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Cao Y, Deng F. Positive pathogens in stool could predict the clinical outcomes of sepsis-associated acute kidney injury in critical ill patient. Sci Rep 2024; 14:11227. [PMID: 38755214 PMCID: PMC11099037 DOI: 10.1038/s41598-024-62136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/14/2024] [Indexed: 05/18/2024] Open
Abstract
In this study, we sought to evaluate the influence of positive pathogens in stool (PPS) on clinical outcomes in critical ill patients with Sepsis-associated acute kidney injury (S-AKI) from intensive care unit. Our sample consisted of 7338 patients, of whom 752 (10.25%) had PPS. We found that the presence of Clostridium difficile (C. difficile) and protists in stool samples was correlated with survival during hospitalization, as well as 30-day and 90-day survival. Interestingly, there was no significant difference in overall survival and 30-day in-hospital survival between the PPS group and the negative pathogens in stool (NPS) control group. However, the cumulative incidence of 90-day infection-related mortality was significantly higher in the PPS group (53 vs. 48%, P = 0.022), particularly in patients with C. difficile in their stool specimens. After adjusting for propensity scores, the results also have statistical significance. These findings suggest that PPS may affect the 90-days survival outcomes of S-AKI, particularly in patients with C. difficile and protists in their stool samples. Further research is warranted to further explore these associations.
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Affiliation(s)
- Yaoyuan Cao
- Department of Forensic Medicine, School of Basic Medical Sciences, Central South University, No 172. Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Fuxing Deng
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
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2
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Joshi M, O'Toole RV, Carlini AR, Gary JL, Obremskey WT, Murray CK, Gaski G, Reid JS, Degani Y, Taylor TJ, Collins SC, Huang Y, Whiting PS, Patterson JT, Lee OC, Castillo RC. Does Topical Vancomycin Powder Use in Fracture Surgery Change Bacteriology and Antibiotic Susceptibilities? An Analysis of the VANCO Trial. J Orthop Trauma 2024; 38:183-189. [PMID: 38206761 DOI: 10.1097/bot.0000000000002767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To determine whether intrawound vancomycin changes the bacteriology of surgical site infection pathogens and investigate the emergence of antibiotic-resistant pathogens. METHODS DESIGN Secondary analysis of phase III, prospective, randomized clinical trial. SETTING Thirty-six US trauma centers. PATIENT SELECTION CRITERIA Patients who became infected after fixation of tibial plateau or pilon fracture. OUTCOME MEASURES AND COMPARISONS Pathogen types and bacterial susceptibilities as determined from routine clinical culture in the operating room. RESULTS Seventy-four patients were studied who were 67.5% male with a mean age of 48.6 years. A lower proportion of gram-positive cocci was observed in the vancomycin powder compared with the standard-of-care group (3.7% vs. 8.0%, P = 0.01). Methicillin-resistant Staphylococcus aureus infection incidence was comparable in both the vancomycin powder and the standard-of-care groups, but rates of methicillin-susceptible S. aureus infections were lower in the treatment group (1.4% vs. 4.8%, P = 0.01). The incidence of coagulase-negative Staphylococci and gram-negative rod infections were similar in both groups. There was no significant difference in susceptibilities between groups in rates of vancomycin-resistant enterococcus. CONCLUSIONS Topical vancomycin powder decreases the likelihood of gram-positive infections consistent with the biologic activity of vancomycin. Fewer methicillin-susceptible S. aureus and coagulase-negative Staphylococci infections were observed in the group treated with vancomycin powder. An effect of vancomycin powder on methicillin-resistant S. aureus infection risk was not detected given the low incidence in both the intrawound vancomycin and the standard-of-care groups. There was no emergence of gram-negative rod infections or increased resistance patterns observed. Use of topical vancomycin powder does not seem to produce infections in these patients with greater antibiotic resistance than would have occurred without its use. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Manjari Joshi
- Division of Infectious Disease, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Anthony R Carlini
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joshua L Gary
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Yasmin Degani
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Tara J Taylor
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan C Collins
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yanjie Huang
- University of Michigan School of Dentistry, Ann Arbor, MI
| | - Paul S Whiting
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI; and
| | - Joseph T Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Olivia C Lee
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Renan C Castillo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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3
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Geilen J, Kainz M, Zapletal B, Naka A, Tichy J, Jäger W, Böhmdorfer M, Zeitlinger M, Schultz MJ, Stamm T, Ritschl V, Geleff S, Tschernko E. Antimicrobial Drug Penetration Is Enhanced by Lung Tissue Inflammation and Injury. Am J Respir Crit Care Med 2024; 209:829-839. [PMID: 38099833 DOI: 10.1164/rccm.202306-0974oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/15/2023] [Indexed: 04/04/2024] Open
Abstract
Rationale: Pneumonia is a frequent and feared complication in intubated critically ill patients. Tissue concentrations of antimicrobial drugs need to be sufficiently high to treat the infection and also prevent development of bacterial resistance. It is uncertain whether pulmonary inflammation and injury affect antimicrobial drug penetration into lung tissue.Objectives: To determine and compare tissue and BAL fluid concentrations of ceftaroline fosamil and linezolid in a model of unilateral acute lung injury in pigs and to evaluate whether dose adjustment is necessary to reach sufficient antimicrobial concentrations in injured lung tissue.Methods: After induction of unilateral acute lung injury, ceftaroline fosamil and linezolid were administered intravenously. Drug concentrations were measured in lung tissue through microdialysis and in blood and BAL fluid samples during the following 8 hours. The primary endpoint was the tissue concentration area under the concentration curve in the first 8 hours (AUC0-8 h) of the two antimicrobial drugs.Measurements and Main Results: In 10 pigs, antimicrobial drug concentrations were higher in inflamed and injured lung tissue compared with those in uninflamed and uninjured lung tissue (median ceftaroline fosamil AUC0-8 h [and interquartile range] = 26.7 mg ⋅ h ⋅ L-1 [19.7-39.0] vs. 16.0 mg ⋅ h ⋅ L-1 [13.6-19.9], P = 0.02; median linezolid AUC0-8 h 76.0 mg ⋅ h ⋅ L-1 [68.1-96.0] vs. 54.6 mg ⋅ h ⋅ L-1 [42.7-60.9], P = 0.01), resulting in a longer time above the minimal inhibitory concentration and in higher peak concentrations and dialysate/plasma ratios. Penetration into BAL fluid was excellent for both antimicrobials, but without left-to-right differences (ceftaroline fosamil, P = 0.78; linezolid, P = 1.00).Conclusions: Tissue penetration of two commonly used antimicrobial drugs for pneumonia is enhanced by early lung tissue inflammation and injury, resulting in longer times above the minimal inhibitory concentration. Thus, lung tissue inflammation ameliorates antimicrobial drug penetration during the acute phase.
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Affiliation(s)
- Johannes Geilen
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Matthias Kainz
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Bernhard Zapletal
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Asami Naka
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Johanna Tichy
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Walter Jäger
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Michaela Böhmdorfer
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Clinical Pharmacokinetics/Pharmacogenetics, and Imaging
| | - Marcus J Schultz
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
- Department of Intensive Care, Amsterdam University Medical Centers, location "AMC", University of Amsterdam, Amsterdam, the Netherlands; and
| | - Tanja Stamm
- Institute of Outcomes Research, Center for Medical Data Science, and
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, and
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Silvana Geleff
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
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Ioannou P, Zacharioudaki M, Spentzouri D, Koutoulakou A, Kitsos-Kalyvianakis K, Chontos C, Karakonstantis S, Maraki S, Samonis G, Kofteridis DP. A Retrospective Study of Staphylococcus aureus Bacteremia in a Tertiary Hospital and Factors Associated with Mortality. Diagnostics (Basel) 2023; 13:diagnostics13111975. [PMID: 37296829 DOI: 10.3390/diagnostics13111975] [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: 04/18/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is a severe infection frequently associated with significant morbidity and mortality. Recent studies have shown that SAB mortality has decreased during the last decades. However, about 25% of patients suffering from the disease will ultimately die. Hence, there is an urgent need for more timely and efficient treatment of patients with SAB. The aim of the present study was to retrospectively evaluate a cohort of SAB patients hospitalized in a tertiary hospital and to identify factors independently associated with mortality. All 256 SAB patients hospitalized from January 2005 to December 2021 in the University Hospital of Heraklion, Greece, were evaluated. Their median age was 72 years, while 101 (39.5%) were female. Most SAB patients were cared for in medical wards (80.5%). The infection was community-acquired in 49.5%. Among all strains 37.9% were methicillin-resistant S. aureus (MRSA), however, definite treatment with an antistaphylococcal penicillin was given only in 22% of patients. Only 14.4% of patients had a repeat blood culture after the initiation of antimicrobial treatment. Infective endocarditis was present in 8%. In-hospital mortality has reached 15.9%. Female gender, older age, higher McCabe score, previous antimicrobial use, presence of a central venous catheter, neutropenia, severe sepsis, septic shock, and MRSA SAB were positively associated with in-hospital mortality, while monomicrobial bacteremia was negatively associated. The multivariate logistic regression model identified only severe sepsis (p = 0.05, odds ratio = 12.294) and septic shock (p = 0.007, odds ratio 57.18) to be independently positively associated with in-hospital mortality. The evaluation revealed high rates of inappropriate empirical antimicrobial treatment and non-adherence to guidelines, as shown, by the lack of repeat blood cultures. These data underline the urgent need for interventions with antimicrobial stewardship, increased involvement of infectious diseases physicians, educational sessions, and creation and implementation of local guidelines for improvement of the necessary steps for timely and efficient SAB treatment. Optimization of diagnostic techniques is needed to overcome challenges such as heteroresistance that may affect treatment. Clinicians should be aware of the factors associated with mortality in patients with SAB to identify those who are at a higher risk and optimize medical management.
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Affiliation(s)
- Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Maria Zacharioudaki
- Pediatrics Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Despoina Spentzouri
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | | | - Christoforos Chontos
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - George Samonis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Diamantis P Kofteridis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
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5
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Vancomycin Use in Children and Neonates across Three Decades: A Bibliometric Analysis of the Top-Cited Articles. Pathogens 2021; 10:pathogens10101343. [PMID: 34684291 PMCID: PMC8537673 DOI: 10.3390/pathogens10101343] [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] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
Vancomycin is frequently prescribed in pediatrics, especially in intensive care unit settings, to treat Gram-positive bacterial infections. This work aims to collect the top-cited articles of pediatric and infectious diseases areas to gather the current evidence and gaps of knowledge on the use of vancomycin in these populations. The most relevant journals reported in the "pediatrics" and "infectious diseases" categories of the 2019 edition of Journal Citation Reports were browsed. Articles with more than 30 citations and published over the last three decades were collected. A bibliometric analysis was performed and 115 articles were retrieved. They were published in 21 journals, with a median impact factor of 4.6 (IQR 2.9-5.4). Sixty-eight of them (59.1%) belonged to "infectious diseases" journals. The most relevant topic was "bloodstream/complicated/invasive infections", followed by "antibiotic resistance/MRSA treatment". As for population distribution, 27 articles were on children only and 27 on neonates, most of which were from intensive care unit (ICU) settings. The current literature mainly deals with vancomycin as a treatment for severe infections and antibiotic resistance, especially in neonatal ICU settings. Lately, attention to new dosing strategies in the neonatal and pediatric population has become a sensible topic.
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6
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Kussmann M, Obermueller M, Karer M, Kriz R, Chen RY, Hohl L, Schneider L, Burgmann H, Traby L, Vossen MG. Synergistic Effect of Cefazolin Plus Fosfomycin Against Staphylococcus aureus in vitro and in vivo in an Experimental Galleria mellonella Model. Front Pharmacol 2021; 12:685807. [PMID: 34045971 PMCID: PMC8144499 DOI: 10.3389/fphar.2021.685807] [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: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study investigated the synergistic in vitro and in vivo activity of cefazolin plus fosfomycin against methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA) to provide the basis for a potential treatment alternative. Methods: Antimicrobial susceptibility and in vitro synergy tests were performed with five MSSA and five MRSA isolates using the broth microdilution and chequerboard assays, respectively. The in vivo efficacy of cefazolin plus fosfomycin for the treatment of MRSA infections was assessed using the Galleria mellonella survival assay. Results: Using fractional inhibitory concentration index (FICI), the evaluated combination of cefazolin plus fosfomycin showed synergistic in vitro activity against all MSSA and MRSA isolates tested. In addition, cefazolin susceptibility was recovered in all MRSA isolates except one fosfomycin-resistant strain when combined with fosfomycin at readily achievable concentrations. The G. mellonella survival assay demonstrated highly synergistic in vivo activity of cefazolin plus fosfomycin, resulting in a 44–52% reduction in mortality when compared to cefazolin-alone and fosfomycin-alone, respectively. Conclusion: If susceptibility to fosfomycin is either confirmed or can be assumed based on local resistance patterns, combination therapy with cefazolin plus fosfomycin could be a valuable treatment option for empirical as well as targeted therapy of S. aureus and MRSA infections. Future studies proving the clinical significance of this combination therapy are therefore warranted.
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Affiliation(s)
- Manuel Kussmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Obermueller
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Karer
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Richard Kriz
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Rui-Yang Chen
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Lena Hohl
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Lisa Schneider
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Ludwig Traby
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias G Vossen
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
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7
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Raeder SB, Sandbakken ET, Nepal A, Løseth K, Bergh K, Witsø E, Otterlei M. Novel Peptides Targeting the β-Clamp Rapidly Kill Planktonic and Biofilm Staphylococcus epidermidis Both in vitro and in vivo. Front Microbiol 2021; 12:631557. [PMID: 33815313 PMCID: PMC8009970 DOI: 10.3389/fmicb.2021.631557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Antimicrobial resistance is an increasing threat to global health and challenges the way we treat infections. Peptides containing the PCNA interacting motif APIM (APIM-peptides) were recently shown to bind to the bacterial PCNA homolog, the beta (β)-clamp, and to have both antibacterial and anti-mutagenic activities. In this study we explore the antibacterial effects of these peptides on Staphylococcus epidermidis, a bacterial species commonly found in prosthetic joint infections (PJI). Drug-resistant bacterial isolates from PJIs often lead to difficult-to-treat chronic infections. We show that APIM-peptides have a rapid bactericidal effect which when used at sublethal levels also increase the efficacy of gentamicin. In addition, APIM-peptides reduce development and eliminate already existing S. epidermidis biofilm. To study the potential use of APIM-peptides to prevent PJI, we used an in vivo bone graft model in rats where APIM-peptide, gentamicin, or a combination of the two was added to cement. The bone grafts containing cement with the combination was more effective than cement containing only gentamicin, which is the current standard of care. In summary, these results suggest that APIM-peptides can be a promising new drug candidate for anti-infective implant materials to use in the fight against resistant bacteria and chronic PJI.
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Affiliation(s)
- Synnøve Brandt Raeder
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Anala Nepal
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kirsti Løseth
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kåre Bergh
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Medical Microbiology, St. Olav University Hospital, Trondheim, Norway
| | - Eivind Witsø
- Department of Orthopaedic Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Marit Otterlei
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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8
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Kim SM, Lee HS, Hwang NY, Kim K, Park HD, Lee SY. Individualized Vancomycin Dosing with Therapeutic Drug Monitoring and Pharmacokinetic Consultation Service: A Large-Scale Retrospective Observational Study. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:423-440. [PMID: 33692613 PMCID: PMC7939511 DOI: 10.2147/dddt.s285488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
Background To date, outcome data with a large sample size and data regarding the clinical outcomes of pharmacokinetic-guided (PK) dosing of vancomycin are limited. Aim We evaluated the pharmacokinetic and clinical outcomes of a PK-guided dosing advisory program, pharmacokinetic consultation service (PKCS), in vancomycin treatment. Methods We investigated vancomycin therapeutic drug monitoring (TDM) and PKCS use through a retrospective review of patients who had serum vancomycin trough concentration data from October 2017 to November 2018. Among these patients, we selected non-critically ill adult patients satisfying our selection criteria to evaluate the effect of PKCS. Target trough attainment rate, time to target attainment, vancomycin-induced nephrotoxicity (VIN), vancomycin treatment failure rate, and duration of vancomycin therapy were compared between patients whose dosing was adjusted according to PKCS (PKCS group), and those whose dose was adjusted at the discretion of the attending physician (non-PKCS group). Results A total of 280 patients met the selection criteria for the VIN analysis (PKCS, n=134; non-PKCS, n=146). The incidence of VIN was similar between the two groups (PKCS, n=5; non-PKCS, n=5); however, the target attainment rate was higher in the PKCS group (75% vs 60%, P = 0.012). The time to target attainment was similar between the two groups. Further exclusions yielded 112 patients for the clinical outcome evaluation (PKCS, n=51; non-PKCS, n=61). The treatment failure rate was similar, and the duration of vancomycin therapy was longer in the PKCS group (12 vs 8 days, P = 0.008). Conclusion In non-critically ill patients, an increase in target trough achieved by PKCS did not lead to decreased vancomycin treatment failures, shorter vancomycin treatment, or decreased nephrotoxicity in vancomycin treatment. Considering the excessive amount of effort currently put into vancomycin dosing and monitoring, more selective criteria for individualized pharmacokinetic-guided dosing needs to be applied.
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Affiliation(s)
- Sang-Mi Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Seung Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Na-Young Hwang
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Clinical Pharmacology & Therapeutics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology, Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Korea
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9
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Xu J, Xu HM, Peng Y, Zhao C, Zhao HL, Huang W, Huang HL, He J, Du YL, Zhou YJ, Zhou YL, Nie YQ. The effect of different combinations of antibiotic cocktails on mice and selection of animal models for further microbiota research. Appl Microbiol Biotechnol 2021; 105:1669-1681. [PMID: 33511441 DOI: 10.1007/s00253-021-11131-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/01/2021] [Accepted: 01/20/2021] [Indexed: 12/20/2022]
Abstract
The gut microbiota is closely related to host health and disease. However, there are no suitable animal models available at present for exploring its functions. We analyzed the effect of 3 different antibiotic cocktails (ABx) via two administration routes on the composition of murine gut microbiota, as well as on the general physiological and metabolic indices. High-throughput 16S rRNA sequencing showed that ABx treatment altered the gut microbiota community structure, and also caused low-degree inflammation in the colon. In addition, ad libitum administration of antibiotics depleted the gut microbiota more effectively compared to direct oral gavage, especially with 3ABx. The ABx treatment also had a significant impact on renal and liver functions, as indicated by the altered serum levels of creatinine, urea, total triglycerides, and total cholesterol. Finally, Spearman's correlation analysis showed that the predominant bacterial genera resulting from ABx intervention, including Lactobacillus, Roseburia, and Candidatus-Saccharimonas, were negatively correlated with renal function indices. Taken together, different antibiotic combinations and interventions deplete the gut microbiota and induce physiological changes in the host. Our findings provide the basis for developing an adaptive animal model for studying gut microbiota. KEY POINTS: • Ad libitum administration of 3ABx can effectively deplete intestinal microbiota. • ABx treatment may have slight effect on renal and liver function. • The levels of urea and creatinine correlated with the growth of Roseburia.
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Affiliation(s)
- Jing Xu
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Hao-Ming Xu
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Yao Peng
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Chong Zhao
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Hai-Lan Zhao
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Wenqi Huang
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Hong-Li Huang
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Jie He
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Yan-Lei Du
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Yong-Jian Zhou
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - You-Lian Zhou
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China.
| | - Yu-Qiang Nie
- Department of Gastroenterology and Hepatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No. 1 Panfu Road, Guangzhou, 510180, Guangdong, China.
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10
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Esmaeili A, Salehi M, Makhdoomi N, H. Ardakani Y, Rajabi M, Namazi S. Evaluation of the Association between Trough and Area Under the Curve to Minimum Inhibitory Concentration Ratio (AUC24/MIC) of Vancomycin in Infected Patients with Methicillin Resistant Staphylococcus aureus (MRSA). PHARMACEUTICAL SCIENCES 2020. [DOI: 10.34172/ps.2020.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The recent studies emphasized on the correlation of vancomycin antibacterial effect with pharmacokinetics properties such as the area under the curve/minimum inhibitory concentration (AUC24/MIC) ≥400 and serum trough level 15-20 mg /L in the patients with severe infection with methicillin-resistant Staphylococcus aureus (MRSA). The purpose is to assay the vancomycin pharmacokinetic properties in our population and evaluates the correlation between AUC24/MIC and trough serum level of vancomycin in given patients. Methods: The patients with a positive MRSA culture, treated with vancomycin, were enrolled in this cross-sectional study. Three plasma samples were obtained during the study including 30 min before fourth and the fifth dose as trough levels and 1 hour after the fourth dose as peak level to determine AUC24. E-TEST determined the MIC of vancomycin. Results: Thirty-eight patients with an average age of 48.33±16.44 were enrolled in this study. The mean ± SD of MIC was 0.99±0.30 mg/L. Thirty-four patients reached the adequate therapeutic range of AUC24/MIC ≥ 400 due to the standard vancomycin dosing method. In comparison, only 7 and 10 patients had the first and second trough levels in target intervals of 15-20 mg/L, respectively. Due to the receiver operating characteristic curve test (ROC test), the trough level after the fourth dose had a strong correlation with target AUC24/MIC with a sensitivity of 94.1%and specificity of 75.0%. Conclusion: This study concluded using only a trough level is not appropriate for therapeutic drug monitoring (TDM) of vancomycin. In our population, target AUC24/MIC (≥ 400) had a reasonably strong correlation with the trough level before the fifth dose which achieved with trough level ≥10.81 mg/L and MIC< 1 mg/L.
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Affiliation(s)
- Ayda Esmaeili
- Clinical Pharmacy Department, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicines, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nava Makhdoomi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Yalda H. Ardakani
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rajabi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- Department of Clinical Pharmacy, University Hospitals of North Midlands NHS Trust, United Kingdom
| | - Soha Namazi
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences,Tehran, Iran
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11
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Zastrow RK, Huang HH, Galatz LM, Saunders-Hao P, Poeran J, Moucha CS. Characteristics of Antibiotic Prophylaxis and Risk of Surgical Site Infections in Primary Total Hip and Knee Arthroplasty. J Arthroplasty 2020; 35:2581-2589. [PMID: 32402578 DOI: 10.1016/j.arth.2020.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite numerous antibiotic prophylaxis options for total hip arthroplasty (THA) and total knee arthroplasty (TKA), an assessment of practice patterns and comparative effectiveness is lacking. We aimed to characterize antibiotic utilization patterns and associations with infection risk and hypothesized differences in infection risk based on regimen. METHODS A retrospective cohort study was performed using data from 436,724 THA and 862,918 TKA (Premier Healthcare Database; 2006-2016). Main exposures were antibiotic type and duration: day of surgery only (day 0) or through postoperative day 1 (day 1). The primary outcome was surgical site infection (SSI) <30 days postoperation. Mixed-effect models measured associations between prophylaxis regimen and SSI as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS SSI prevalence was 0.21% (n = 914) for THA and 0.22% (n = 1914) for TKA. Among THA procedures, the most commonly used antibiotics were cefazolin (74.1%), vancomycin (8.4%), "other" antibiotic combinations (7.1%), vancomycin + cefazolin (5.1%), and clindamycin (3.3%). Here, 51.8% received prophylaxis on day 0 only, whereas 48.2% received prophylaxis through day 1. Similar patterns existed for TKA. Relative to cefazolin, higher SSI odds were seen with vancomycin (OR = 1.36; CI 1.09-1.71) in THA and with vancomycin (OR = 1.29; CI = 1.10-1.52), vancomycin + cefazolin (OR = 1.35; CI = 1.12-1.64), clindamycin (OR = 1.38; CI = 1.11-1.71), and "other" antibiotic combinations (OR = 1.28; CI = 1.07-1.53) in TKA. Prophylaxis duration did not alter SSI odds. Results were corroborated in sensitivity analyses. CONCLUSION Antibiotic prophylaxis regimens other than cefazolin were associated with increased SSI risk among THA/TKA patients. These findings emphasize a modifiable intervention to mitigate infection risk.
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Affiliation(s)
- Ryley K Zastrow
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hsin-Hui Huang
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Jashvant Poeran
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Calin S Moucha
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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12
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Wang Y, Yang J, Zhan H, Zhang S, Deng Y. The potential risk factors of nephrotoxicity during vancomycin therapy in Chinese adult patients. Eur J Hosp Pharm 2020; 28:e51-e55. [PMID: 32522809 DOI: 10.1136/ejhpharm-2020-002261] [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: 02/21/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate potential risk factors that may make patients susceptible to nephrotoxicity in those concomitantly receiving vancomycin in the hospital. METHODS This was a single-centre retrospective analysis of patients treated with vancomycin for gram-positive or mixed infections in the Renmin Hospital of Wuhan University from January 2017 to May 2018. All of them were treated for ≥48 hours and had no kidney disease. Nephrotoxicity refers to acute kidney diseases and disorders after the use of vancomycin, and includes acute kidney injury. Univariate analysis and binary logistic regression analysis with the forward stepwise method were used to assess the risk factors associated with nephrotoxicity. RESULTS Of the 790 patients treated with vancomycin, only 257 patients met the inclusion criteria, and 40 (15.6%) subjects developed nephrotoxicity. Significant differences (p<0.05) were seen in the number of combined antimicrobials (p=0.012), dose adjustment (p<0.001), more than three antimicrobials (p=0.015), monitoring trough concentrations (p=0.001), furosemide (p<0.001), torasemide (p<0.001), cefoperazone sodium tazobactam sodium (p=0.039), voriconazole (p=0.012) and ganciclovir (p=0.008). Regression analysis further indicated that furosemide (OR 7.983, p<0.001) and torasemide (OR 3.496, p<0.001) were risk factors for vancomycin nephrotoxicity. Diabetes mellitus (OR 3.062, p=0.035), voriconazole (OR 3.515, p=0.020) and fluconazole (OR 3.326, p=0.018) might be also risk factors. CONCLUSION Fluconazole and voriconazole might be potential risk factors for vancomycin nephrotoxicity, besides furosemide and torasemide. It is not recommended to use imipenem cilastatin sodium and vancomycin at the same time. If necessary, meropenem may be safer. Appropriate combination drugs, cautious initial dose or timely dose adjustment might reduce the occurrence of nephrotoxicity when using vancomycin.
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Affiliation(s)
- Yulin Wang
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Wuhan University School of Pharmaceutical Sciences, Wuhan, Hubei, China
| | - Jian Yang
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Haiyan Zhan
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Wuhan University School of Pharmaceutical Sciences, Wuhan, Hubei, China
| | - Shuxiao Zhang
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Wuhan University School of Pharmaceutical Sciences, Wuhan, Hubei, China
| | - Yin Deng
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Wuhan University School of Pharmaceutical Sciences, Wuhan, Hubei, China
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13
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Li Y, Li G, Sha X, Li L, Zhang K, Liu D, Hao Y, Cui X, Wang L, Wang H. An intelligent vancomycin release system for preventing surgical site infections of bone tissues. Biomater Sci 2020; 8:3202-3211. [PMID: 32374304 DOI: 10.1039/d0bm00255k] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An intelligent anti-bacterial system can be constructed on implants during surgery.
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Affiliation(s)
- Yuan Li
- College of Medicine
- Southwest Jiaotong University
- Chengdu 610036
- China
- CAS Center for Excellence in Nanoscience
| | - Guang Li
- College of Medicine
- Hebei North University
- Zhangjiakou 075000
- China
| | - Xiaoling Sha
- College of Medicine
- Southwest Jiaotong University
- Chengdu 610036
- China
- CAS Center for Excellence in Nanoscience
| | - Litao Li
- Department of Orthopaedics
- The 8thMedical Center of Chinese PLA General Hospital
- Beijing 100000
- China
| | - Kuo Zhang
- CAS Center for Excellence in Nanoscience
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety
- National Center for Nanoscience and Technology (NCNST)
- Beijing 100000
- China
| | - Daohong Liu
- Department of Orthopaedics
- The 8thMedical Center of Chinese PLA General Hospital
- Beijing 100000
- China
| | - Yanfei Hao
- Department of Orthopaedics
- The 8thMedical Center of Chinese PLA General Hospital
- Beijing 100000
- China
| | - Xu Cui
- Department of Orthopaedics
- The 8thMedical Center of Chinese PLA General Hospital
- Beijing 100000
- China
| | - Lei Wang
- CAS Center for Excellence in Nanoscience
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety
- National Center for Nanoscience and Technology (NCNST)
- Beijing 100000
- China
| | - Hao Wang
- CAS Center for Excellence in Nanoscience
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety
- National Center for Nanoscience and Technology (NCNST)
- Beijing 100000
- China
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14
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Pharmacodynamics of ClpP-Activating Antibiotic Combinations against Gram-Positive Pathogens. Antimicrob Agents Chemother 2019; 64:AAC.01554-19. [PMID: 31611348 DOI: 10.1128/aac.01554-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022] Open
Abstract
It is often difficult to cure endocarditis, osteomyelitis, and device-associated infections caused by Gram-positive pathogens, despite therapy with clinically appropriate antibiotics. This may be due to antibiotic tolerance or resistance development. Acyldepsipeptides (ADEPs) are a class of bactericidal compounds active against a variety of clinically important Gram-positive bacteria, including staphylococci, streptococci, and enterococci. ADEPs activate caseinolytic protease P (ClpP), killing high-density, nondividing cultures of bacteria that are tolerant to approved classes of antibiotics. Acyldepsipeptide analog 4 (ADEP4) was active against a panel of drug-resistant Gram-positive pathogens in MIC assays, with no preexisting resistance detected. Killing of stationary-phase cultures was observed when ADEP4 was combined with multiple classes of approved antibiotics. Additionally, a hollow-fiber infection model was used to assess the effects of ADEP4 antibiotic combinations on bacterial killing and resistance development. These studies were performed on high-density cultures of methicillin-resistant S. aureus (MRSA), methicillin-susceptible S. aureus (MSSA), and vancomycin-resistant Enterococcus faecalis (VRE). None of the approved antibiotics linezolid, ampicillin, and oxacillin tested alone had bactericidal activity under these conditions. ADEP4 initially caused killing, but regrowth of the culture was apparent within 96 h due to resistance. Combinations of ADEP4 with linezolid or oxacillin caused substantially improved killing of MRSA or MSSA cultures, respectively, and no regrowth due to resistance was observed. The combination of ADEP4 and ampicillin eradicated cultures of VRE to the limit of detection within 52 h. These data suggest that combining ClpP activators with traditional antibiotics may be a good strategy to treat complicated Gram-positive infections.
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15
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Liao CH, Chen CS, Chen YC, Jiang NE, Farn CJ, Shen YS, Hsu ML, Chang CH. Vancomycin-loaded oxidized hyaluronic acid and adipic acid dihydrazide hydrogel: Bio-compatibility, drug release, antimicrobial activity, and biofilm model. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 53:525-531. [PMID: 31607570 DOI: 10.1016/j.jmii.2019.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prosthesis infection is a difficult-to-treat situation. Hydrogel is a novel biomaterial, which can be applied by simply spraying or by coating on implants before surgery and can be easily mixed with antibiotics. METHODS In order to evaluate the potential use of antibiotic-loaded hydrogel, we incorporated vancomycin into oxidized hyaluronic acid (HA) and adipic acid dihydrazide and evaluated the drug release and antimicrobial activity against methicillin-resistant Staphylococcus aureus (ATCC 29213). RESULTS The average release percentage of vancomycin on day 3 was about 86%. The antibiotic-loaded gel was biocompatible with mesenchymal stem cell, MC3T3, and L929 cell lines. The in vitro inhibition zones of vancomycin-loaded hydrogel [500X minimal inhibition concentration (MIC), 50X MIC, 10X MIC, and blank hydrogel] were 21, 13, 9, and 5 mm, respectively. In the Ti6Al4V implant biofilm model, 0.01-1% vancomycin-loaded gel exhibited significant anti-biofilm activity, measured by the MTT assay. CONCLUSIONS Vancomycin could be loaded onto oxidized HA and adipic acid dihydrazide, which exhibited excellent drug release and in vitro antimicrobial activity with minimal cell toxicity.
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Affiliation(s)
- Chun-Hsing Liao
- Department of Medicine, Yang-Ming University, Taiwan; Division of Infectious Disease, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chiang Sang Chen
- Department of Material and Fiber, Oriental Institute of Technology, New Taipei City, Taiwan; Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Chun Chen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; College of General Studies, Yuan Ze University, Taoyuan City, Taiwan
| | - Ni-En Jiang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chui Jia Farn
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan
| | - Yi-Shan Shen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ming-Lun Hsu
- School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan.
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16
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Liñana Granell C, Belles Medall MD, Ferrando Piqueres R, Montañes Pauls B, Álvarez Martín T, Mendoza Aguilera M, Garcia Martinez T. Vancomycin dose optimisation comparing a pharmacokinetic/pharmacodynamic model versus the pharmacokinetic model. Eur J Hosp Pharm 2019; 26:16-22. [PMID: 31157090 DOI: 10.1136/ejhpharm-2017-001222] [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: 02/09/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 11/03/2022] Open
Abstract
Objectives To compare vancomycin dosage adjustment by evaluating trough concentrations (Ctrough) of vancomycin and its pharmacokinetic/pharmacodynamic (PK/PD) correlation (AUC/MIC ≥400). Methods A retrospective study of 52 adult haematological patients and 29 ICU patients was carried out. Dosage adjustment was performed in routine clinical practice with Ctrough and then compared using a PK/PD model. The probability of achieving the PK/PD target associated with the success of antimicrobial therapy was evaluated. When the susceptibility of the organism responsible for infection is not known, Monte Carlo simulation calculates the cumulative fraction of response (CFR) from the distribution of MIC values. Values of CFR >90% represent an optimal achieved regimen against a population of microorganisms. Results According to dosage adjustment performed with Ctrough, in haematological patients the dose of vancomycin was increased in 65.4% compared with an increase in 53.8% of patients with the PK/PD model. No dose adjustment was needed in 21.1% of patients using Ctrough compared with 7.7% with the PK/PD model and in 13.5% of patients using Ctrough determination and in 38.5% of patients with the PK/PD model the dose was reduced. For ICU patients the dosage adjustment made with Ctrough resulted in an increased dose of vancomycin in 79.4% of patients compared with 41.4% with the PK/PD model. No dose adjustment was needed in 3.4% of patients using Ctrough in comparison with 13.8% with the PK/PD model, and the dose was reduced in 17.2% of patients using Ctrough determination and in 44.8% with the PK/PD model. Conclusions Data for bacterial susceptibility combined with measured data for antibiotic concentrations using a PK/PD model predict and improve the dosage adjustment for individual patients. A larger study with more complete datasets are needed for validation before it can be fully introduced into clinical practice.
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Affiliation(s)
- Carla Liñana Granell
- Department of Clinical Pharmacy, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - M Dolores Belles Medall
- Department of Clinical Pharmacy, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Raul Ferrando Piqueres
- Department of Clinical Pharmacy, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Belen Montañes Pauls
- Department of Clinical Pharmacy, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Tamara Álvarez Martín
- Department of Clinical Pharmacy, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Maria Mendoza Aguilera
- Department of Clinical Pharmacy, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Teresa Garcia Martinez
- Department of Clinical Pharmacy, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
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17
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Wang L, Yuan Q, Tan M, Xie S, Wu J, Song X, Wang C. Evaluation of efficacy and nephrotoxicity during vancomycin therapy: A retrospective study in China. Exp Ther Med 2019; 17:2389-2396. [PMID: 30867724 DOI: 10.3892/etm.2019.7188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/23/2018] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the predictive value of vancomycin serum concentrations regarding its efficacy and nephrotoxicity in a Chinese population and to determine a relatively safe optimal target concentration during vancomycin therapy. A total of 65 patients that received vancomycin between March 2013 and March 2018 at Shanghai 10th People's Hospital (Shanghai, China) were enrolled and their vancomycin trough and peak concentrations were monitored. Factor analysis was performed in order to exclude interaction between variables. Univariate and multivariate analyses were used to identify predictors of drug efficacy and nephrotoxicity. Receiver operating characteristic curve analysis was performed to determine the thresholds of the vancomycin trough and peak concentrations for optimal efficacy and acceptable nephrotoxicity, respectively. Among the 65 cases, treatment was deemed to be effective for 43 patients and ineffective for 22 patients. Furthermore, 20 patients fulfilled the criteria for nephrotoxicity. A total of 15 continuous variables loaded the first five factors by factor analysis (which converts large numbers of highly inter-correlated variables into a small number of comprehensive indicators that reflect a dimensionality reduction) and the factors were as follows: Inflammation, renal function, liver function, vancomycin trough and peak concentrations, and nutritional status. Univariate and multivariate analyses identified the trough concentration and peak concentration as independent variables associated with efficacy and nephrotoxicity of vancomycin, and the nutritional status was a risk factor associated with efficacy. Regarding efficacy, the critical values for the trough concentration and peak concentration were determined to be 9.02 mg/l (95.3% sensitivity and 68.2% specificity) and 23.62 mg/l (83.7% sensitivity and 59.1% specificity), respectively. The thresholds of vancomycin trough and peak concentrations for the development of nephrotoxicity were 16.08 mg/l (80.0% sensitivity and 84.4% specificity) and 30.42 mg/l (75.0% sensitivity and 73.3% specificity), respectively. In conclusion, during vancomycin therapy, the trough and peak concentrations are associated with efficacy and nephrotoxicity. Furthermore, a trough concentration between 9.02 and 16.08 mg/l and a peak concentration of 23.62-30.42 mg/l were determined to be relatively safe (the clinical trial registry no. ChiCTR-OPC-16007920).
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Affiliation(s)
- Liping Wang
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Qing Yuan
- Department of Emergency Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Min Tan
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Shuanshuan Xie
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Jufang Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Xiaolian Song
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, P.R. China
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18
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Zamoner W, Prado IRS, Balbi AL, Ponce D. Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice. Clin Exp Pharmacol Physiol 2019; 46:292-301. [DOI: 10.1111/1440-1681.13066] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Welder Zamoner
- Botucatu School of Medicine University São Paulo State‐UNESP Botucatu Brazil
| | | | - André Luis Balbi
- Botucatu School of Medicine University São Paulo State‐UNESP Botucatu Brazil
| | - Daniela Ponce
- Botucatu School of Medicine University São Paulo State‐UNESP Botucatu Brazil
- Bauru School of Medicine – USPUniversity of São Paulo Bauru Brazil
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19
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Bondarenko S, Chang CB, Cordero-Ampuero J, Kates S, Kheir M, Klement MR, McPherson E, Morata L, Silibovsky R, Skaliczki G, Soriano A, Suárez R, Szatmári A, Webb J, Young S, Zimmerli W. General Assembly, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S61-S73. [PMID: 30348584 DOI: 10.1016/j.arth.2018.09.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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20
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Abdalla MA, McGaw LJ. Natural Cyclic Peptides as an Attractive Modality for Therapeutics: A Mini Review. Molecules 2018; 23:molecules23082080. [PMID: 30127265 PMCID: PMC6222632 DOI: 10.3390/molecules23082080] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/14/2018] [Accepted: 08/19/2018] [Indexed: 01/04/2023] Open
Abstract
Peptides are important biomolecules which facilitate the understanding of complex biological processes, which in turn could be serendipitous biological targets for future drugs. They are classified as a unique therapeutic niche and will play an important role as fascinating agents in the pharmaceutical landscape. Until now, more than 40 cyclic peptide drugs are currently in the market, and approximately one new cyclopeptide drug enters the market annually on average. Interestingly, the majority of clinically approved cyclic peptides are derived from natural sources, such as peptide antibiotics and human peptide hormones. In this report, the importance of cyclic peptides is discussed, and their role in drug discovery as interesting therapeutic biomolecules will be highlighted. Recently isolated naturally occurring cyclic peptides from microorganisms, sponges, and other sources with a wide range of pharmacological properties are reviewed herein.
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Affiliation(s)
- Muna Ali Abdalla
- Phytomedicine Programme, Department of Paraclinical Sciences, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa.
- Department of Food Science and Technology, Faculty of Agriculture, University of Khartoum, Khartoum North 13314, Sudan.
| | - Lyndy J McGaw
- Phytomedicine Programme, Department of Paraclinical Sciences, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa.
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Park SJ, Lim NR, Park HJ, Yang JW, Kim MJ, Kim K, In YW, Lee YM. Evaluation of risk factors for vancomycin-induced nephrotoxicity. Int J Clin Pharm 2018; 40:1328-1334. [PMID: 29744794 DOI: 10.1007/s11096-018-0634-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Abstract
Background Vancomycin is a glycopeptide antibiotic of choice for the treatment of serious infections caused by multi-resistant Gram-positive bacteria. However, vancomycin-associated nephrotoxicity (VAN) often limits its use. Previous data suggested a few risk factors of VAN, including higher mean vancomycin trough level, higher daily doses, old age, long duration of vancomycin therapy, and concomitant nephrotoxins. Objective To evaluate the incidence and risk factors of VAN and determine whether higher vancomycin trough concentrations were associated with a greater risk for VAN. Settings A retrospective, observational, single-center study at the 1960-bed university-affiliated tertiary care hospital (Samsung Medical Center), Seoul, Korea. Method A retrospective analysis of adult patients who received vancomycin parenterally in a tertiary care medical center from March 1, 2013 to June 30, 2013 was performed. We excluded patients with a baseline serum creatinine level > 2 mg/dL and those who had a history of end-stage renal disease and dialysis at baseline. The clinical characteristics were compared between patients with nephrotoxicity and those without nephrotoxicity to identify the risk factors associated with VAN. Main outcome measure Incidence of VAN and VAN-associated risk factors were analyzed. Results Of the 315 vancomycin-treated patients, nephrotoxicity occurred in 15.2% of the patients. In multivariate analysis, higher vancomycin trough concentrations of > 20 mg∕L (OR 9.57, 95% CI 2.49-36.83, p < 0.01) and intensive care unit (ICU) residence (OR 2.86, 95% CI 1.41-5.82, p < 0.01) were independently associated with VAN. Conclusion Our findings suggest that higher vancomycin trough levels and ICU residence might be associated with a greater risk for VAN. More careful monitoring of vancomycin serum trough levels and patient status might facilitate the timely prevention of VAN.
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Affiliation(s)
- So Jin Park
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Na Ri Lim
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Hyo Jung Park
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea.
| | - Jae Wook Yang
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
- Department of Pharmaceutical Sciences, Sahmyook University, Seoul, Korea
| | - Min-Ji Kim
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
- Statistics and Data center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
- Statistics and Data center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Yong Won In
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Young Mee Lee
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
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22
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Oh DH, Kim JJ, Kim J, Seong H, Lee SJ, Kim YC, Kim EJ, Jung IY, Jeong WY, Jeong SJ, Ku NS, Han SH, Choi JY, Song YG, Kim JM. Comparison of the efficacy of nafcillin and glycopeptides as definitive therapy for patients with methicillin-susceptible Staphylococcus aureus bacteremia: a retrospective cohort study. BMC Infect Dis 2018; 18:60. [PMID: 29378565 PMCID: PMC5789670 DOI: 10.1186/s12879-018-2978-z] [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: 05/02/2017] [Accepted: 01/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background Studies have shown that the prognosis of the treatment of methicillin-susceptible S. aureus (MSSA) with glycopeptides is inferior compared to treatment with β-lactam. However, there are only few studies comparing treatment with antistaphylococcal penicillin alone to glycopeptide treatment. The aim of this study was to compare the efficacy of nafcillin, an antistaphylococcal penicillin, with that of glycopeptides as a definitive therapy for MSSA bacteremia. Methods Patients with MSSA bacteremia recruited from a tertiary referral hospital were enrolled in this retrospective cohort study. Demographic characteristics, laboratory data, and clinical outcome of the treatment were compared between a group receiving nafcillin and a group receiving glycopeptides. Results A total of 188 patients with MSSA bacteremia were included in this study. The glycopeptide group had a higher rate of malignancy (28.6 vs. 60.8%, p < 0.001) and proportion of healthcare-associated infections (47.3 vs. 72.2%, p < 0.001) compared to the nafcillin group. The ratio of skin and soft tissue infections (30.0 vs. 16.7%, p = 0.037) and bone and joint infections (17.8 vs. 6.3%, p = 0.022), as well as levels of C-reactive protein (139.60 vs. 107.61 mg/dL, p = 0.022) were higher in the nafcillin group. All-cause 28-day mortality was significantly high in the glycopeptide group (7.7 vs. 20.6%, p = 0.013). Conclusion In patients with MSSA bacteremia, all-cause 28-day mortality rate was higher in a group treated with glycopeptides than in a group treated with nafcillin. Therefore, the use of nafcillin should be considered as a definitive therapy for MSSA bacteremia. Electronic supplementary material The online version of this article (10.1186/s12879-018-2978-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dong Hyun Oh
- Department of Internal Medicine, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, 02053, Seoul, South Korea
| | - Jung Ju Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jinnam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Hye Seong
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Se Ju Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Yong Chan Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - In Young Jung
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Woo Yong Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea. .,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea.
| | - Sang Hoon Han
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Young Goo Song
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
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23
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Jimi S, Miyazaki M, Takata T, Ohjimi H, Akita S, Hara S. Increased drug resistance of meticillin-resistant Staphylococcus aureus biofilms formed on a mouse dermal chip model. J Med Microbiol 2017; 66:542-550. [PMID: 28463660 PMCID: PMC5817199 DOI: 10.1099/jmm.0.000461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Meticillin-resistant Staphylococcus aureus (MRSA) biofilm formation in humans is of serious clinical concern. Previous in vitro studies have been performed with biofilms grown only on inorganic substrates; therefore, we investigated the vancomycin (VCM) resistance of MRSA biofilms grown on skin tissue. Methodology We established a novel tissue substrate model, namely MRSA grown on segments of mouse skin tissue (dermal chips, DCs), and compared its resistance capacity against VCM with that of MRSA biofilms grown on plastic chips (PCs). Results/Key findings For one MRSA isolate, we found that the VCM MIC was identical (1.56 µg ml−1) for planktonic cultures and for biofilms-formed on PCs (PC-BF), although the minimum bactericidal concentration (MBC) increased to 6.25 µg ml−1 in PC-BF. On the contrary, the MIC and MBC for biofilms formed on DCs (DC-BF) significantly increased (25 and 50 µg ml−1, respectively). Furthermore, the minimum biofilm-eradicating concentration was higher for DC-BF (100 µg ml−1) than for PC-BF (25 µg ml−1). Using six MRSA strains, we found that in PC-BF, the c.f.u. number decreased with increasing VCM concentration, whereas in DC-BF, it greatly increased until the MIC was reached, accompanied by the formation of large colonies, thicker bacterial walls and the presence of many mitotic cells. Conclusion Our results indicate that the VCM resistance of MRSA was greater in DC-BF. We conclude that DCs may provide a specific environment for MRSA that enhances bacterial growth under cytotoxic VCM concentrations, and might be useful for the study of skin wound infections and the effects of antimicrobial drugs.
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Affiliation(s)
- Shiro Jimi
- Central Laboratory for Pathology and Morphology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- *Correspondence: Shiro Jimi,
| | - Motoyasu Miyazaki
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Tohru Takata
- Department of Oncology, Hematology and Infectious Diseases, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroyuki Ohjimi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shuuji Hara
- Department of Drug Informatics, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
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24
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Venter H, Henningsen ML, Begg SL. Antimicrobial resistance in healthcare, agriculture and the environment: the biochemistry behind the headlines. Essays Biochem 2017; 61:1-10. [PMID: 28258225 PMCID: PMC5900547 DOI: 10.1042/ebc20160053] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/29/2022]
Abstract
The crisis of antimicrobial resistance (AMR) is one of the most serious issues facing us today. The scale of the problem is illustrated by the recent commitment of Heads of State at the UN to coordinate efforts to curb the spread of AMR infections. In this review, we explore the biochemistry behind the headlines of a few stories that were recently published in the public media. We focus on examples from three different issues related to AMR: (i) hospital-acquired infections, (ii) the spread of resistance through animals and/or the environment and (iii) the role of antimicrobial soaps and other products containing disinfectants in the dissemination of AMR. Although these stories stem from three very different settings, the underlying message in all of them is the same: there is a direct relationship between the use of antimicrobials and the development of resistance. In addition, one type of antimicrobial could select for cross-resistance to another type and/or for multidrug resistance. Therefore, we argue the case for increased stewardship to not only cover clinical use of antibiotics, but also the use of antimicrobials in agriculture and stewardship of our crucially important biocides such as chlorhexidine.
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Affiliation(s)
- Henrietta Venter
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia
| | - Michael L Henningsen
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia
| | - Stephanie L Begg
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia
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25
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Stefano GB, Samuel J, Kream RM. Antibiotics May Trigger Mitochondrial Dysfunction Inducing Psychiatric Disorders. Med Sci Monit 2017; 23:101-106. [PMID: 28063266 PMCID: PMC5240889 DOI: 10.12659/msm.899478] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Clinical usage of several classes of antibiotics is associated with moderate to severe side effects due to the promotion of mitochondrial dysfunction. We contend that this may be due to perturbation of unique evolutionary relationships that link selective biochemical and molecular aspects of mitochondrial biology to conserved enzymatic processes derived from bacterial progenitors. Operationally, stereo-selective conformational matching between mitochondrial respiratory complexes, cytosolic and nuclear signaling complexes appears to support the conservation of a critically important set of chemical messengers required for existential regulation of homeostatic cellular processes. Accordingly, perturbation of normative mitochondrial function by select classes of antibiotics is certainly reflective of the high degree of evolutionary pressure designed to maintain ongoing bidirectional signaling processes between cellular compartments. These issues are of critical importance in evaluating potentially severe side effects of antibiotics on complex behavioral functions mediated by CNS neuronal groups. The CNS is extremely dependent on delivery of molecular oxygen for maintaining a required level of metabolic activity, as reflected by the high concentration of neuronal mitochondria. Thus, it is not surprising to find several distinct behavioral abnormalities conforming to established psychiatric criteria that are associated with antibiotic usage in humans. The manifestation of acute and/or chronic psychiatric conditions following antibiotic usage may provide unique insights into key etiological factors of major psychiatric syndromes that involve rundown of cellular bioenergetics via mitochondrial dysfunction. Thus, a potential window of opportunity exists for development of novel therapeutic agents targeting diminished mitochondrial function as a factor in severe behavioral disorders.
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Affiliation(s)
- George B Stefano
- Department of Research, MitoGenetics Research Institute, Farmingdale, NY, USA
| | - Joshua Samuel
- Department of Research, MitoGenetics Research Institute, Farmingdale, NY, USA
| | - Richard M Kream
- Department of Research, MitoGenetics Research Institute, Farmingdale, NY, USA
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26
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Stefano GB, Kream RM. Dysregulated mitochondrial and chloroplast bioenergetics from a translational medical perspective (Review). Int J Mol Med 2016; 37:547-55. [PMID: 26821064 PMCID: PMC4771107 DOI: 10.3892/ijmm.2016.2471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
Mitochondria and chloroplasts represent endosymbiotic models of complex organelle development, driven by intense evolutionary pressure to provide exponentially enhanced ATP-dependent energy production functionally linked to cellular respiration and photosynthesis. Within the realm of translational medicine, it has become compellingly evident that mitochondrial dysfunction, resulting in compromised cellular bioenergetics, represents a key causative factor in the etiology and persistence of major diseases afflicting human populations. As a pathophysiological consequence of enhanced oxygen utilization that is functionally uncoupled from the oxidative phosphorylation of ADP, significant levels of reactive oxygen species (ROS) may be generated within mitochondria and chloroplasts, which may effectively compromise cellular energy production following prolonged stress/inflammatory conditions. Empirically determined homologies in biochemical pathways, and their respective encoding gene sequences between chloroplasts and mitochondria, suggest common origins via entrapped primordial bacterial ancestors. From evolutionary and developmental perspectives, the elucidation of multiple biochemical and molecular relationships responsible for errorless bioenergetics within mitochondrial and plastid complexes will most certainly enhance the depth of translational approaches to ameliorate or even prevent the destructive effects of multiple disease states. The selective choice of discussion points contained within the present review is designed to provide theoretical bases and translational insights into the pathophysiology of human diseases from a perspective of dysregulated mitochondrial bioenergetics with special reference to chloroplast biology.
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Quach DT, Sakoulas G, Nizet V, Pogliano J, Pogliano K. Bacterial Cytological Profiling (BCP) as a Rapid and Accurate Antimicrobial Susceptibility Testing Method for Staphylococcus aureus. EBioMedicine 2016; 4:95-103. [PMID: 26981574 PMCID: PMC4776060 DOI: 10.1016/j.ebiom.2016.01.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/07/2016] [Accepted: 01/15/2016] [Indexed: 12/01/2022] Open
Abstract
Successful treatment of bacterial infections requires the timely administration of appropriate antimicrobial therapy. The failure to initiate the correct therapy in a timely fashion results in poor clinical outcomes, longer hospital stays, and higher medical costs. Current approaches to antibiotic susceptibility testing of cultured pathogens have key limitations ranging from long run times to dependence on prior knowledge of genetic mechanisms of resistance. We have developed a rapid antimicrobial susceptibility assay for Staphylococcus aureus based on bacterial cytological profiling (BCP), which uses quantitative fluorescence microscopy to measure antibiotic induced changes in cellular architecture. BCP discriminated between methicillin-susceptible (MSSA) and -resistant (MRSA) clinical isolates of S. aureus (n = 71) within 1–2 h with 100% accuracy. Similarly, BCP correctly distinguished daptomycin susceptible (DS) from daptomycin non-susceptible (DNS) S. aureus strains (n = 20) within 30 min. Among MRSA isolates, BCP further identified two classes of strains that differ in their susceptibility to specific combinations of beta-lactam antibiotics. BCP provides a rapid and flexible alternative to gene-based susceptibility testing methods for S. aureus, and should be readily adaptable to different antibiotics and bacterial species as new mechanisms of resistance or multidrug-resistant pathogens evolve and appear in mainstream clinical practice. Bacterial cytological profiling identifies antibiotic resistant S. aureus. BCP predicts best treatment options for multidrug resistant MRSA. Resistant strains are correctly identified within 1 h. BCP does not require prior knowledge of resistance mechanism.
There is a great need for rapid antimicrobial susceptibility testing (AST) as it can dramatically improve clinical outcome for bacterial infections. Most currently proposed ASTs are dependent on knowledge of known resistance genes or based solely on growth/lysis. We have developed a new diagnostic method for rapidly determining antibiotic susceptibility of Staphylococcus aureus using quantitative fluorescence microscopy to measure antibiotic induced changes in cellular architecture. Our test has the potential to change the way antibiotic susceptibility testing is done in the future and is readily adaptable to different antibiotics and bacterial species regardless of the mechanisms of resistance.
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Affiliation(s)
- D T Quach
- Department of Bioengineering, University of California, San Diego La Jolla, CA, USA; Division of Biological Sciences, University of California, San Diego La Jolla, CA, USA
| | - G Sakoulas
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego La Jolla, CA, USA
| | - V Nizet
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego La Jolla, CA, USA; Skaggs School of Pharmacy and Pharmaceutical Science, University of California, San Diego La Jolla, CA, USA
| | - J Pogliano
- Division of Biological Sciences, University of California, San Diego La Jolla, CA, USA
| | - K Pogliano
- Division of Biological Sciences, University of California, San Diego La Jolla, CA, USA
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Yayan J, Ghebremedhin B, Rasche K. No Resistance to Penicillin, Cefuroxime, Cefotaxime, or Vancomycin in Pneumococcal Pneumonia. Int J Med Sci 2015; 12:980-6. [PMID: 26664260 PMCID: PMC4661297 DOI: 10.7150/ijms.13203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/26/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Group B Streptococcus is a primary source of pneumonia, which is a leading cause of death worldwide. During the last few decades, there has been news of growing antibiotic resistance in group B streptococci to penicillin and different antibiotic agents. This clinical study retrospectively analyzes antimicrobial resistance in inpatients who were diagnosed with group B streptococcal pneumonia. METHODS All of the required information from inpatients who were identified to have group B streptococcal pneumonia was sourced from the database at the Department of Internal Medicine of HELIOS Clinic Wuppertal, Witten/Herdecke University, in Germany, from 2004-2014. Antimicrobial susceptibility testing was performed for the different antimicrobial agents that were regularly administered to these inpatients. RESULTS Sixty-six inpatients with a mean age of 63.3 ± 16.1 years (45 males [68.2%, 95% CI 60.0%-79.4%] and 21 females [31.8%, 95% CI 20.6%-43.0%]) were detected to have group B streptococcal pneumonia within the study period from January 1, 2004, to August 12, 2014. Group B Streptococcus had a high resistance rate to gentamicin (12.1%), erythromycin (12.1%), clindamycin (9.1%), and co-trimoxazole (3.0%), but it was not resistant to penicillin, cefuroxime, cefotaxime, or vancomycin (P < 0.0001). CONCLUSION No resistance to penicillin, cefuroxime, cefotaxime, or vancomycin was detected among inpatients with pneumonia caused by group B streptococci.
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Affiliation(s)
- Josef Yayan
- 1. Witten/Herdecke University, Witten, Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, HELIOS Clinic Wuppertal, Germany
| | - Beniam Ghebremedhin
- 2. Witten/Herdecke University, Witten, Institute of Medical Laboratory Diagnostics, Center for Clinical and Translational Research, HELIOS Clinic Wuppertal, Germany
| | - Kurt Rasche
- 1. Witten/Herdecke University, Witten, Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, HELIOS Clinic Wuppertal, Germany
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Dong MH, Wang JW, Wu Y, Chen BY, Yu M, Wen AD. Evaluation of body weight-based vancomycin therapy and the incidence of nephrotoxicity: a retrospective study in the northwest of China. Int J Infect Dis 2015; 37:125-8. [DOI: 10.1016/j.ijid.2015.06.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/26/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022] Open
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Trough concentration over 12.1 mg/L is a major risk factor of vancomycin-related nephrotoxicity in patients with therapeutic drug monitoring. Ther Drug Monit 2015; 36:606-11. [PMID: 24577126 DOI: 10.1097/ftd.0000000000000061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High doses of vancomycin increase the risk of nephrotoxicity, but the quantitative relationship between vancomycin exposure and nephrotoxicity is still controversial. This study evaluated the relationship between vancomycin trough concentration and nephrotoxicity, and risk factors for nephrotoxicity in patients undergoing therapeutic drug monitoring. METHODS A total of 1269 cases from patients who underwent therapeutic drug monitoring were collected from 2006 to 2010. Receiver operating characteristic curve analysis was used to evaluate the relationship between trough concentration and the incidence of nephrotoxicity. Logistic regression using the generalized Least Absolute Shrinkage and Selection Operator (lasso) method was used to evaluate possible risk factors for nephrotoxicity. The data were divided into high/low-concentration groups by the cutoff value obtained from the receiver operating characteristic curve, and additional logistic regression using the generalized lasso method was performed for each group. RESULTS The cutoff value of the vancomycin trough concentration was 12.1 mg/L. Patients with high concentrations (>12.1 mg/L) were more likely to develop nephrotoxicity (odds ratio = 16.0, 95% confidence interval, 8.2-31.1). The vancomycin trough concentration was the only significant risk factor for nephrotoxicity identified using the generalized lasso (P < 0.001). In contrast, no factor was associated with nephrotoxicity in the low-concentration group. CONCLUSIONS Vancomycin trough concentrations over 12.1 mg/L were associated with an increased risk of nephrotoxicity. This is lower than the known threshold. Trough vancomycin concentration over the threshold was the only risk factor of nephrotoxicity among demographic factors, dosing regimen, and other clinical conditions in this study. It is suggested that vancomycin trough concentrations greater than 12.1 mg/L require close monitoring for nephrotoxicity.
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Liu Y, Yin Y, Liu XZ, Yao HJ, Li LX, Chen JH, Chen T, Lu XT, Bu SH, Zhang J. Retrospective Analysis of Vancomycin Nephrotoxicity in Elderly Chinese Patients. Pharmacology 2015; 95:279-84. [PMID: 25997622 DOI: 10.1159/000381783] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/19/2015] [Indexed: 11/19/2022]
Abstract
This study explored nephrotoxicity in elderly Chinese patients after exposure to vancomycin and other nephrotoxic risk factors. This was a single-center retrospective study. The patient population included those who were ≥60 years of age, had normal baseline serum creatinine values, and received vancomycin for ≥48 h between January 1, 2013 and August 30, 2014. Nephrotoxicity occurred in 29% of 124 patients. A baseline creatinine clearance ≥63.5 ml/min was more common in the nephrotoxic group. Patients with high (≥15 mg/l) rather than low (<15 mg/l) average vancomycin troughs had elevated nephrotoxicity (47.2 vs. 27.3%, p = 0.0001). Of the comorbid conditions evaluated, there were more patients with shock (p = 0.001), hypertension (p = 0.020) and congestive heart failure (p = 0.04) in the nephrotoxic group. Drugs frequently given at the same time with vancomycin, such as angiotensin receptor blockers and furosemide, were also associated with increased nephrotoxic risk. In conclusion, nephrotoxicity was frequently observed in patients with concurrent vancomycin trough concentrations ≥15 μg/ml and hypertension, shock, congestive heart failure. In addition, drugs concurrently used with vancomycin may also increase its nephrotoxicity. Therefore, renal function and vancomycin serum troughs should be closely monitored, especially in patients with other renal injury risk factors.
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Affiliation(s)
- Yan Liu
- Department of Pharmacy, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Ceftaroline Fosamil for the Treatment of Staphylococcus aureus Bacteremia Secondary to Acute Bacterial Skin and Skin Structure Infections or Community-Acquired Bacterial Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015; 23:39-43. [PMID: 25574117 PMCID: PMC4280277 DOI: 10.1097/ipc.0000000000000191] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND The Clinical Assessment Program and Teflaro® Utilization Registry is designed to collect information on the clinical use of ceftaroline fosamil in the Unites States. This report presents data on the treatment of patients with Staphylococcus aureus bacteremia (SAB) secondary to acute bacterial skin and skin structure infections (ABSSSIs) or community-acquired bacterial pneumonia (CABP). METHODS Patients diagnosed with ABSSSI or CABP were identified through sequential review of randomly ordered charts generated from pharmacy listings from August 2011 to February 2013. Data were collected by chart review 30 days or more after completion of ceftaroline fosamil therapy. RESULTS Secondary SAB was reported in a total of 48 of 1428 evaluable patients (27 with ABSSSI, 21 with CABP). The mean (SD) patient age was 61 (15) years. At least 1 comorbidity was recorded for 74% of patients with ABSSSI and 81% with CABP. Methicillin-resistant S. aureus was isolated from 59% of patients with ABSSSI and 76% with CABP. The mean (SD) duration of ceftaroline fosamil therapy was 5.8 (4.8) days for ABSSSI and 7.0 (3.8) days for CABP. Clinical success among all patients with SAB treated with ceftaroline fosamil was 58% (52% for SAB secondary to ABSSSI, 67% for SAB secondary to CABP). Clinical success rates of methicillin-resistant S. aureus SAB were 50% (8/16) for ABSSSI and 63% (10/16) for CABP. CONCLUSIONS This study supports the use of ceftaroline fosamil as a viable treatment option in hospitalized patients with SAB secondary to ABSSSI or CABP. Further studies evaluating the use of ceftaroline fosamil for the treatment of SAB are warranted.
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del Río A, Gasch O, Moreno A, Peña C, Cuquet J, Soy D, Mestres CA, Suárez C, Pare JC, Tubau F, Garcia de la Mària C, Marco F, Carratalà J, Gatell JM, Gudiol F, Miró JM, del Rio A, Moreno A, Pericas JM, Cervera C, Gatell JM, Marco F, de la Maria CG, Armero Y, Almela M, Mestres CA, Pare JC, Fuster D, Cartana R, Ninot S, Azqueta M, Sitges M, Heras M, Pomar JL, Ramirez J, Brunet M, Soy D, Llopis J, Gasch O, Suarez C, Pena C, Pujol M, Ariza J, Carratala J, Gudiol F, Cuquet J, Marti C, Mijana M. Efficacy and safety of fosfomycin plus imipenem as rescue therapy for complicated bacteremia and endocarditis due to methicillin-resistant Staphylococcus aureus: a multicenter clinical trial. Clin Infect Dis 2014; 59:1105-12. [PMID: 25048851 DOI: 10.1093/cid/ciu580] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is an urgent need for alternative rescue therapies in invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA). We assessed the clinical efficacy and safety of the combination of fosfomycin and imipenem as rescue therapy for MRSA infective endocarditis and complicated bacteremia. METHODS The trial was conducted between 2001 and 2010 in 3 Spanish hospitals. Adult patients with complicated MRSA bacteremia or endocarditis requiring rescue therapy were eligible for the study. Treatment with fosfomycin (2 g/6 hours IV) plus imipenem (1 g/6 hours IV) was started and monitored. The primary efficacy endpoints were percentage of sterile blood cultures at 72 hours and clinical success rate assessed at the test-of-cure visit (45 days after the end of therapy). RESULTS The combination was administered in 12 patients with endocarditis, 2 with vascular graft infection, and 2 with complicated bacteremia. Therapy had previously failed with vancomycin in 9 patients, daptomycin in 2, and sequential antibiotics in 5. Blood cultures were negative 72 hours after the first dose of the combination in all cases. The success rate was 69%, and only 1 of 5 deaths was related to the MRSA infection. Although the combination was safe in most patients (94%), a patient with liver cirrhosis died of multiorgan failure secondary to sodium overload. There were no episodes of breakthrough bacteremia or relapse. CONCLUSIONS Fosfomycin plus imipenem was an effective and safe combination when used as rescue therapy for complicated MRSA bloodstream infections and deserves further clinical evaluation as initial therapy in these infections.
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Affiliation(s)
- Ana del Río
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Oriol Gasch
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell
| | - Asunción Moreno
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Carmen Peña
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - Jordi Cuquet
- Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona
| | - Dolors Soy
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Carlos A Mestres
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Cristina Suárez
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - Juan C Pare
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Fe Tubau
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat CIBERES (CIBER de Enfermedades Respiratorias), ISCIII, Madrid
| | | | - Francesc Marco
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Spain
| | - Jordi Carratalà
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - José M Gatell
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Francisco Gudiol
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - José M Miró
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
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Chastre J, Blasi F, Masterton RG, Rello J, Torres A, Welte T. European perspective and update on the management of nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid. Clin Microbiol Infect 2014; 20 Suppl 4:19-36. [PMID: 24580739 DOI: 10.1111/1469-0691.12450] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant hospital-acquired infections worldwide and remains a public health priority in Europe. Nosocomial pneumonia (NP) involving MRSA often affects patients in intensive care units with substantial morbidity, mortality and associated costs. A guideline-based approach to empirical treatment with an antibacterial agent active against MRSA can improve the outcome of patients with MRSA NP, including those with ventilator-associated pneumonia. New methods may allow more rapid or sensitive diagnosis of NP or microbiological confirmation in patients with MRSA NP, allowing early de-escalation of treatment once the pathogen is known. In Europe, available antibacterial agents for the treatment of MRSA NP include the glycopeptides (vancomycin and teicoplanin) and linezolid (available as an intravenous or oral treatment). Vancomycin has remained a standard of care in many European hospitals; however, there is evidence that it may be a suboptimal therapeutic option in critically ill patients with NP because of concerns about its limited intrapulmonary penetration, increased nephrotoxicity with higher doses, as well as the emergence of resistant strains that may result in increased clinical failure. Linezolid has demonstrated high penetration into the epithelial lining fluid of patients with ventilator-associated pneumonia and shown statistically superior clinical efficacy versus vancomycin in the treatment of MRSA NP in a phase IV, randomized, controlled study. This review focuses on the disease burden and clinical management of MRSA NP, and the use of linezolid after more than 10 years of clinical experience.
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Affiliation(s)
- J Chastre
- Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Aminzadeh Z, Yadegarynia D, Fatemi A, Tahmasebian Dehkordi E, Azad Armaki S. Vancomycin Minimum Inhibitory Concentration for Methicillin-Resistant Staphylococcus aureus Infections; Is There Difference in Mortality Between Patients? Jundishapur J Microbiol 2014; 7:e12831. [PMID: 25632329 PMCID: PMC4295319 DOI: 10.5812/jjm.12831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND New data indicates that vancomycin may be less effective against methicillin-resistant Staphylococcus aureus (MRSA) infections with minimum inhibition concentration (MIC) within a sensitive range. OBJECTIVES The aim of this study was to determine the distribution of the vancomycin MIC between MRSA strains and observe the difference in mortality between patients, while the influence of changes in MIC on the efficacy of vancomycin was also examined. PATIENTS AND METHODS A routine date-based study was conducted on 41 MRSA isolates in a hospital in Tehran, Iran. The isolates were assessed for MIC by using the E-test method, and results were categorized into three groups: A (MIC < 1.5 μg/mL), B (1.5 ≤ MIC < 2 μg/mL) and C (MIC ≥ 2 μg/mL) MRSA. RESULTS Group A was the most common group, followed by groups C and B. Although there was no statistically significant difference between patients' mortality with the MIC group, the mortality rate of group A was higher than C and B. CONCLUSIONS Regarding Clinical and Laboratory Standards Institute (CLSI) definition for vancomycin susceptibility (MIC < 2 μg/mL), it seems that vancomycin may not be considered as the best antibiotic in order to treat heteroresistant vancomycin intermediate S. aureus (hVISA) and vancomycin sensitive S. aureus (VSSA) infections, and a new breakpoint for vancomycin and alternative antibiotics should be considered.
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Affiliation(s)
- Zohreh Aminzadeh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Davood Yadegarynia
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Alireza Fatemi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Alireza Fatemi, Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, P.O.BOX: 19615-1159, Tehran, IR Iran. Tel: +982122439963-8, +989128949858, Fax: +982122439964, E-mail:
| | - Elham Tahmasebian Dehkordi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Saeed Azad Armaki
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Yoshizumi A, Ishii Y, Iwata M, Murakami H, Yumoto S, Yasui K, Maehara C, Fukuzawa S, Enokizono K, Tateda K. Daptomycin susceptibility of 833 strains of Gram-positive cocci from a university hospital in Japan (2009-2011). Diagn Microbiol Infect Dis 2014; 80:151-3. [PMID: 25056827 DOI: 10.1016/j.diagmicrobio.2014.06.011] [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: 02/24/2014] [Revised: 05/23/2014] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Abstract
The aim of this study was to confirm the daptomycin (DAP) susceptibility of bacteria isolated before the launch of DAP in Japan. DAP showed good activity against all 833 isolates (MIC90 = 0.25-0.5 mg/L for staphylococci, 0.5-4 mg/L for enterococci, and 0.25-0.5 mg/L for streptococci). This is the first report of the in vitro activity of DAP against Gram-positive cocci, including methicillin-resistant Staphylococcus aureus and enterococci, isolated in Japan.
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Affiliation(s)
- Ayumi Yoshizumi
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo 143-8540, Japan
| | - Yoshikazu Ishii
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo 143-8540, Japan; Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan.
| | - Morihiro Iwata
- Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan
| | - Hinako Murakami
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo 143-8540, Japan; Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan
| | - Shigeo Yumoto
- Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan
| | - Kumiko Yasui
- Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan
| | - Chikako Maehara
- Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan
| | - Shigeru Fukuzawa
- Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan
| | - Kyoko Enokizono
- Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo 143-8540, Japan; Clinical laboratories Department, Toho University Medical Centre, Omori Hospital, Tokyo 143-8541, Japan
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Longo VM, De Foggi CC, Ferrer MM, Gouveia AF, André RS, Avansi W, Vergani CE, Machado AL, Andrés J, Cavalcante LS, Hernandes AC, Longo E. Potentiated Electron Transference in α-Ag2WO4 Microcrystals with Ag Nanofilaments as Microbial Agent. J Phys Chem A 2014; 118:5769-78. [DOI: 10.1021/jp410564p] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Valéria M. Longo
- INCTMN-USP, Universidade de São Paulo, Instituto de Física de São Carlos, 13560-970 São Carlos, SP, Brazil
| | - Camila C. De Foggi
- Department
of Dental Materials and Prosthodontics, UNESP − Univ. Estadual Paulista, P.O. Box 355, 14801-903 Araraquara, SP, Brazil
| | - Mateus M. Ferrer
- INCTMN-UFSCar, Universidade Federal de São Carlos, P.O. Box 676, 13565-905 São Carlos, SP, Brazil
| | - Amanda F. Gouveia
- INCTMN-UFSCar, Universidade Federal de São Carlos, P.O. Box 676, 13565-905 São Carlos, SP, Brazil
| | - Rafaela S. André
- INCTMN-UFSCar, Universidade Federal de São Carlos, P.O. Box 676, 13565-905 São Carlos, SP, Brazil
| | - Waldir Avansi
- INCTMN-UFSCar, Universidade Federal de São Carlos, P.O. Box 676, 13565-905 São Carlos, SP, Brazil
| | - Carlos E. Vergani
- Department
of Dental Materials and Prosthodontics, UNESP − Univ. Estadual Paulista, P.O. Box 355, 14801-903 Araraquara, SP, Brazil
| | - Ana L Machado
- Department
of Dental Materials and Prosthodontics, UNESP − Univ. Estadual Paulista, P.O. Box 355, 14801-903 Araraquara, SP, Brazil
| | - Juan Andrés
- Department
of Química-Física-Analítica, Universitat Juame I, 12071 Castello, Spain
| | - Laécio S. Cavalcante
- CCN-DQ-GERATEC, Universidade Estadual do Piauí, P.O. Box 381, 64002-150 Teresina, PI, Brazil
| | - Antonio C. Hernandes
- INCTMN-USP, Universidade de São Paulo, Instituto de Física de São Carlos, 13560-970 São Carlos, SP, Brazil
| | - Elson Longo
- INCTMN-UNESP, Universidade Estadual Paulista, P.O. Box 355, CEP 14801-907 Araraquara, SP, Brazil
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Zaffiri L, Gardner J, Toledo-Pereyra LH. History of antibiotics: from fluoroquinolones to daptomycin (Part 2). J INVEST SURG 2014; 26:167-79. [PMID: 23869821 DOI: 10.3109/08941939.2013.808461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In the Modern Era, physicians attested to the reciprocal influence among a technologically advanced society, rapid scientific progresses in medicine, and the need for new antimicrobials. The results of these changes were not only seen in the prolongation of life expectancy but also by the emergence of new pathogens. We first observed the advent of Gram-negative bacteria as a major source of nosocomial infections. The treatment of these microorganisms was complicated by the appearance and spread of drug resistance. We first focused on the development of two major classes of antimicrobials still currently used for the treatment of Gram-negative bacteria, such as fluoroquinolones and carbapenemes. Subsequently, we directed our attention to the growth of the incidence of infections due to Methicillin-Resistant Staphylococcus aureus (MRSA). Although the first MRSA was already isolated in 1961, the treatment of this new pathogen has been based on the efficacy of vancomycin for more than four decades. Only in the last 15 yr, we assisted in the development of new antimicrobial agents such as linezolid and daptomycin.
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Affiliation(s)
- Lorenzo Zaffiri
- Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
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Ellis MW. Effect of linezolid in ventilator-associated pneumonia caused by MRSA. Expert Rev Anti Infect Ther 2014; 7:183-8. [DOI: 10.1586/14787210.7.2.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Anstead GM, Cadena J, Javeri H. Treatment of infections due to resistant Staphylococcus aureus. Methods Mol Biol 2014; 1085:259-309. [PMID: 24085702 DOI: 10.1007/978-1-62703-664-1_16] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This chapter reviews data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review covers findings reported in the English language medical literature up to January of 2013. Despite the emergence of resistant and multidrug-resistant S. aureus, we have seven effective drugs in clinical use for which little resistance has been observed: vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, telavancin, ceftaroline, and daptomycin. However, vancomycin is less effective for infections with MRSA isolates that have a higher MIC within the susceptible range. Linezolid is probably the drug of choice for the treatment of complicated MRSA skin and soft tissue infections (SSTIs); whether it is drug of choice in pneumonia remains debatable. Daptomycin has shown to be non-inferior to either vancomycin or β-lactams in the treatment of staphylococcal SSTIs, bacteremia, and right-sided endocarditis. Tigecycline was also non-inferior to comparator drugs in the treatment of SSTIs, but there is controversy about whether it is less effective than other therapeutic options in the treatment of more serious infections. Telavancin has been shown to be non-inferior to vancomycin in the treatment of SSTIs and pneumonia, but has greater nephrotoxicity. Ceftaroline is a broad-spectrum cephalosporin with activity against MRSA; it is non-inferior to vancomycin in the treatment of SSTIs. Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, rifampin, moxifloxacin, and minocycline are oral anti-staphylococcal agents that may have utility in the treatment of SSTIs and osteomyelitis, but the clinical data for their efficacy is limited. There are also several drugs with broad-spectrum activity against Gm-positive organisms that have reached the phase II and III stages of clinical testing that will hopefully be approved for clinical use in the upcoming years: oritavancin, dalbavancin, omadacycline, tedizolid, delafloxacin, and JNJ-Q2. Thus, there are currently many effective drugs to treat resistant S. aureus infections and many promising agents in the pipeline. Nevertheless, S. aureus remains a formidable adversary, and despite our deep bullpen of potential therapies, there are still frequent treatment failures and unfortunate clinical outcomes. The following discussion summarizes the clinical challenges presented by MRSA, the clinical experience with our current anti-MRSA antibiotics, and the gaps in our knowledge on how to use these agents to most effectively combat MRSA infections.
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Affiliation(s)
- Gregory M Anstead
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
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Vancomycin-induced acute kidney injury detected by a prospective pharmacovigilance program from laboratory signals. Ther Drug Monit 2013; 35:360-6. [PMID: 23666575 DOI: 10.1097/ftd.0b013e318286eb86] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Retrospective studies have identified elevated vancomycin trough levels >20 mg/L as a predictor of nephrotoxicity with a high variable incidence of 12.6%-65%. However, the elevated levels may represent the effect of renal compromise rather than the cause of nephrotoxicity. The aim of this study was to report the incidence of acute kidney injury (AKI) and associated risk factors in adult patients with vancomycin trough levels >20 mg/L in a prospective Pharmacovigilance Program from Laboratory Signals at a Hospital. METHODS This was a prospective follow-up of all cases with serum vancomycin trough levels >20 mg/L between June 2010 and May 2011. AKI was defined using the Risk, Injury, Failure, Loss, End-stage criteria. Patients with vancomycin-induced AKI (VIAKI) were compared with vancomycin-tolerant patients. RESULTS During 12 months of study, 271 samples corresponding to 179 cases were monitored. Vancomycin did not alter the renal function in 68.2% [95% confidence interval (CI): 60.8-74.9] of cases, and 13.4% (95% CI: 8.8-19.3) of AKI cases were induced by other causes. Nephrotoxicity without AKI criteria was found in 10.1% (95% CI: 6.1-15.4) of cases, and VIAKI occurred in 8.4% (95% CI: 4.8-13.4) of cases. The VIAKI group had a significantly lower basal glomerular filtration rate at baseline and higher vancomycin trough levels at the time of the signal. The majority of the group was in the intensive care unit and received nephrotoxic agents during vancomycin therapy. The most frequent stage of VIAKI was injury (53.3%). VIAKI occurred after 7 days (range: 3-14) of treatment, and in 53.3% of cases, the daily dose was >30 mg/kg. Renal function was recovered at discharge in 73.3% of cases and 66.7% of cases had other suspected drugs. CONCLUSIONS The Pharmacovigilance Program from Laboratory Signals at a Hospital provides early identification and early evaluation of cases. Renal function and vancomycin trough levels should be closely monitored from the second week of treatment in adults, intensive care patients, and those who receive concurrent nephrotoxic agents.
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Gasch O, Camoez M, Dominguez MA, Padilla B, Pintado V, Almirante B, Molina J, Lopez-Medrano F, Ruiz E, Martinez JA, Bereciartua E, Rodriguez-Lopez F, Fernandez-Mazarrasa C, Goenaga MA, Benito N, Rodriguez-Baño J, Espejo E, Pujol M. Predictive factors for mortality in patients with methicillin-resistant Staphylococcus aureus bloodstream infection: impact on outcome of host, microorganism and therapy. Clin Microbiol Infect 2013; 19:1049-57. [PMID: 23331461 DOI: 10.1111/1469-0691.12108] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/03/2012] [Accepted: 11/18/2012] [Indexed: 02/05/2023]
Abstract
Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥1.5 did not have a significant impact on mortality, regardless of the method used to assess it.
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Affiliation(s)
- O Gasch
- Department of Infectious Diseases and Microbiology, H. Bellvitge, Universitat de Barcelona, Barcelona, Spain
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Effects of aggregate and individual antibiotic exposure on vancomycin MICs for Staphylococcus aureus isolates recovered from pediatric patients. J Clin Microbiol 2013; 51:2837-42. [PMID: 23784116 DOI: 10.1128/jcm.00768-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated the evolution of vancomycin MICs for Staphylococcus aureus and their relationship with vancomycin use among hospitalized children. S. aureus isolates recovered from sterile sites were prospectively tested for vancomycin susceptibility using the Etest between 1 April 2000 and 31 March 2008. Vancomycin MICs were grouped into three categories: ≤ 1, 1.5, and 2 μg/ml. The association between vancomycin MICs and aggregate vancomycin use and individual patient vancomycin exposure 6 months prior to the documented infection was assessed. The geometric mean values for vancomycin MICs for S. aureus fluctuated over time without a significant trend (P = 0.146). Of the 436 patients included in the study, 363 (83%) had methicillin-susceptible S. aureus (MSSA) and 73 (17%) had methicillin-resistant S. aureus (MRSA) infections. The rate of isolates with a vancomycin MIC of 2 μg/ml increased from 4% (2 of 46) in 2000 to 2001 to 24% (11 of 46) in 2007 to 2008, despite a decrease in vancomycin use (r = -0.11; P = 0.825). The percentage of isolates with a vancomycin MIC of 2 μg/ml was higher for MRSA (15%; 11 of 73) than for MSSA strains (5.2%; 19 of 363) (χ(2) = 9.2; P = 0.01). Individual patient vancomycin exposure was not associated with a higher vancomycin MIC. In the unadjusted model, in which we compared patients with S. aureus infections with MICs of ≤ 1 μg/ml, the odds ratios of exposure rates for patients with isolates with MICs of 1.5 μg/ml and 2 μg/ml were 1.02 (P = 0.929) and 1.13 (P = 0.767), respectively. In our experience, the geometric means of vancomycin MICs from S. aureus isolates recovered from hospitalized children oscillated over time and were not associated with previous individual patient vancomycin exposure or aggregate vancomycin use.
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A Stewardship Program’s Retrospective Evaluation of Vancomycin AUC24/MIC and Time to Microbiological Clearance in Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia and Osteomyelitis. Clin Ther 2013; 35:772-9. [DOI: 10.1016/j.clinthera.2013.05.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/08/2013] [Accepted: 05/10/2013] [Indexed: 11/19/2022]
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Fahrenfeld N, Ma Y, O'Brien M, Pruden A. Reclaimed water as a reservoir of antibiotic resistance genes: distribution system and irrigation implications. Front Microbiol 2013; 4:130. [PMID: 23755046 PMCID: PMC3664959 DOI: 10.3389/fmicb.2013.00130] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/06/2013] [Indexed: 12/21/2022] Open
Abstract
Treated wastewater is increasingly being reused to achieve sustainable water management in arid regions. The objective of this study was to quantify the distribution of antibiotic resistance genes (ARGs) in recycled water, particularly after it has passed through the distribution system, and to consider point-of-use implications for soil irrigation. Three separate reclaimed wastewater distribution systems in the western U.S. were examined. Quantitative polymerase chain reaction (qPCR) was used to quantify ARGs corresponding to resistance to sulfonamides (sul1, sul2), macrolides (ermF), tetracycline [tet(A), tet(O)], glycopeptides (vanA), and methicillin (mecA), in addition to genes present in waterborne pathogens Legionella pneumophila (Lmip), Escherichia coli (gadAB), and Pseudomonas aeruginosa (ecfx, gyrB). In a parallel lab study, the effect of irrigating an agricultural soil with secondary, chlorinated, or dechlorinated wastewater effluent was examined in batch microcosms. A broader range of ARGs were detected after the reclaimed water passed through the distribution systems, highlighting the importance of considering bacterial re-growth and the overall water quality at the point of use (POU). Screening for pathogens with qPCR indicated presence of Lmip and gadAB genes, but not ecfx or gyrB. In the lab study, chlorination was observed to reduce 16S rRNA and sul2 gene copies in the wastewater effluent, while dechlorination had no apparent effect. ARGs levels did not change with time in soil slurries incubated after a single irrigation event with any of the effluents. However, when irrigated repeatedly with secondary wastewater effluent (not chlorinated or dechlorinated), elevated levels of sul1 and sul2 were observed. This study suggests that reclaimed water may be an important reservoir of ARGs, especially at the POU, and that attention should be directed toward the fate of ARGs in irrigation water and the implications for human health.
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Affiliation(s)
- Nicole Fahrenfeld
- Department of Civil and Environmental Engineering, Virginia Tech Blacksburg, VA, USA
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McKamy S, Chen T, Lee M, Ambrose PJ. Evaluation of a pediatric continuous-infusion vancomycin therapy guideline. Am J Health Syst Pharm 2013; 69:2066-71. [PMID: 23172265 DOI: 10.2146/ajhp120072] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE An institutional guideline for converting pediatric patients to continuous-infusion vancomycin (CIV) therapy if therapeutic targets are not achieved with intermittent i.v. dosing was evaluated. METHODS All patients within a specified age range (>6 months but <19 years) who were converted to CIV therapy for pneumonia or osteomyelitis during the 2 years after guideline implementation were included in the evaluation. The guideline calls for conversion to CIV therapy if goals for trough serum vancomycin concentration (SVC) are not attained with escalating intermittent-infusion vancomycin (IIV) dosing. Primary outcome measures included the rate of attainment of the goal steady-state trough SVC (15-20 mg/L), preferably within 24-48 hours, the adequacy of an empirical dosing strategy, and adverse events. Secondary study outcomes included final vancomycin doses and the time to attainment of therapeutic SVCs. RESULTS Within 24-48 hours after conversion to CIV therapy, the mean initial plateau SVC in the evaluated cases (n = 15) was 20.2 mg/L; the mean of all SVCs was 19.1 mg/L. The range of dosages required to achieve a plateau SVC of 15 mg/L was 23.8-65.4 mg/kg/day (median, 41 mg/kg/day). The mean ± S.D. vancomycin dosage at the end of CIV therapy was 44.3 ± 12.8 mg/kg/day. Monitoring of serum creatinine, urine output, and glomerular filtration rate indicated that no patients developed nephrotoxicity during CIV therapy. CONCLUSION Conversion from IIV to CIV therapy in selected pediatric patients appeared to be safe and well tolerated, with few adverse effects noted. Using the institutional CIV dosing guideline, goal plateau SVC values were attained in most patients within 24-48 hours.
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Affiliation(s)
- Susan McKamy
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, USA.
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Fu J, Ye X, Chen C, Chen S. The efficacy and safety of linezolid and glycopeptides in the treatment of Staphylococcus aureus infections. PLoS One 2013; 8:e58240. [PMID: 23484002 PMCID: PMC3590119 DOI: 10.1371/journal.pone.0058240] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/01/2013] [Indexed: 01/22/2023] Open
Abstract
To assess the effectiveness and safety of linezolid in comparison with glycopeptides (vancomycin and teicoplanin) for the treatment of Staphylococcus aureus infections, we conducted a meta-analysis of relevant randomized controlled trials. A thorough search of Pubmed and other databases was performed. Thirteen trials on 3863 clinically assessed patients were included. Linezolid was slightly more effective than glycopeptides in the intent-to-treat population (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01–1.10), was more effective in clinically assessed patients (OR 95% CI: 1.38, 1.17–1.64) and in all microbiologically assessed patients (OR 95% CI: 1.38, 1.15–1.65). Linezolid was associated with better treatment in skin and soft-tissue infections (SSTIs) patients (OR 95% CI: 1.61, 1.22–2.12), but not in bacteraemia (OR 95% CI: 1.24, 0.78–1.97) or pneumonia (OR 95% CI: 1.25, 0.97–1.60) patients. No difference of mortality between linezolid and glycopeptides was seen in the pooled trials (OR 95% CI: 0.98, 0.83–1.15). While linezolid was associated with more haematological (OR 95% CI: 2.23, 1.07–4.65) and gastrointestinal events (OR 95% CI: 2.34, 1.53–3.59), a significantly fewer events of skin adverse effects (OR 95% CI: 0.27, 0.16–0.46) and nephrotoxicity (OR 95% CI: 0.45, 0.28–0.72) were recorded in linezolid. Based on the analysis of the pooled data of randomized control trials, linezolid should be a better choice for treatment of patients with S. aureus infections, especially in SSTIs patients than glycopeptides. However, when physicians choose to use linezolid, risk of haematological and gastrointestinal events should be taken into account according to the characteristics of the specific patient populations.
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Affiliation(s)
- Jinjian Fu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Molecular Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
- Department of Laboratory Medicine, Liuzhou Municipal Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Xiaohua Ye
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Molecular Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Cha Chen
- Department of Laboratory Medicine, Guangzhou High Education Mega Centre Hospital, Branch of Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Sidong Chen
- Guangdong Key Laboratory of Molecular Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
- * E-mail:
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Inoculum effects of ceftobiprole, daptomycin, linezolid, and vancomycin with Staphylococcus aureus and Streptococcus pneumoniae at inocula of 10(5) and 10(7) CFU injected into opposite thighs of neutropenic mice. Antimicrob Agents Chemother 2013; 57:1434-41. [PMID: 23295932 DOI: 10.1128/aac.00362-12] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Reduced bactericidal efficacy at a high inoculum is known as the inoculum effect (IE). We used neutropenic mice to compare the IEs of ceftobiprole (CFB), daptomycin (DAP), linezolid (LZD), and vancomycin (VAN) against 6 to 9 strains of Staphylococcus aureus and 4 strains of Streptococcus pneumoniae at 2 inocula in opposite thighs of the same mice. Neutropenic mice had 10(4.5) to 10(5.7) CFU/thigh (low inoculum [LI]) in one thigh and 10(6.4) to 10(7.2) CFU/thigh (high inoculum [HI]) in the opposite thigh when treated for 24 h with subcutaneous (s.c.) doses every 12 h of DAP at 0.024 to 100 mg/kg of body weight and LZD at 0.313 to 320 mg/kg and s.c. doses every 6 h of CFB at 0.003 to 160 mg/kg and VAN at 0.049 to 800 mg/kg. Dose-response data were analyzed by a maximum effect (E(max)) model using nonlinear regression. Static doses for each drug and at each inoculum were calculated, and the difference between HI and LI (IE index) gave the magnitude of IE for each drug-organism combination. Mean (range) IE indexes of S. aureus were 2.9 (1.7 to 4.6) for CFB, 4.1 (2.6 to 9.3) for DAP, 4.6 (1.7 to 7.1) for LZD, and 10.1 (6.3 to 20.3) for VAN. In S. pneumoniae, the IE indexes were 2.5 (1.3 to 3.3) for CFB, 2.0 (1.6 to 2.8) for DAP, 1.9 (1.7 to 2.2) for LZD, and 1.5 (0.8 to 3.2) for VAN; these values were similar for all drugs. In S. aureus, the IE was much larger with VAN than with CFB, DAM, and LZD (P < 0.05). An in vivo time course of vancomycin activity showed initiation of killing at 4- to 16-fold-higher doses at HI than at LI despite similar initial growth of controls.
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Reduced vancomycin susceptibility in an in vitro catheter-related biofilm model correlates with poor therapeutic outcomes in experimental endocarditis due to methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2013; 57:1447-54. [PMID: 23295925 DOI: 10.1128/aac.02073-12] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus is the most common cause of endovascular infections, including catheter sepsis and infective endocarditis (IE). Vancomycin (VAN) is the primary choice for treatment of methicillin-resistant S. aureus (MRSA) infections. However, high rates of VAN treatment failure in MRSA infections caused by VAN-susceptible strains have been increasingly reported. Biofilm-associated MRSA infections are especially prone to clinical antibiotic failure. The present studies examined potential relationships between MRSA susceptibility to VAN in biofilms in vitro and nonsusceptibility to VAN in endovascular infection in vivo. Using 10 "VAN-susceptible" MRSA bloodstream isolates previously investigated for VAN responsiveness in experimental IE, we studied the mechanism(s) of such in vivo VAN resistance, including: (i) VAN binding to MRSA organisms; (ii) the impact of VAN on biofilm formation and biofilm composition; (iii) VAN efficacy in an in vitro catheter-related biofilm model; (iv) effects on cell wall thickness. As a group, the five strains previously categorized as VAN nonresponders (non-Rsp) in the experimental IE model differed from the five responders (Rsp) in terms of lower VAN binding, increased biofilm formation, higher survival in the presence of VAN within biofilms in the presence or absence of catheters, and greater biofilm reduction upon proteinase K treatment. Interestingly, sub-MICs of VAN significantly promoted biofilm formation only in the non-Rsp isolates. Cell wall thickness was similar among all MRSA strains. These results suggest that sublethal VAN levels that induce biofilm formation and reduce efficacy of VAN in the in vitro catheter-associated biofilms may contribute to suboptimal treatment outcomes for endovascular infections caused by "VAN-susceptible" MRSA strains.
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