-PSA) imposes great limitations on empirical therapeutic choices, which are further complicated by metallo-β-lactamase production. This study evaluated in vitro antimicrobial synergy of ceftolozane/tazobactam in combination with aztreonam and fosfomycin against MDR PSA. METHODS MICs were determined by broth microdilution and gradient strips. The effect of ceftolozane/tazobactam+aztreonam and ceftolozane/tazobactam+fosfomycin combinations were tested against 27 MDR PSA isolates carrying blaSPM-1 (n = 13), blaIMP (n = 4), blaVIM (n = 3), blaGES-1 (n = 2) and blaCTX-M-like (n = 2), and 3 isolates with no acquired β-lactamase production detected by gradient diffusion strip crossing (GDSC). Six genetically unrelated SPM-1-producing isolates were also evaluated by time-kill analysis (TKA). RESULTS All CR-PSA isolates harbouring blaSPM-1, blaGES-1 and blaIMP-1 were categorized as resistant to ceftolozane/tazobactam, meropenem and fosfomycin, with 70% being susceptible to aztreonam. Synergism for ceftolozane/tazobactam+fosfomycin and ceftolozane/tazobactam+aztreonam combinations was observed for 88.9% (24/27) and 18.5% (5/27) of the isolates by GDSC, respectively. A 3- to 9-fold reduction in ceftolozane/tazobactam MICs was observed, depending on the combination. Ceftolozane/tazobactam+fosfomycin was synergistic by TKA against one of six SPM-1-producing isolates, with additional non-synergistic bacterial density reduction for another isolate. Aztreonam peak concentrations alone demonstrated a ≥3 log10 cfu/mL reduction against all six isolates, but all strains were within the susceptible range for the drug. No antagonism was observed. CONCLUSIONS In the context of increasing CR-PSA and the genetic diversity of resistance mechanisms, new combinations and stewardship strategies may need to be explored in the face of increasingly difficult to treat pathogens.
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Affiliation(s)
- Gabriel T Cuba
- Universidade Federal de São Paulo - UNIFESP, Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil
| | - Gerlan Rocha-Santos
- Universidade Federal de São Paulo - UNIFESP, Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil
| | - Rodrigo Cayô
- Universidade Federal de São Paulo - UNIFESP, Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil.,Universidade Federal de São Paulo - UNIFESP, Laboratório de Imunologia e Bacteriologia - LIB, Setor de Biologia Molecular, Microbiologia e Imunologia, Departamento de Ciências Biológicas - DCB, Instituto de Ciências Ambientais, Químicas e Farmacêuticas - ICAQF, Diadema - SP, Brazil
| | - Ana Paula Streling
- Universidade Federal de São Paulo - UNIFESP, Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil
| | - Carolina S Nodari
- Universidade Federal de São Paulo - UNIFESP, Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil
| | - Ana C Gales
- Universidade Federal de São Paulo - UNIFESP, Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil.,Universidade Federal de São Paulo - UNIFESP, Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil
| | - Antonio C C Pignatari
- Universidade Federal de São Paulo - UNIFESP, Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil.,Universidade Federal de São Paulo - UNIFESP, Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil
| | - David P Nicolau
- Center for Anti-infective Research and Development, Hartford Hospital, Hartford, CT, USA.,Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
| | - Carlos R V Kiffer
- Universidade Federal de São Paulo - UNIFESP, Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina - EPM, São Paulo - SP, Brazil
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Galani I, Papoutsaki V, Karantani I, Karaiskos I, Galani L, Adamou P, Deliolanis I, Kodonaki A, Papadogeorgaki E, Markopoulou M, Maraki S, Damala M, Prifti E, Vagiakou E, Petinaki E, Fountoulis K, Tsiplakou S, Kirikou H, Souli M, Antoniadou A, Giamarellou H. In vitro activity of ceftolozane/tazobactam alone and in combination with amikacin against MDR/XDR Pseudomonas aeruginosa isolates from Greece. J Antimicrob Chemother 2021; 75:2164-2172. [PMID: 32449909 DOI: 10.1093/jac/dkaa160] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/11/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES We evaluated the in vitro activity of ceftolozane/tazobactam and comparator agents against MDR non-MBL Pseudomonas aeruginosa isolates collected from nine Greek hospitals and we assessed the potential synergistic interaction between ceftolozane/tazobactam and amikacin. METHODS A total of 160 non-MBL P. aeruginosa isolates collected in 2016 were tested for susceptibility to ceftolozane/tazobactam and seven comparator agents including ceftazidime/avibactam. Time-kill assays were performed for synergy testing using ceftolozane/tazobactam 60 or 7.5 mg/L, corresponding to the peak and trough concentrations of a 1.5 g q8h dose, respectively, in combination with 69 mg/L amikacin, corresponding to the free peak plasma concentration. Synergy was defined as a ≥2 log10 cfu/mL reduction compared with the most active agent. RESULTS Overall, ceftolozane/tazobactam inhibited 64.4% of the P. aeruginosa strains at ≤4 mg/L. Colistin was the most active agent (MIC50/90, 0.5/2 mg/L; 96.3% susceptible) followed by ceftazidime/avibactam (MIC50/90, 4/16 mg/L; 80.6% susceptible). GES-type enzymes were predominantly responsible for ceftolozane/tazobactam resistance; 81.6% of the non-producers were susceptible. MICs for the P. aeruginosa isolates selected for synergy testing were 2-32 mg/L ceftolozane/tazobactam and 2-128 mg/L amikacin. The combination of ceftolozane/tazobactam with amikacin was synergistic against 85.0% of all the isolates tested and against 75.0% of the GES producers. No antagonistic interactions were observed. CONCLUSIONS Ceftolozane/tazobactam demonstrated good in vitro activity against MDR/XDR P. aeruginosa clinical isolates, including strains with co-resistance to other antipseudomonal drugs. In combination with amikacin, a synergistic interaction at 24 h was observed against 85.0% of P. aeruginosa strains tested, including isolates with ceftolozane/tazobactam MICs of 32 mg/L or GES producers.
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Affiliation(s)
- Irene Galani
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.,University General Hospital 'ATTIKON', Chaidari, Athens, Greece
| | | | - Irene Karantani
- Infectious Diseases Laboratory, Hygeia General Hospital, Athens, Greece
| | - Ilias Karaiskos
- 1st Internal Medicine & Infectious Diseases Clinic, Hygeia General Hospital, Athens, Greece
| | - Lamprini Galani
- 1st Internal Medicine & Infectious Diseases Clinic, Hygeia General Hospital, Athens, Greece
| | - Panagiota Adamou
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Antigoni Kodonaki
- Department of Microbiology, 'Laikon' General Hospital, Athens, Greece
| | | | | | - Sofia Maraki
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Damala
- Microbiology Department, 'Alexandra' General Hospital of Athens, Athens, Greece
| | - Eleni Prifti
- Microbiology Department, 'Alexandra' General Hospital of Athens, Athens, Greece
| | - Eleni Vagiakou
- Microbiology Laboratory, General Hospital of Athens 'G. Gennimatas', Athens, Greece
| | - Efthimia Petinaki
- Department of Microbiology, University Hospital of Larissa, Larissa, Greece
| | - Kimon Fountoulis
- Microbiology Department, Evangelismos General Hospital, Athens, Greece
| | | | - Helen Kirikou
- Microbiology Department, Agia Sofia Children's Hospital, Athens, Greece
| | - Maria Souli
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniadou
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Giamarellou
- 1st Internal Medicine & Infectious Diseases Clinic, Hygeia General Hospital, Athens, Greece
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Chen T, Xu W, Yu K, Zeng W, Xu C, Cao J, Zhou T. In Vitro Activity of Ceftazidime-Avibactam Alone and in Combination with Amikacin Against Colistin-Resistant Gram-Negative Pathogens. Microb Drug Resist 2020; 27:401-409. [PMID: 32721272 DOI: 10.1089/mdr.2019.0463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aims: Colistin became the critical treatment option for multidrug-resistant Gram-negative bacteria (GNB); however, resistance to colistin is increasingly being reported among clinical isolates. New therapy strategies should be considered nowadays. The aim of this study was to investigate the in vitro activity of a novel β-lactam/β-lactamases inhibitor ceftazidime-avibactam (CZA) alone and in combination with amikacin against colistin-resistant Gram-negative pathogens. Results: Among all the colistin-resistant GNB strains, 30.4% (21/69) were resistant to CZA, which was similar to the resistance rate of 25.4% (35/138) in colistin-susceptible strains (p > 0.05), displaying a relatively lower resistance rate compared with other antimicrobial agents (except amikacin). A majority of CZA-resistant GNB isolates (33/56) produced NDM carbapenemase. The fractional inhibitory concentration index method revealed synergistic (47.6%, 10/21) or additive (52.4%, 11/21) effects of CZA in combination with amikacin against colistin- and CZA-resistant GNB isolates, wherein the synergistic activity was found against all tested Klebsiella pneumoniae isolates (four) and Pseudomonas aeruginosa isolates (two). The time-killing curve assay verified the synergistic activity of CZA and amikacin in K. pneumoniae (FK2778) and P. aeruginosa (TL2294). The susceptible breakpoint index values showed that CZA in combination with amikacin reduced the MIC to less than the susceptibility breakpoint among 71.4% (15/21) of all tested strains. Conclusion: CZA may be a new alternative for colistin-resistant Gram-negative infections and pending clinical studies combining CZA with amikacin should be considered against these pathogens, particularly for K. pneumoniae and P. aeruginosa.
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Affiliation(s)
- Tao Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenya Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kaihang Yu
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Weiliang Zeng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Chunquan Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianming Cao
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Gatadi S, Gour J, Shukla M, Kaul G, Dasgupta A, Madhavi YV, Chopra S, Nanduri S. Synthesis and evaluation of new quinazolin-4(3H)-one derivatives as potent antibacterial agents against multidrug resistant Staphylococcus aureus and Mycobacterium tuberculosis. Eur J Med Chem 2019; 175:287-308. [PMID: 31096152 DOI: 10.1016/j.ejmech.2019.04.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 01/05/2023]
Abstract
Staphylococcus aureus and Mycobacterium tuberculosis are major causative agents responsible for serious nosocomial and community-acquired infections impacting healthcare systems globally. Over several decades, these pathogens have developed resistance to multiple antibiotics significantly affecting morbidity and mortality. Thus, these recalcitrant pathogens are amongst the most formidable microbial pathogens for which international healthcare agencies have mandated active identification and development of new antibacterial agents for chemotherapeutic intervention. In our present work, a series of new quinazolin-4(3H)-one derivatives were designed, synthesized and evaluated for their antibacterial activity against ESKAP pathogens and pathogenic mycobacteria. The experiments revealed that 4'c, 4'e, 4'f and 4'h displayed selective and potent inhibitory activity against Staphylococcus aureus with MIC values ranging from 0.03-0.25 μg/mL. Furthermore, compounds 4'c and 4'e were found to be benign to Vero cells (CC50 = >5 μg/mL) and displayed promising selectivity index (SI) > 167 and > 83.4 respectively. Additionally, 4'c and 4'e demonstrated equipotent MIC against multiple drug-resistant strains of S. aureus including VRSA, concentration dependent bactericidal activity against S. aureus and synergized with FDA approved drugs. Moreover, compound 4'c exhibited more potent activity in reducing the biofilm and exhibited a PAE of ∼2 h at 10X MIC which is comparable to levofloxacin and vancomycin. In vivo efficacy of 4'c in murine neutropenic thigh infection model revealed that 4'c caused a similar reduction in cfu as vancomycin. Gratifyingly, compounds 4d, 4e, 9a, 9b, 14a, 4'e and 4'f also exhibited anti-mycobacterial activity with MIC values in the range of 2-16 μg/mL. In addition, the compounds were found to be less toxic to Vero cells (CC50 = 12.5->100 μg/mL), thus displaying a favourable selectivity index. The interesting results obtained here suggest the potential utilization of these new quinazolin-4(3H)-one derivatives as promising antibacterial agents for treating MDR-Staphylococcal and mycobacterial infections.
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Affiliation(s)
- Srikanth Gatadi
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India
| | - Jitendra Gour
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India
| | - Manjulika Shukla
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India
| | - Grace Kaul
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India
| | - Arunava Dasgupta
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India
| | - Y V Madhavi
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India
| | - Sidharth Chopra
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India.
| | - Srinivas Nanduri
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India.
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Gatadi S, Gour J, Shukla M, Kaul G, Das S, Dasgupta A, Malasala S, Borra RS, Madhavi YV, Chopra S, Nanduri S. Synthesis of 1,2,3-triazole linked 4(3H)-Quinazolinones as potent antibacterial agents against multidrug-resistant Staphylococcus aureus. Eur J Med Chem 2018; 157:1056-1067. [PMID: 30176536 DOI: 10.1016/j.ejmech.2018.08.070] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 12/14/2022]
Abstract
Methicillin and vancomycin resistant Staphylococcus aureus infections are an emerging global health concern leading to increasing morbidity and mortality. Continuous increase in drug resistance has underlined the need for discovery and development of new antibacterial agents acting via novel mechanisms to overcome this pressing issue. In this context, a number of 1,2,3-triazole linked 4(3H)-quinazolinone derivatives were designed and synthesized as potent antibacterial agents. When evaluated against ESKAP pathogen panel, compounds 7a, 7b, 7c, 7e, 7f, 7g, 7h, 7i, 9a, 9c, 9d and 9e exhibited significantly selective inhibitory activities towards Staphylococcus aureus (MIC = 0.5-4 μg/mL). To understand and confirm the specificity of these compounds, the compounds 7a and 9a were tested against E. coli and A. baumannii in combination with sub-lethal concentrations of Polymyxin B nonapeptide (PMBN) and were found to be inactive. This clearly indicated that these compounds possess specific and potent activity towards S. aureus and are inactive against gram-negative pathogens. Encouragingly, the compounds were also found to be non toxic to Vero cells and displayed favourable selectivity index (SI = 40 to 80). Furthermore, 7a and 9a were found to possess potent inhibitory activity when tested against multidrug resistant S. aureus including strains resistant to vancomycin (MIC values 0.5-32 μg/mL), indicating that the compounds are able to escape current drug-resistance mechanisms. With the potent anti-bacterial activity exhibited the new series of 1,2,3-triazole linked 4(3H)-quinazolinones have emerged as promising candidates for treating multidrug resistant Staphylococcus aureus infections.
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Affiliation(s)
- Srikanth Gatadi
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500 037, India
| | - Jitendra Gour
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500 037, India
| | - Manjulika Shukla
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India
| | - Grace Kaul
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India
| | - Swetarka Das
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India
| | - Arunava Dasgupta
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India
| | - Satyaveni Malasala
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500 037, India
| | - Ramya Sri Borra
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500 037, India
| | - Y V Madhavi
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500 037, India
| | - Sidharth Chopra
- Division of Microbiology, CSIR-Central Drug Research Institute, Sitapur Road, Sector 10, Janakipuram Extension, Lucknow, 226031, Uttar Pradesh, India.
| | - Srinivas Nanduri
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500 037, India.
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Viana Marques DDA, Machado SEF, Ebinuma VCS, Duarte CDAL, Converti A, Porto ALF. Production of β-Lactamase Inhibitors by Streptomyces Species. Antibiotics (Basel) 2018; 7:E61. [PMID: 30018235 PMCID: PMC6163296 DOI: 10.3390/antibiotics7030061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/07/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022] Open
Abstract
β-Lactamase inhibitors have emerged as an effective alternative to reduce the effects of resistance against β-lactam antibiotics. The Streptomyces genus is known for being an exceptional natural source of antimicrobials and β-lactamase inhibitors such as clavulanic acid, which is largely applied in clinical practice. To protect against the increasing prevalence of multidrug-resistant bacterial strains, new antibiotics and β-lactamase inhibitors need to be discovered and developed. This review will cover an update about the main β-lactamase inhibitors producers belonging to the Streptomyces genus; advanced methods, such as genetic and metabolic engineering, to enhance inhibitor production compared with wild-type strains; and fermentation and purification processes. Moreover, clinical practice and commercial issues are discussed. The commitment of companies and governments to develop innovative strategies and methods to improve the access to new, efficient, and potentially cost-effective microbial products to combat the antimicrobial resistance is also highlighted.
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Affiliation(s)
- Daniela de Araújo Viana Marques
- Campus Serra Talhada, University of Pernambuco, Avenida Custódio Conrado, 600, AABB, Serra Talhada, Pernambuco 56912-550, Brazil.
| | - Suellen Emilliany Feitosa Machado
- Department of Antibiotics, Federal University of Pernambuco, Avenida da Engenharia, 2° andar, Cidade Universitária, Recife, Pernambuco 50740-600, Brazil.
| | - Valéria Carvalho Santos Ebinuma
- Department of Bioprocesses and Biotechnology, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara-Jaú/Km 01, Araraquara 14800-903, Brazil.
| | | | - Attilio Converti
- Department of Civil, Chemical and Environmental Engineering, Chemical Pole, University of Genoa, Via Opera Pia 15, 16145 Genoa, Italy.
| | - Ana Lúcia Figueiredo Porto
- Department of Morphology and Animal Physiology, Federal Rural University of Pernambuco, Av. Dom Manoel de Medeiros, Recife, Pernambuco 52171-900, Brazil.
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