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Tiwari P, Thakkar S, Dufossé L. Antimicrobials from endophytes as novel therapeutics to counter drug-resistant pathogens. Crit Rev Biotechnol 2024:1-27. [PMID: 38710617 DOI: 10.1080/07388551.2024.2342979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/29/2024] [Indexed: 05/08/2024]
Abstract
The rapid increase in antimicrobial resistance (AMR) projects a "global emergency" and necessitates a need to discover alternative resources for combating drug-resistant pathogens or "superbugs." One of the key themes in "One Health Concept" is based on the fact that the interconnected network of humans, the environment, and animal habitats majorly contribute to the rapid selection and spread of AMR. Moreover, the injudicious and overuse of antibiotics in healthcare, the environment, and associated disciplines, further aggravates the concern. The prevalence and persistence of AMR contribute to the global economic burden and are constantly witnessing an upsurge due to fewer therapeutic options, rising mortality statistics, and expensive healthcare. The present decade has witnessed the extensive exploration and utilization of bio-based resources in harnessing antibiotics of potential efficacies. The discovery and characterization of diverse chemical entities from endophytes as potent antimicrobials define an important yet less-explored area in natural product-mediated drug discovery. Endophytes-produced antimicrobials show potent efficacies in targeting microbial pathogens and synthetic biology (SB) mediated engineering of endophytes for yield enhancement, forms a prospective area of research. In keeping with the urgent requirements for new/novel antibiotics and growing concerns about pathogenic microbes and AMR, this paper comprehensively reviews emerging trends, prospects, and challenges of antimicrobials from endophytes and their effective production via SB. This literature review would serve as the platform for further exploration of novel bioactive entities from biological organisms as "novel therapeutics" to address AMR.
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Affiliation(s)
- Pragya Tiwari
- Department of Biotechnology, Yeungnam University, Gyeongsan, Republic of Korea
| | - Shreya Thakkar
- Department of Biotechnology and Bioengineering, Institute of Advanced Research, Gandhinagar, India
| | - Laurent Dufossé
- Laboratoire CHEMBIOPRO (Chimie et Biotechnologie des Produits Naturels), ESIROI Département agroalimentaire, Université de La Réunion, Saint-Denis, France
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Le CY, Ye YJ, Xu J, Li L, Feng XQ, Chen NP, Zhu BQ, Ding ZS, Qian CD. Hinokitiol Selectively Enhances the Antibacterial Activity of Tetracyclines against Staphylococcus aureus. Microbiol Spectr 2023; 11:e0320522. [PMID: 36943047 PMCID: PMC10101018 DOI: 10.1128/spectrum.03205-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
The increasing prevalence of antibiotic resistance causes an urgent need for alternative agents to combat drug-resistant bacterial pathogens. Plant-derived compounds are promising candidates for the treatment of infections caused by antibiotic-resistant bacteria. Hinokitiol (β-thujaplicin), a natural tropolone derivative found in the heartwood of cupressaceous plants, has been widely used in oral and skin care products as an antimicrobial agent. The aim of this work was to study the synergy potential of hinokitiol with antibiotics against Staphylococcus aureus, which is an extremely successful opportunistic pathogen capable of causing nosocomial and community-acquired infections worldwide. The MIC was determined by the broth microdilution method, and the effect of combinations was evaluated through fractional inhibitory concentration indices (FICI). The mechanism behind this synergy was also investigated by using fluorescence spectroscopy and high-performance liquid chromatography (HPLC). The MICs of hinokitiol alone against most S. aureus strains were 32 μg/mL. Selectively synergistic activities (FICIs of ≤0.5) were observed for combinations of this phytochemical with tetracyclines against all tested strains of S. aureus. Importantly, hinokitiol at 1 μg/mL completely or partially reversed tetracycline resistance in staphylococcal isolates. The increased accumulation of tetracycline inside S. aureus in the presence of hinokitiol was observed. In addition, hinokitiol promoted the uptake of ethidium bromide (EB) in bacterial cells without membrane depolarization, suggesting that it may be an efflux pump inhibitor. IMPORTANCE The disease caused by S. aureus is a public health issue due to the continuing emergence of drug-resistant strains, particularly methicillin-resistant S. aureus (MRSA). Tetracyclines, one of the old classes of antimicrobials, have been used for the treatment of infections caused by S. aureus. However, the increased resistance to tetracyclines together with their toxicity have limited their use in the clinic. Here, we demonstrated that the combination of hinokitiol and tetracyclines displayed synergistic antibacterial activity against S. aureus, including tetracycline-resistant strains and MRSA, offering a potential alternative approach for the treatment of infections caused by this bacterium.
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Affiliation(s)
- Chun-Yan Le
- College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yu-Jian Ye
- Department of Dermatology, Third People’s Hospital of Hangzhou, Hangzhou, China
| | - Jian Xu
- College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lei Li
- College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xi-Qing Feng
- College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ni-Pi Chen
- College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bing-Qi Zhu
- College of Medical Technology, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhi-Shan Ding
- College of Medical Technology, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chao-Dong Qian
- College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, China
- Institute of Molecular Medicine, College of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
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Kim S, Lee JW, Kim JH, Truong VM, Park YS. Assessing Microleakage at 2 Different Implant-Healing Abutment Interfaces. Int Dent J 2022; 73:370-376. [PMID: 36075760 DOI: 10.1016/j.identj.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate implants from different manufacturers and determine whether implant-healing abutment interface has a significant impact on implant seal. METHODS An air-injection pressure measurement test was performed on implants with either line-contact (modified TSIII [TSM] and Bone Level Tapered [BLT]) or partial face-contact (BlueDiamond [BD], SuperLine [SL], ISII, and UFII) interface design from 6 different manufacturers. Forty implants per implant type were analysed. Pressure data were evaluated with Kruskal-Wallis test and Dunn's post hoc analysis (statistical significance was set at P < .05). RESULTS BLT implants leaked when the mean pressure was increased to 199.9 kPa. The following implants showed mean leakage pressures of 182.9 (TSM), 157.4 (BD), 112.9 (SL), 101.8 (ISII), and 30.6 (UFII). There was a significant difference between line-contact and partial face-contact implants (P < .001). CONCLUSIONS The implant interface design has a significant impact on implant microbial leakage. Implants with a line-contact interface exhibited a higher resistance to leakage than those with partial face-contact.
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Affiliation(s)
- Soyeon Kim
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Joo Won Lee
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jae-Heon Kim
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Van Mai Truong
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Young-Seok Park
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea; Center for Future Dentistry, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
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Discovery of a novel class of small-molecule antibacterial agents against Staphylococcus aureus. Future Med Chem 2021; 14:299-305. [PMID: 34951320 DOI: 10.4155/fmc-2021-0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: With constantly increasing resistance against the known antibiotics, the search for novel antibacterial compounds is a challenge. The number of synthetic antibacterial agents is limited. Materials & methods: We discovered novel small-molecule antibacterial agents that are accessible via a simple two-step procedure. The evaluation against Staphylococcus aureus showed antibacterial effects depending on the substituent positioning at the residues of the molecular scaffold. Additionally, we investigated the potential of the compounds to increase the antibacterial activity of tetracycline. Results: The most effective antibacterial compounds possessed a 3-methoxy function at an aromatic residue. In combination with tetracycline, we found a strong effect for a few compounds in boosting the antibacterial activity, so the first promising lead compounds with dual activities could be identified.
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Bidell MR, Lodise TP. Use of oral tetracyclines in the treatment of adult outpatients with skin and skin structure infections: Focus on doxycycline, minocycline, and omadacycline. Pharmacotherapy 2021; 41:915-931. [PMID: 34558677 PMCID: PMC9292343 DOI: 10.1002/phar.2625] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 12/12/2022]
Abstract
Oral tetracyclines have been used in clinical practice for over 60 years. One of the most common indications for use of oral tetracyclines is for treatment of adult outpatients with skin and soft infections (SSTIs), including acute bacterial skin and skin structure infections (ABSSSIs). The 2014 Infectious Diseases Society of America (IDSA) skin and soft tissue guideline strongly recommends sulfamethoxazole/trimethoprim, clindamycin, and tetracyclines as oral treatment options for patients with purulent SSTIs, especially when methicillin‐resistant Staphylococcus aureus is of clinical concern. Despite the long‐standing use of tetracyclines, practice patterns indicate that they are often considered after other guideline‐concordant oral options for the treatment of patients with SSTIs. Clinicians may therefore be less familiar with the clinical data associated with use of commercially available tetracycline agents for treatment of patients with SSTI. This review summarizes the literature on the use of oral tetracyclines (ie, doxycycline, minocycline, and omadacycline) for the treatment of adult patients with SSTIs. As part of this review, we describe their common mechanisms of resistance, susceptibility profiles against common SSTI pathogens, pharmacokinetics and pharmacodynamics, and comparative clinical data.
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Affiliation(s)
- Monique R Bidell
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas P Lodise
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
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Antifungal Azoles as Tetracycline Resistance Modifiers in Staphylococcus aureus. Appl Environ Microbiol 2021; 87:e0015521. [PMID: 33990311 DOI: 10.1128/aem.00155-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus has developed resistance to antimicrobials since their first use. The S. aureus major facilitator superfamily (MFS) efflux pump Tet(K) contributes to resistance to tetracyclines. The efflux pump diminishes antibiotic accumulation, and biofilm hampers the diffusion of antibiotics. None of the currently known compounds have been approved as efflux pump inhibitors (EPIs) for clinical use. In the current study, we screened clinically approved drugs for possible Tet(K) efflux pump inhibition. By performing in silico docking followed by in vitro checkerboard assays, we identified five azoles (the fungal ergosterol synthesis inhibitors) showing putative EPI-like potential with a fractional inhibitory concentration index of ≤0.5, indicating synergism. The functionality of the azoles was confirmed using ethidium bromide (EtBr) accumulation and efflux inhibition assays. In time-kill kinetics, the combination treatment with butoconazole engendered a marked increase in the bactericidal capacity of tetracycline. When assessing the off-target effects of the azoles, we observed no disruption of bacterial membrane permeability and polarization. Finally, the combination of azoles with tetracycline led to a significant eradication of preformed mature biofilms. This study demonstrates that azoles can be repurposed as putative Tet(K) EPIs and to reduce biofilm formation at clinically relevant concentrations. IMPORTANCE Staphylococcus aureus uses efflux pumps to transport antibiotics out of the cell and thus increases the dosage at which it endures antibiotics. Also, efflux pumps play a role in biofilm formation by the excretion of extracellular matrix molecules. One way to combat these pathogens may be to reduce the activity of efflux pumps and thereby increase pathogen sensitivity to existing antibiotics. We describe the in silico-based screen of clinically approved drugs that identified antifungal azoles inhibiting Tet(K), a pump that belongs to the major facilitator superfamily, and showed that these compounds bind to and block the activity of the Tet(K) pump. Azoles enhanced the susceptibility of tetracycline against S. aureus and its methicillin-resistant strains. The combination of azoles with tetracycline led to a significant reduction in preformed biofilms. Repurposing approved drugs may help solve the classical toxicity issues related to efflux pump inhibitors.
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Noel AR, Attwood M, Bowker KE, MacGowan AP. The pharmacodynamics of minocycline alone and in combination with rifampicin against Staphylococcus aureus studied in an in vitro pharmacokinetic model of infection. J Antimicrob Chemother 2021; 76:1840-1844. [PMID: 33975336 DOI: 10.1093/jac/dkab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tetracyclines are widely used as oral therapy of MRSA infection, however, the pharmacodynamic underpinning is absent. OBJECTIVES We employed an in vitro pharmacokinetic model to study the pharmacodynamics of minocycline alone and in combination with rifampicin. METHODS An exposure-ranging design was used to establish fAUC/MIC targets for static, -1 log drop and -2 log drop effects against Staphylococcus aureus for minocycline and in combination with rifampicin. We then simulated 7-10 day human dosing of minocycline and the combination. RESULTS The minocycline fAUC/MIC for 24 h static effect and -1 log drop in bacterial load were 12.5 ± 7.1 and 23.3 ± 12.4. fAUC/MIC targets for static and -1 log drop were greater at 48 and 72 h. The addition of simulated free rifampicin associated with dosing 300 mg q12h reduced the 24 h minocycline fAUC/MICs. Simulations performed over 7-10 days exposure indicated that for minocycline standard human doses there was a 1-3 log reduction in viable count and no changes in population profiles. Addition of rifampicin resulted in larger reductions in staphylococcal load but emergence of resistance to rifampicin. There was no resistance to minocycline. CONCLUSIONS An fAUC/MIC minocycline target of 12-36 is appropriate for S. aureus. Addition of rifampicin decreases bacterial load but results in emergence of resistance to rifampicin. Unusually, there was no emergence of resistance to minocycline.
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Affiliation(s)
- A R Noel
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), North Bristol NHS Trust, Department of Infection Sciences, Pathology Sciences Building-Phase 2, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - M Attwood
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), North Bristol NHS Trust, Department of Infection Sciences, Pathology Sciences Building-Phase 2, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - K E Bowker
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), North Bristol NHS Trust, Department of Infection Sciences, Pathology Sciences Building-Phase 2, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - A P MacGowan
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), North Bristol NHS Trust, Department of Infection Sciences, Pathology Sciences Building-Phase 2, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
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Sivaraman GK, Sivam V, Ganesh B, Elangovan R, Vijayan A, Mothadaka MP. Whole genome sequence analysis of multi drug resistant community associated methicillin resistant Staphylococcus aureus from food fish: detection of clonal lineage ST 28 and its antimicrobial resistance and virulence genes. PeerJ 2021; 9:e11224. [PMID: 34113482 PMCID: PMC8158172 DOI: 10.7717/peerj.11224] [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: 10/13/2020] [Accepted: 03/15/2021] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant staphylococcus aureus (MRSA) sequence type 28 (ST 28) and spa type t021 is a CC30, prototype of ST-30, Community Associated-MRSA (CA-MRSA) (lukS-lukF +). It is a multi-drug resistant strain harbouring staphylococcal endotoxins, haemolysins, ureolysin, serine protease, and antimicrobial resistance genes. In this study, we report the draft genome sequence of this MRSA isolated from the most commonly used food fish, ribbon fish (Trichiurus lepturus). The total number of assembled paired-end high-quality reads was 7,731,542 with a total length of 2.8Mb of 2797 predicted genes. The unique ST28/ t021 CA- MRSA in fish is the first report from India, and in addition to antibiotic resistance is known to co-harbour virulence genes, haemolysins, aureolysins and endotoxins. Comprehensive comparative genomic analysis of CA-MRSA strain7 can help further understand their diversity, genetic structure, diversity and a high degree of virulence to aid in fisheries management.
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Affiliation(s)
- Gopalan Krishnan Sivaraman
- Microbiology, Fermentation & Biotechnology, ICAR- Central Institute of Fisheries Technology, Cochin, Kerala, India
| | - Visnuvinayagam Sivam
- Microbiology, Fermentation & Biotechnology, ICAR- Central Institute of Fisheries Technology, Cochin, Kerala, India
| | - Balasubramanian Ganesh
- Division of Laoratory, ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Ardhra Vijayan
- Microbiology, Fermentation & Biotechnology, ICAR- Central Institute of Fisheries Technology, Cochin, Kerala, India
| | - Mukteswar Prasad Mothadaka
- Microbiology, Fermentation & Biotechnology, ICAR- Central Institute of Fisheries Technology, Cochin, Kerala, India
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Abstract
Staphylococcus aureus is the most common bacteria causing purulent skin and soft tissue infections. Many disease-causing S aureus strains are methicillin resistant; thus, empiric therapy should be given to cover methicillin-resistant S aureus. Bacterial wound cultures are important for characterizing local susceptibility patterns. Definitive antibiotic therapy is warranted, although there are no compelling data demonstrating superiority of any one antibiotic over another. Antibiotic choice is predicated by the infection severity, local susceptibility patterns, and drug-related safety, tolerability, and cost. Response to therapy is expected within the first days; 5 to 7 days of therapy is typically adequate to achieve cure.
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Abstract
The rates of methicillin-resistant infections in the hand and upper extremity approach 50% in many facilities. In addition, multidrug resistance is beginning to include clindamycin. This article discusses the history, prevalence, and treatment of both community-acquired and health care-associated methicillin-resistant Staphylococcus aureus in regard to hand infections.
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Affiliation(s)
- Jessica M Intravia
- Philadelphia Hand to Shoulder Center, 834 Chestnut Street, Philadelphia, PA 19107, USA.
| | - Meredith N Osterman
- Philadelphia Hand to Shoulder Center, 834 Chestnut Street, Philadelphia, PA 19107, USA
| | - Rick Tosti
- Philadelphia Hand to Shoulder Center, 834 Chestnut Street, Philadelphia, PA 19107, USA
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Bart G, Zeller V, Kerroumi Y, Heym B, Meyssonnier V, Desplaces N, Kitzis MD, Ziza JM, Marmor S. Minocycline Combined with Vancomycin for the Treatment of Methicillin-Resistant Coagulase-Negative Staphylococcal Prosthetic Joint Infection Managed with Exchange Arthroplasty. J Bone Jt Infect 2020; 5:110-117. [PMID: 32566448 PMCID: PMC7295649 DOI: 10.7150/jbji.43254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/14/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction: Treatment of methicillin-resistant (MR) staphylococcal prosthetic joint infections (PJIs) remains a matter of discussion, with vancomycin-rifampin combination therapy being the preferred treatment for DAIR and one-stage exchange arthroplasty strategies. This study analyzes the outcomes of patients with chronic methicillin-resistant coagulase-negative staphylococcal PJIs treated with vancomycin-minocycline combination therapy. Methods: This prospective, single center cohort study included all chronic MR coagulase-negative staphylococcal PJIs (01/2004-12/2014) treated with exchange arthroplasty and at least 4 weeks of minocycline-vancomycin. The following endpoints were considered: reinfection including relapse (same microorganism) and a new infection (different microorganism) and PJI-related deaths. Their outcomes were compared with PJIs treated with rifampin-vancomycin during the same period. Results: Thirty-four patients (median age, 69 years) with 22 hip and 12 knee arthroplasty infections were included. Sixteen (47%) had previously been managed in another center. Median vancomycin MIC of strains was 3 mg/L. Nineteen underwent one-stage, 15 two-stage exchange arthroplasty. After a median [IQR] follow-up of 43 [26-68] months, 2 patients relapsed and 6 developed a new PJI. Compared to 36 rifampin-vancomycin treated PJIs, relapse- or reinfection-free survival rates didn't differ, but more new infections developed in the minocycline group (6 vs 3; P 0.3). Conclusions: Minocycline-vancomycin combination therapy for chronic MR coagulase-negative staphylococcal PJIs seems to be an interesting therapeutic alternative.
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Affiliation(s)
- Géraldine Bart
- Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Valérie Zeller
- Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.,Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Beate Heym
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.,Laboratoire des Centres de Santé et Hôpitaux d'Ile de France, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Vanina Meyssonnier
- Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.,Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Nicole Desplaces
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | | | - Jean Marc Ziza
- Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.,Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.,Service de Chirurgie Osseuse et Traumatologique; Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
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Dagher M, Fowler VG, Wright PW, Staub MB. A Narrative Review of Early Oral Stepdown Therapy for the Treatment of Uncomplicated Staphylococcus aureus Bacteremia: Yay or Nay? Open Forum Infect Dis 2020; 7:ofaa151. [PMID: 32523971 PMCID: PMC7270708 DOI: 10.1093/ofid/ofaa151] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
Historically, intravenous (IV) antibiotics have been the cornerstone of treatment for uncomplicated Staphylococcus aureus bacteremia (SAB). However, IV antibiotics are expensive, increase the rates of hospital readmission, and can be associated with catheter-related complications. As a result, the potential role of oral antibiotics in the treatment of uncomplicated SAB has become a subject of interest. This narrative review article aims to summarize key arguments for and against the use of oral antibiotics to complete treatment of uncomplicated SAB and evaluates the available evidence for specific oral regimens. We conclude that evidence suggests that oral step-down therapy can be an alternative for select patients who meet the criteria for uncomplicated SAB and will comply with medical treatment and outpatient follow-up. Of the currently studied regimens discussed in this article, linezolid has the most support, followed by fluoroquinolone plus rifampin.
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Affiliation(s)
- Michael Dagher
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Patty W Wright
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Milner B Staub
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Geriatric Research, Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee, USA
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Markley JL, Fang L, Gasparrini AJ, Symister CT, Kumar H, Tolia NH, Dantas G, Wencewicz TA. Semisynthetic Analogues of Anhydrotetracycline as Inhibitors of Tetracycline Destructase Enzymes. ACS Infect Dis 2019; 5:618-633. [PMID: 30835428 DOI: 10.1021/acsinfecdis.8b00349] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The synthesis and biological evaluation of semisynthetic anhydrotetracycline analogues as small molecule inhibitors of tetracycline-inactivating enzymes are reported. Inhibitor potency was found to vary as a function of enzyme (major) and substrate-inhibitor pair (minor), and anhydrotetracycline analogue stability to enzymatic and nonenzymatic degradation in solution contributes to their ability to rescue tetracycline activity in whole cell Escherichia coli expressing tetracycline destructase enzymes. Taken collectively, these results provide the framework for the rational design of next-generation inhibitor libraries en route to a viable and proactive adjuvant approach to combat the enzymatic degradation of tetracycline antibiotics.
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Affiliation(s)
| | | | - Andrew J. Gasparrini
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, 4513 Clayton Ave., Campus Box 8510, St. Louis, Missouri 63108, United States
| | | | - Hirdesh Kumar
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, BG 29B Rm 4NN08, Bethesda, Maryland 20814, United States
| | - Niraj H. Tolia
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, BG 29B Rm 4NN08, Bethesda, Maryland 20814, United States
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, 4513 Clayton Ave., Campus Box 8510, St. Louis, Missouri 63108, United States
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri 63110, United States
- Department of Molecular Microbiology, Washington University School of Medicine, 4515 McKinley Avenue, fifth Floor, Room 5314, St. Louis, Missouri 63110, United States
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Isolation and Characterization of Antibiotic-producing Endophytic Bacteria from Citrus aurantifolia Swingle. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2018. [DOI: 10.22207/jpam.12.3.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Payne KD, Das A, Ndiulor M, Hall RG. Dosing strategies to optimize currently available anti-MRSA treatment options (Part 2: PO options). Expert Rev Clin Pharmacol 2017; 11:139-149. [DOI: 10.1080/17512433.2018.1411800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kenna D. Payne
- Pharmacy Practice Department, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Amrita Das
- Texas Tech University Health Sciences Center, Dallas, TX, USA
| | | | - Ronald G. Hall
- Texas Tech University Health Sciences Center, Dallas, TX, USA
- Dose Optimization and Outcomes Research (DOOR) program, Dallas, TX, USA
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16
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Carter MK, Ebers VA, Younes BK, Lacy MK. Doxycycline for Community-Associated Methicillin-Resistant Staphylococcus aureus Skin and Soft-Tissue Infections. Ann Pharmacother 2016; 40:1693-5. [PMID: 16896018 DOI: 10.1345/aph.1h084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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17
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Sabol KE, Echevarria KL, Lewis JS. Community-Associated Methicillin-Resistant Staphylococcus aureus: New Bug, Old Drugs. Ann Pharmacother 2016; 40:1125-33. [PMID: 16735661 DOI: 10.1345/aph.1g404] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To discuss community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections and evaluate older antibiotics as suitable therapeutic treatment options. Data Sources: Searches of MEDLINE, EMBASE, and the Cochrane Library (1966–May 2006) were performed using the key terms methicillin resistance, community-acquired, community associated, treatment, Staphylococcus aureus, mec, and Panton-Valentine leukocidin. Study Selection and Data Extraction: All articles were critically evaluated and all relevant information was included in this review. Data Synthesis: There has been a documented shift of methicillin resistance occurring in staphylococcal infections manifested within the community. Infections caused by CA-MRSA possess unique characteristics including lack of hospital-associated risk factors, improved susceptibility patterns, distinct genotypes, faster doubling times, and additional toxins. Potential therapeutic options to treat these infections include trimethoprim/sulfamethoxazole (TMP/SMX), clindamycin, tetracyclines, fluoroquinolones, and new antimicrobials. Conclusions: CA-MRSA infections can be successfully treated with older, oral antibiotic agents including TMP/SMX, clindamycin, and tetracyclines. Fluoroquinolones and linezolid should be avoided as first-line agents.
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Affiliation(s)
- Kathryn E Sabol
- Infectious Diseases, Parkland Health and Hospital System, Dallas, TX 78229, USA
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18
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VanEperen AS, Segreti J. Empirical therapy in Methicillin-resistant Staphylococcus Aureus infections: An Up-To-Date approach. J Infect Chemother 2016; 22:351-9. [PMID: 27066882 DOI: 10.1016/j.jiac.2016.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) continues to be an important pathogen worldwide, with high prevalence of infection in both community and hospital settings. Timely and appropriate choice of empirical therapy in the setting of MRSA infection is imperative due to the high rate of associated morbidity and mortality with MRSA infections. Initial choices should be made based on the site and severity of the infection, most notably moderate skin and soft tissue infections which may be treated with oral antibiotics (trimethoprim-sulfamethoxazole, clindamycin, doxycycline/minocycline, linezolid) in the outpatient setting, versus choice of parenteral therapy in the inpatient setting of more invasive or severe disease. Though the current recommendations continue to strongly rely on vancomycin as a standard empiric choice in the setting of severe/invasive infections, alternative therapies exist with studies supporting their non-inferiority. This includes the use of linezolid in pneumonia and severe skin and skin structure infections (SSSI) and daptomycin for MRSA bacteremia, endocarditis, SSSIs and bone/joint infections. Additionally, concerns continue to arise in regards to vancomycin, such as increasing isolate MICs, and relatively high rates of clinical failures with vancomycin. Thus, the growing interest in vanomycin alternatives, such as ceftaroline, ceftobribole, dalbavancin, oritavancin, and tedizolid, and their potential role in treating MRSA infections.
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Affiliation(s)
- Alison S VanEperen
- Section of Infectious Diseases, Rush University Medical Center, 600 South Paulina, Suite 143 Armour Academic Facility, Chicago, IL 60612, USA
| | - John Segreti
- Section of Infectious Diseases, Rush University Medical Center, 600 South Paulina, Suite 143 Armour Academic Facility, Chicago, IL 60612, USA.
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19
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Carris NW, Pardo J, Montero J, Shaeer KM. Minocycline as A Substitute for Doxycycline in Targeted Scenarios: A Systematic Review. Open Forum Infect Dis 2015; 2:ofv178. [PMID: 26719847 PMCID: PMC4690502 DOI: 10.1093/ofid/ofv178] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/11/2015] [Indexed: 01/08/2023] Open
Abstract
Doxycycline remains on intermittent shortage. Evidence supports the substitution of minocycline in skin and soft-tissue infections and carefully selected cases of pneumonia. Minocycline may be carefully considered in Lyme disease prophylaxis and Rickettsial disease in the complete absence of doxycycline. Doxycycline, a commonly prescribed tetracycline, remains on intermittent shortage. We systematically reviewed the literature to assess minocycline as an alternative to doxycycline in select conditions, given doxycycline's continued shortage. We identified 19 studies, 10 of which were published before 2000. Thirteen of the studies were prospective, but only 1 of these studies was randomized. Based on the available data, we found minocycline to be a reasonable substitute for doxycycline in the following scenarios: skin and soft-tissue infections and outpatient treatment of community-acquired pneumonia in young, otherwise healthy patients or in patients with macrolide-resistant Mycoplasma pneumoniae, as well as Lyme disease prophylaxis and select rickettsial disease should doxycycline be unavailable.
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Affiliation(s)
- Nicholas W Carris
- Department of Pharmacotherapeutics and Clinical Research , University of South Florida College of Pharmacy ; Departments of Family Medicine
| | - Joe Pardo
- Department of Pharmacy , North Florida/South Georgia Veterans Health System , Gainesville
| | - Jose Montero
- Internal Medicine , University of South Florida, Morsani College of Medicine , Tampa
| | - Kristy M Shaeer
- Department of Pharmacotherapeutics and Clinical Research , University of South Florida College of Pharmacy ; Internal Medicine , University of South Florida, Morsani College of Medicine , Tampa
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20
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Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus has become an increasingly common cause of skin and soft-issue infections. The purpose of this study was to review and summarize the most recent literature on methicillin-resistant S. aureus infections of the hand. METHODS The English-language literature related to methicillin-resistant S. aureus infections of the hand was reviewed, and information related to the history, epidemiology, clinical presentation, and treatment of methicillin-resistant S. aureus infections of the hand was summarized. RESULTS Community-acquired methicillin-resistant S. aureus hand infections have increased rapidly in prevalence over the past two decades. The prevalence varies markedly around the world, but in the United States, community-acquired methicillin-resistant S. aureus now causes the majority of purulent hand infections. CONCLUSIONS Purulent hand infections should be treated with surgical drainage. When antibiotics are indicated, empiric coverage for community-acquired methicillin-resistant S. aureus should be provided if local prevalence rates exceed 10 to 15 percent.
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21
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Cassir N, Rolain JM, Brouqui P. A new strategy to fight antimicrobial resistance: the revival of old antibiotics. Front Microbiol 2014; 5:551. [PMID: 25368610 PMCID: PMC4202707 DOI: 10.3389/fmicb.2014.00551] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/02/2014] [Indexed: 01/05/2023] Open
Abstract
The increasing prevalence of hospital and community-acquired infections caused by multidrug-resistant (MDR) bacterial pathogens is limiting the options for effective antibiotic therapy. Moreover, this alarming spread of antimicrobial resistance has not been paralleled by the development of novel antimicrobials. Resistance to the scarce new antibiotics is also emerging. In this context, the rational use of older antibiotics could represent an alternative to the treatment of MDR bacterial pathogens. It would help to optimize the armamentarium of antibiotics in the way to preserve new antibiotics and avoid the prescription of molecules known to favor the spread of resistance (i.e., quinolones). Furthermore, in a global economical perspective, this could represent a useful public health orientation knowing that several of these cheapest “forgotten” antibiotics are not available in many countries. We will review here the successful treatment of MDR bacterial infections with the use of old antibiotics and discuss their place in current practice.
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Affiliation(s)
- Nadim Cassir
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63 CNRS 7278 IRD 198 INSERM U1095, Facultés de Médecine et de Pharmacie, Aix-Marseille Université Marseille, France ; Institut Hospitalo-Universitaire en Maladies Infectieuses et Tropicales, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille Marseille, France
| | - Jean-Marc Rolain
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63 CNRS 7278 IRD 198 INSERM U1095, Facultés de Médecine et de Pharmacie, Aix-Marseille Université Marseille, France
| | - Philippe Brouqui
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63 CNRS 7278 IRD 198 INSERM U1095, Facultés de Médecine et de Pharmacie, Aix-Marseille Université Marseille, France ; Institut Hospitalo-Universitaire en Maladies Infectieuses et Tropicales, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille Marseille, France
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22
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Gelfand MS, Mazumder SA, Cleveland KO. Minocycline for the treatment of community-acquired Staphylococcus aureus infections. Int J Antimicrob Agents 2014; 43:385-6. [PMID: 24613609 DOI: 10.1016/j.ijantimicag.2014.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Michael S Gelfand
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shirin A Mazumder
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kerry O Cleveland
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.
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23
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Cunha BA. Minocycline is a reliable and effective oral option to treat meticillin-resistant Staphylococcus aureus skin and soft-tissue infections, including doxycycline treatment failures. Int J Antimicrob Agents 2014; 43:386-7. [PMID: 24559866 DOI: 10.1016/j.ijantimicag.2014.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA.
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24
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Loffler CA, MacDougall C. Update on prevalence and treatment of methicillin-resistantStaphylococcus aureusinfections. Expert Rev Anti Infect Ther 2014; 5:961-81. [DOI: 10.1586/14787210.5.6.961] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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25
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Marcinak JF, Frank AL. Epidemiology and treatment of community-associated methicillin-resistantStaphylococcus aureusin children. Expert Rev Anti Infect Ther 2014; 4:91-100. [PMID: 16441212 DOI: 10.1586/14787210.4.1.91] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Similar to the epidemiology of methicillin-sensitive Staphylococcus aureus, community-associated methicillin-resistant S. aureus infections occur in children in different regions of the USA and throughout the world. Although minor skin and soft-tissue infections predominate, life-threatening invasive disease and death can result. The novel genetic elements, staphylococcal cassette chromosome mec IV and V, explain the narrow antibiotic resistance pattern, and suggest the mechanism of spread among staphylococci. Panton-Valentine leukocidin apparently plays a role in its pathogenesis. Clindamycin therapy is often effective for treatment, but inducible resistance can develop if the isolate exhibits macrolide resistance due to the erm mechanism. Other drugs displaying in vitro activity against community-associated methicillin-resistant S. aureus include trimethoprim-sulfamethoxazole, tetracyclines, quinolones, linezolid and vancomycin. While experience in pediatric patients is limited, daptomycin, ketolides, glycylcyclines, newer glycopeptides and beta-lactamase-stable cephalosporins may be useful in the future. Further research could include well-designed studies of mechanisms of virulence, continued surveillance of changes in pathogenicity and susceptibility, as well as treatment effectiveness.
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Affiliation(s)
- John F Marcinak
- Department of Pediatrics, University of Chicago, MC 6054, Chicago, IL 60637, USA.
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26
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Use of Intravenous Minocycline for the Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) and Resistant Gram-Negative Organisms. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e31828bbb82] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Cole J, Popovich K. Impact of community-associated methicillin resistant Staphylococcus aureus on HIV-infected patients. Curr HIV/AIDS Rep 2013; 10:244-53. [PMID: 23645115 DOI: 10.1007/s11904-013-0161-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an increasingly important pathogen, causing infections in persons who have no significant healthcare exposures. Persons with human immunodeficiency virus (HIV) infection have been disproportionately affected by CA-MRSA, with increased colonization and infection documented. Several factors are likely involved in the increased CA-MRSA burden observed among HIV-infected patients, including immune factors as well as healthcare and community exposures. Proposed community exposures that have been associated with increased CA-MRSA risk include substance abuse, incarceration, geographic area of residence, and social networks. This article explores these associations and reviews the current knowledge of the epidemiology, pathogenesis, clinical manifestations, and treatment of CA-MRSA in HIV-infected persons.
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Affiliation(s)
- Joanna Cole
- Rush University Medical Center, 600 S Paulina Ste 140, Chicago, IL 60612, USA.
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28
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Kim BN, Kim ES, Oh MD. Oral antibiotic treatment of staphylococcal bone and joint infections in adults. J Antimicrob Chemother 2013; 69:309-22. [DOI: 10.1093/jac/dkt374] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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29
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30
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Vyas KJ, Shadyab AH, Lin CD, Crum-Cianflone NF. Trends and factors associated with initial and recurrent methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections among HIV-infected persons: an 18-year study. J Int Assoc Provid AIDS Care 2013; 13:206-13. [PMID: 23603632 DOI: 10.1177/2325957412473780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Factors associated with initial methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTIs) and their recurrence have not been fully elucidated among HIV-infected persons. METHODS We retrospectively evaluated a large cohort of HIV-infected patients from 1993 to 2010 for culture-proven MRSA SSTIs. Separate logistic regression models evaluated factors associated with initial and recurrent infections. RESULTS Of the 794 patients, 63 (8%) developed an initial infection (19.8 infections/1000 person years [PY]); risk factors included CD4 count <500 cells/mm(3) and HIV RNA level ≥400 copies/mL (P < .01), US Centers for Disease Control and Prevention (CDC) stage C versus A/B (P < .01), and injection drug use (IDU, P < .01). In all, 27% developed recurrence (206 infections/1000 PY); risk factors included hospital admission (P = .02). Minocycline for treatment of the initial infection was associated with an 80% decreased odds for recurrence (P = .03). CONCLUSION HIV control and avoidance of IDU may be useful in reducing rates of MRSA SSTIs among HIV-infected persons.
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Affiliation(s)
- Kartavya J Vyas
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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31
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Optimizing combination rifampin therapy for staphylococcal osteoarticular infections. Joint Bone Spine 2013; 80:11-7. [PMID: 23332140 DOI: 10.1016/j.jbspin.2012.09.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2012] [Indexed: 11/23/2022]
Abstract
Staphylococcus spp. causes more than half of all osteoarticular infections of native structures or implanted material. The ability of Staphylococcus spp. to persist within infected bone tissue and to produce a bacterial biofilm, most notably in infections of implanted material, can lead to treatment failures and microbiological relapses. Rifampin is a cornerstone of the treatment of staphylococcal osteoarticular infections, particularly those of implanted material. Rifampin is a bactericidal antibiotic that diffuses very well within bone tissue and bacterial biofilms. The mechanism of action is inhibition of bacterial DNA transcription to mRNA independently from bacterial division, which results in activity against even dormant Staphylococcus spp. organisms. However, the high risk of emergence of rifampin-resistant mutants requires the concomitant administration of another antibiotic. Several antibiotics are recommended in the French guidelines issued by the French-Speaking Society for Infectious Diseases (Société de Pathologie Infectieuse de Langue Française [SPILF]). Here, we discuss the results from in vitro, animal, and clinical studies that explain the advantages and drawbacks of each antibiotic used with rifampin to treat osteoarticular infections due to Staphylococcus spp.
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32
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Buchanan D, Heiss-Dunlop W, Mathy JA. COMMUNITY ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS HAND INFECTIONS: A SOUTH PACIFIC PERSPECTIVE — CHARACTERISTICS AND IMPLICATIONS FOR ANTIBIOTIC COVERAGE. ACTA ACUST UNITED AC 2012; 17:317-24. [DOI: 10.1142/s0218810412500244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) infections are reported to be increasing worldwide. In the United States when rates exceed 15% empiric treatment is suggested. The aim of our study was to determine local rates and treatment of CA-MRSA within our region. Methods: Nine hundred and forty-two patients were admitted to our service during a six-year period with culture-positive hand infections identified from operative cultures at the time of surgery. Results: Sixty-six (7.0%) patients had CA-MRSA positive cultures identified. Thirty-two (48.5%) patients were noted to have remained on antibiotic treatment that did not reflect their MRSA positive status after cultures returned. Despite this, re-admission and re-operation rates were low and comparable to our non-MRSA control group. Conclusions: Within our CA-MRSA group, current rates do not support automatic empiric treatment for CA-MRSA. Based on sensitivity data, co-trimoxazole and intravenous vancomycin are appropriate and effective antibiotic treatment within our region. Our data supports the importance of drainage of pyogenic infections in helping to resolve complicated hand infections.
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Affiliation(s)
- Derek Buchanan
- Auckland Regional Plastic, Reconstructive and Hand Surgery Unit, Middlemore Hospital, New Zealand
| | - Wolfgang Heiss-Dunlop
- Auckland Regional Plastic, Reconstructive and Hand Surgery Unit, Middlemore Hospital, New Zealand
| | - Jon A. Mathy
- Auckland Regional Plastic, Reconstructive and Hand Surgery Unit, Middlemore Hospital, New Zealand
- University of Auckland, New Zealand
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Abstract
Diabetic foot infections (DFIs) are a commonly encountered medical problem. They are associated with an increased frequency and length of hospitalization and risk for lower-extremity amputation. Furthermore, they have substantial economic consequences. Patients with diabetes mellitus are particularly susceptible to foot infections because of neuropathy, vascular insufficiency, and diminished neutrophil function. The approach to managing DFIs starts with determining if an infection exists. If an infection exists, then the type, severity, extent of infection, and risk factors for resistant organisms should be determined through history, physical examination, and additional laboratory and radiological testing. Optimal management requires surgical debridement, pressure offloading, effective antibiotic therapy, wound care and moisture, maintaining good vascular supply, and correction of metabolic abnormalities, such as hyperglycemia, through a multidisciplinary team. Empiric antibiotics for DFIs vary based on the severity of the infection, but must include anti-staphylococcal coverage.
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Affiliation(s)
- Mazen S Bader
- McMaster University, Faculty of Health Sciences, Division of Infectious Diseases, Hamilton, Ontario, Canada.
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34
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Pogue JM, Marchaim D, Kaye D, Kaye KS. Revisiting "older" antimicrobials in the era of multidrug resistance. Pharmacotherapy 2012; 31:912-21. [PMID: 21923592 DOI: 10.1592/phco.31.9.912] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Infections due to multidrug-resistant (MDR) organisms continue to increase, and the antimicrobial pipeline remains unacceptably lean. Given this challenge, it is has become necessary to use older antimicrobials for treatment of MDR pathogens despite concerns regarding toxicity and the lack of clinical efficacy data. In some cases, older antimicrobials offer potential advantages compared with new agents, including lower cost and better in vitro activity. In this review, we focus on the pharmacology, in vitro activity, and clinical experience of older agents, including colistin, minocycline, trimethoprim-sulfamethoxazole, and fosfomycin. We also discuss some new antimicrobial agents that are used to treat MDR pathogens. As MDR pathogens continue to outpace the development of new antimicrobials, it will become imperative to develop strategies regarding the optimal use of older agents in terms of monotherapy versus combination therapy, dosing regimens, and treatment of invasive infections caused by these pathogens.
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Affiliation(s)
- Jason M Pogue
- Department of Pharmacy, Detroit Medical Center, and Wayne State University School of Medicine, Detroit, Michigan, USA.
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35
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Abstract
MRSA is becoming increasingly common worldwide. With the emergence of new highly spreadable strains (community associated or CA-MRSA) novel presentation skin and soft tissue infections (SSTI) are being seen. Recurrent SSTI, including folliculitis, furunculosis and abscesses account for an increasing proportion of SSTI seen in the emergency department. Empirical antimicrobial management choices can be difficult, but clues to the nature of the MRSA may be gleaned from the history and clinical presentation. More severe SSTI due to necrotising fasciitis and purpura fulminans are emerging and warrant the broadest possible empirical Gram-positive cover, ideally with antimicrobials that stop exotoxin production, and sometimes intravenous immunoglobulin to neutralise exotoxins already produced.
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Affiliation(s)
- M Morgan
- Department of Microbiology, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK.
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36
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Lin TC, Chang CH, Hong SJ, Tsai YC, Chang CH. Methicillin-resistant Staphylococcus aureus in skin and soft tissue infections and minocyclin treatment experience in the dermatological setting of eastern Taiwan. DERMATOL SIN 2011. [DOI: 10.1016/j.dsi.2011.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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37
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Abstract
Appropriately designed antibiotic regimens are critical to the management of all stages of osteomyelitis, although goals of therapy may vary in different stages of infection. The most important consideration for antibiotic selection is spectrum of action. Route of administration by intravenous or oral route is less important than drug levels that are achievable at the site of infection. Outpatient parenteral therapy and use of oral agents has simplified delivery of long-term treatment regimens. There are few high-quality studies that compare specific treatment regimens or durations of therapy, and recommendations for drugs and duration of antibiotic therapy are based on expert opinion, case series, and extrapolations from animal models. Intravenous beta-lactams are the treatment of choice for methicillin-susceptible Staphylococcus aureus, but there are also oral options available. Vancomycin has been the treatment of choice for methicillin-resistant Staphylococcus aureus osteomyelitis, but there are several newer parenteral and oral agents for treatment of methicillin-resistant Staphylococcus aureus including linezolid and daptomycin. Rifampin combined with other staphylococcal agents may increase cure rates, especially for device-associated infections. Oral fluoroquinolones and parenteral beta-lactam agents can be used for treatment of gram-negative osteomyelitis, but increasing resistance has complicated management of these infections.
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Affiliation(s)
- Henry S Fraimow
- University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Division of Infectious Diseases, Cooper University Hospital, Camden, New Jersey
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38
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Drebes J, Perbandt M, Wrenger C, Betzel C. Purification, crystallization and preliminary X-ray diffraction analysis of ThiM from Staphylococcus aureus. Acta Crystallogr Sect F Struct Biol Cryst Commun 2011; 67:479-481. [PMID: 21505246 PMCID: PMC3080155 DOI: 10.1107/s1744309111004192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/03/2011] [Indexed: 05/30/2023]
Abstract
ThiM [5-(hydroxyethyl)-4-methylthiazole kinase; EC 2.7.1.50] from Staphylococcus aureus is an essential enzyme of thiamine or vitamin B(1) metabolism and has been crystallized by the vapour-diffusion method. The crystals belonged to the primitive space group P1, with unit-cell parameters a = 62.06, b = 62.40, c = 107.82 Å, α = 92.25, β = 91.37, γ = 101.48° and six protomers in the unit cell, corresponding to a packing parameter V(M) of 2.3 Å(3) Da(-1). Diffraction data were collected to 2.1 Å resolution using synchrotron radiation. The phase problem was solved by molecular replacement.
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Affiliation(s)
- Julia Drebes
- Department of Chemistry, c/o DESY, Laboratory for Structural Biology of Infection and Inflammation, University of Hamburg, Building 22A, Notkestrasse 85, D-22603 Hamburg, Germany
- Department of Biochemistry, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, D-20359 Hamburg, Germany
| | - Markus Perbandt
- Department of Chemistry, c/o DESY, Laboratory for Structural Biology of Infection and Inflammation, University of Hamburg, Building 22A, Notkestrasse 85, D-22603 Hamburg, Germany
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
| | - Carsten Wrenger
- Department of Biochemistry, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, D-20359 Hamburg, Germany
| | - Christian Betzel
- Department of Chemistry, c/o DESY, Laboratory for Structural Biology of Infection and Inflammation, University of Hamburg, Building 22A, Notkestrasse 85, D-22603 Hamburg, Germany
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Novy P, Urban J, Leuner O, Vadlejch J, Kokoska L. In vitro synergistic effects of baicalin with oxytetracycline and tetracycline against Staphylococcus aureus. J Antimicrob Chemother 2011; 66:1298-300. [PMID: 21421582 DOI: 10.1093/jac/dkr108] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In this study we examined the in vitro synergistic effect of baicalin, the flavone constituent of Scutellaria spp., in combinations with oxytetracycline and tetracycline on the growth of Staphylococcus aureus. METHODS The MICs were determined by the broth microdilution method and the effect of combinations was evaluated according to the sum of fractional inhibitory concentration indices (FICIs). RESULTS Synergistic activity (FICI ≤ 0.5) was observed for combinations of baicalin with oxytetracycline or tetracycline against 4 of 10 strains tested, whereas the baicalin/oxytetracycline combination possessed the strongest synergistic effect (FICI = 0.418). CONCLUSIONS Baicalin acts synergistically with oxytetracycline and tetracycline, enhancing its antimicrobial activity against S. aureus, including methicillin- and tetracycline-resistant strains.
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Affiliation(s)
- Pavel Novy
- Department of Crop Sciences and Agroforestry, Institute of Tropics and Subtropics, Czech University of Life Sciences Prague, Kamycka 129, 16521 Prague 6-Suchdol, Czech Republic
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40
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Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, Chambers HF. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18-55. [PMID: 21208910 DOI: 10.1093/cid/ciq146] [Citation(s) in RCA: 1891] [Impact Index Per Article: 145.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.
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Affiliation(s)
- Catherine Liu
- Department of Medicine, Division of Infectious Diseases, University of California-San Francisco, San Francisco, California94102, USA.
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41
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Kim BN. Oral Agents for the Treatment of Orthopedic Infections Caused by Methicillin-resistant Staphylococci. Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.4.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Baek-Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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42
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Pichereau S, Rose WE. Invasive community-associated MRSA infections: epidemiology and antimicrobial management. Expert Opin Pharmacother 2010; 11:3009-25. [DOI: 10.1517/14656566.2010.511614] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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43
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Hidron AI, Kempker R, Moanna A, Rimland D. Methicillin-resistant Staphylococcus aureus in HIV-infected patients. Infect Drug Resist 2010; 3:73-86. [PMID: 21694896 PMCID: PMC3108732 DOI: 10.2147/idr.s7641] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Indexed: 01/09/2023] Open
Abstract
Concordant with the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community setting, colonization and infections with this pathogen have become a prevalent problem among the human immunodeficiency virus (HIV)-positive population. A variety of different host- and, possibly, pathogen-related factors may play a role in explaining the increased prevalence and incidence observed. In this article, we review pathophysiology, epidemiology, clinical manifestations, and treatment of MRSA in the HIV-infected population.
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44
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45
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Abstract
Methicillin-resistant Staphylococcus aureus has emerged in the community among patient populations without traditional antibiotic resistance risk factors and is causing a variety of clinical syndromes, in particular skin and soft tissue infections. These infections can range from minor skin involvement that can be treated in an outpatient setting to more serious infections such as necrotizing fasciitis requiring hospitalization. Inpatient and outpatient healthcare providers must be aware of the treatment, prevention, and infection control practices for this emerging pathogen.
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46
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Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide, and causes substantial morbidity and mortality. Health-care-associated MRSA infections arise in individuals with predisposing risk factors, such as surgery or presence of an indwelling medical device. By contrast, many community-associated MRSA (CA-MRSA) infections arise in otherwise healthy individuals who do not have such risk factors. Additionally, CA-MRSA infections are epidemic in some countries. These features suggest that CA-MRSA strains are more virulent and transmissible than are traditional hospital-associated MRSA strains. The restricted treatment options for CA-MRSA infections compound the effect of enhanced virulence and transmission. Although progress has been made towards understanding emergence of CA-MRSA, virulence, and treatment of infections, our knowledge remains incomplete. Here we review the most up-to-date knowledge and provide a perspective for the future prophylaxis or new treatments for CA-MRSA infections.
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Affiliation(s)
- Frank R DeLeo
- Laboratory of Human Bacterial Pathogenesis, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
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47
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Nguyen HM, Graber CJ. Limitations of antibiotic options for invasive infections caused by methicillin-resistant Staphylococcus aureus: is combination therapy the answer? J Antimicrob Chemother 2010; 65:24-36. [PMID: 19861337 DOI: 10.1093/jac/dkp377] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA), particularly those involving persistent bacteraemia, necrotizing pneumonia, osteomyelitis and other deep-seated sites of infections, are associated with high mortality and are often difficult to treat. The response to treatment of severe MRSA infection with currently available antibiotics active against MRSA is often unsatisfactory, leading some physicians to resort to combination antibiotic therapy. Now, with the emergence of community-associated MRSA (CA-MRSA) clones that display enhanced virulence potentially related to up-regulated toxin production, the use of adjuvant protein synthesis-inhibiting antibiotics to reduce toxin production also has been advocated by some experts. In this review, we discuss the limitations of antibiotics currently available for the treatment of serious invasive MRSA infections and review the existing literature that examines the potential role of combination therapy in these infections.
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Affiliation(s)
- Hien M Nguyen
- Veterans Affairs Greater Los Angeles Healthcare System, CA, USA
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48
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Koomanachai P, Crandon JL, Nicolau DP. Newer developments in the treatment of Gram-positive infections. Expert Opin Pharmacother 2010; 10:2829-43. [PMID: 19929705 DOI: 10.1517/14656560903357491] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Gram-positive organisms are continually a major cause of infection. These organisms are ever-evolving and exhibit resistance to nearly all available agents. Historically, vancomycin was crowned the drug of choice for many of these organisms including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, and penicillin-resistant Enterococcus spp. Many of these organisms have exhibited reduced susceptibility or frank resistance to vancomycin which has resulted in treatment failure. For this reason, new strategies in treating Gram-positive infections are a hot topic. There are two general approaches to waging this war: i) development of new antimicrobial agents; and ii) reinvigorating old antibiotics that still retain appreciable activity against Gram-positives. We review both antibiotic groupings with a focus on S. aureus, S. pneumoniae and Enterococcus spp.
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Affiliation(s)
- Pornpan Koomanachai
- Hartford Hospital, Center for Anti-Infective Research and Development, 80 Seymour Street, Hartford, CT 06102, USA
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49
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Tosti R, Ilyas AM. Empiric antibiotics for acute infections of the hand. J Hand Surg Am 2010; 35:125-8. [PMID: 20117314 DOI: 10.1016/j.jhsa.2009.10.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 10/22/2009] [Indexed: 02/02/2023]
Affiliation(s)
- Rick Tosti
- Temple Hand Center, Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA, USA
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50
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Nguyen S, Pasquet A, Legout L, Beltrand E, Dubreuil L, Migaud H, Yazdanpanah Y, Senneville E. Efficacy and tolerance of rifampicin–linezolid compared with rifampicin–cotrimoxazole combinations in prolonged oral therapy for bone and joint infections. Clin Microbiol Infect 2009; 15:1163-9. [DOI: 10.1111/j.1469-0691.2009.02761.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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