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Dadashi M, Hajikhani B, Nazarinejad N, Noorisepehr N, Yazdani S, Hashemi A, Hashemizadeh Z, Goudarzi M, Fatemeh S. Global prevalence and distribution of antibiotic resistance among clinical isolates of Stenotrophomonas maltophilia: A systematic review and meta-analysis. J Glob Antimicrob Resist 2023; 34:253-267. [PMID: 36906172 DOI: 10.1016/j.jgar.2023.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/18/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES Stenotrophomonas maltophilia (S. maltophilia), an opportunistic pathogen, causes infection in patients undergoing immunosuppressive therapy, mechanical ventilation, or catheters and in long-term hospitalized patients. Due to its extensive resistance to various antibiotics and chemotherapeutic agents, S. maltophilia is challenging to treat. Using case reports, case series, and prevalence studies, the current study provides a systematic review and meta-analysis of antibiotic resistance profiles across clinical isolates of S. maltophilia. METHODS A systematic literature search was performed for original research articles published in Medline, Web of Science, and Embase databases from 2000 to 2022. Statistical analysis was performed using STATA 14 software to report antibiotic resistance of S. maltophilia clinical isolates worldwide. RESULTS 223 studies (39 case reports/case series and 184 prevalence studies) were collected for analysis. A meta-analysis of prevalence studies demonstrated that the most antibiotic resistance worldwide was to levofloxacin, trimethoprim-sulfamethoxazole (TMP/SMX), and minocycline (14.4%, 9.2%, and 1.4%, respectively). Resistance to TMP/SMX (36.84%), levofloxacin (19.29%), and minocycline (1.75%) were the most prevalent antibiotic resistance types found in evaluated case reports/case series studies. The highest resistance rate to TMP/SMX was reported in Asia (19.29%), Europe (10.52%), and America (7.01%), respectively. CONCLUSION Considering the high resistance to TMP/SMX, more attention should be paid to patients' drug regimens to prevent the emergence of multidrug-resistant S. maltophilia isolates.
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Affiliation(s)
- Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nooshin Nazarinejad
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Negin Noorisepehr
- Department of Biotechnology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Shahrooz Yazdani
- Department of Cardiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Cardiovascular Research Center, Shahid Rajaei Educational and Medical Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sameni Fatemeh
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
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Ahmad N, Singh A, Gupta A, Pant P, Singh TP, Sharma S, Sharma P. Discovery of the Lead Molecules Targeting the First Step of the Histidine Biosynthesis Pathway of Acinetobacter baumannii. J Chem Inf Model 2022; 62:1744-1759. [PMID: 35333517 DOI: 10.1021/acs.jcim.1c01421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acinetobacter baumannii is a multidrug-resistant, opportunistic, nosocomial pathogen for which a new line of treatments is desperately needed. We have targeted the enzyme of the first step of the histidine biosynthesis pathway, viz., ATP-phosphoribosyltransferase (ATP-PRT). The three-dimensional structure of ATP-PRT was predicted on the template of the known three-dimensional structure of ATP-PRT from Psychrobacter arcticus (PaATPPRT) using a homology modeling approach. High-throughput virtual screening (HTVS) of the antibacterial library of Life Chemicals Inc., Ontario, Canada was carried out followed by molecular dynamics simulations of the top hit compounds. In silico results were then biochemically validated using surface plasmon resonance spectroscopy. We found that two compounds, namely, F0843-0019 and F0608-0626, were binding with micromolar affinities to the ATP-phosphoribosyltransferase from Acinetobacter baumannii (AbATPPRT). Both of these compounds were binding in the same way as AMP in PaATPPRT, and the important residues of the active site, viz., Val4, Ser72, Thr76, Tyr77, Glu95, Lys134, Val136, and Tyr156, were also interacting via hydrogen bonds. The calculated binding energies of these compounds were -10.5 kcal/mol and -11.1 kcal/mol, respectively. These two compounds can be used as the potential lead molecules for designing antibacterial compounds in the future, and this information will help in drug discovery programs against Acinetobacter worldwide.
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Affiliation(s)
- Nabeel Ahmad
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anamika Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Akshita Gupta
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pradeep Pant
- Department of Chemistry, Indian Institute of Technology, Delhi 110016, India
| | - Tej P Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sujata Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pradeep Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India
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Yaghoubi S, Zekiy AO, Krutova M, Gholami M, Kouhsari E, Sholeh M, Ghafouri Z, Maleki F. Tigecycline antibacterial activity, clinical effectiveness, and mechanisms and epidemiology of resistance: narrative review. Eur J Clin Microbiol Infect Dis 2021; 41:1003-1022. [PMID: 33403565 PMCID: PMC7785128 DOI: 10.1007/s10096-020-04121-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
Tigecycline is unique glycylcycline class of semisynthetic antimicrobial agents developed for the treatment of polymicrobial infections caused by multidrug-resistant Gram-positive and Gram-negative pathogens. Tigecycline evades the main tetracycline resistance genetic mechanisms, such as tetracycline-specific efflux pump acquisition and ribosomal protection, via the addition of a glycyclamide moiety to the 9-position of minocycline. The use of the parenteral form of tigecycline is approved for complicated skin and skin structure infections (excluding diabetes foot infection), complicated intra-abdominal infections, and community-acquired bacterial pneumonia in adults. New evidence also suggests the effectiveness of tigecycline for the treatment of severe Clostridioides difficile infections. Tigecycline showed in vitro susceptibility to Coxiella spp., Rickettsia spp., and multidrug-resistant Neisseria gonnorrhoeae strains which indicate the possible use of tigecycline in the treatment of infections caused by these pathogens. Except for intrinsic, or often reported resistance in some Gram-negatives, tigecycline is effective against a wide range of multidrug-resistant nosocomial pathogens. Herein, we summarize the currently available data on tigecycline pharmacokinetics and pharmacodynamics, its mechanism of action, the epidemiology of tigecycline resistance, and its clinical effectiveness.
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Affiliation(s)
- Sajad Yaghoubi
- Department of Clinical Microbiology, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Angelina Olegovna Zekiy
- Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University, Russian Federation, Trubetskaya st., 8-2, 119991, Moscow, Russia
| | - Marcela Krutova
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Mehrdad Gholami
- Department of Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, P.O. Box 6939177143, Gorgan- Sari Road, Golestan Province, Gorgan, Iran. .,Department of Laboratory Sciences, Faculty of Paramedicine, Golestan University of Medical Sciences, P.O. Box 6939177143, Gorgan- Sari Road, Golestan Province, Gorgan, Iran.
| | - Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghafouri
- Department of Biochemistry, Biophysics and Genetics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farajolah Maleki
- Department of Laboratory Sciences, School of Allied Medical Sciences, Ilam University of Medical sciences, Ilam, Iran.
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Hasanin A, Mukhtar A, El-adawy A, Elazizi H, Lotfy A, Nassar H, Ghaith D. Ventilator associated pneumonia caused by extensive-drug resistant Acinetobacter species: Colistin is the remaining choice. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Ahmed Hasanin
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Mukhtar
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Akram El-adawy
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Hossam Elazizi
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Lotfy
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Heba Nassar
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Doaa Ghaith
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Egypt
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KARAMANLIOĞLU D, DİZBAY M. In vitro combination of tigecycline with other antibiotics in
Stenotrophomonas maltophilia isolates. Turk J Med Sci 2019; 49:683-686. [PMID: 30866602 PMCID: PMC7018222 DOI: 10.3906/sag-1808-55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background/aim The aim of this study was to determine the usefulness of tigecycline in combination treatment of Stenotrophomonas maltophilia infections by evaluating the in vitro synergistic effects of tigecycline with various antibiotics using the E-test method. Materials and methods Synergy testing by E-test was performed with various antibiotic combinations in 10 S. maltophilia isolates identified as a cause of infection. The antibiotics used in the study included tigecycline (TGC), cefoperazone-sulbactam (CPS), ceftazidime (TZ), levofloxacin (LEV), and trimethoprim-sulfamethoxazole (cotrimoxazole) (TS). Four different combinations (TGC-CPS, TGC-TZ, TGC-LEV, TGC-TS) were studied with the E-test synergy method. Results S. maltophilia isolates were found to have the highest level of susceptibility to trimethoprim-sulfamethoxazole, tigecycline, and levofloxacin. The fractional inhibitory concentration (FIC) index was calculated as FIC = MICAB/MICA + MICBA/MICB. The FIC index values were calculated and classified as synergistic (FIC < 0.5), additive (FIC = 0.5–1), indifferent (FIC = 1–4), and antagonistic (FIC > 4). According to FIC index values, synergy was found with the highest rate with TGC-CPS and TGC-LEV combinations (20%). Antagonistic activity was not found in any combination. Conclusion When trimethoprim-sulfamethoxazole cannot be used because of resistance or allergy, tigecycline alone or in combination may be included as an alternative option. Although in vitro results are promising, clinical data are required.
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Affiliation(s)
- Dilek KARAMANLIOĞLU
- Clinic of Infectious Diseases and Clinical Microbiology, Dr. Nafiz Körez State Hospital, Sincan, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Murat DİZBAY
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Gazi University, Beşevler, AnkaraTurkey
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Singhal L, Kaur P, Gautam V. Stenotrophomonas maltophilia: From trivial to grievous. Indian J Med Microbiol 2018; 35:469-479. [PMID: 29405136 DOI: 10.4103/ijmm.ijmm_16_430] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Stenotrophomonas maltophilia, once regarded as an organism of low virulence, has evolved as a significant opportunistic pathogen causing severe human infections in both hospital and community settings, especially amongst highly debilitated patients. Globally, S. maltophilia ranks third amongst the four most common pathogenic non-fermenting Gram-negative bacilli (NFGNBs), others being Pseudomonas aeruginosa, Acinetobacter baumannii and Burkholderia cepacia complex (Bcc). The worth of accurate identification of S. maltophilia comes to the forefront as it needs to be differentiated from other NFGNBs such as Acinetobacter, P. aeruginosa and Bcc due to its inherently contrasting antibiotic susceptibility pattern. Consequently, its correct identification is essential as no single drug is amply effective against all NFGNBs, which hinders initiation of appropriate empirical treatment resulting in increased morbidity and mortality.
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Affiliation(s)
- Lipika Singhal
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - Parvinder Kaur
- Department of Biotechnology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College, Bela, Ropar, Punjab, India
| | - Vikas Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Tang J, Zhu H, Cai L, Tang T, Tang J, Sun Y, Liu M, Dai K, Qiao Z, Yu C. Postoperative infection caused by Acinetobacter baumannii misdiagnosed as a free-living amoeba species in a humeral head hemiarthroplasty patient: a case report. Infect Dis Poverty 2018; 7:33. [PMID: 29631621 PMCID: PMC5890356 DOI: 10.1186/s40249-018-0408-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 03/19/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acinetobacter baumannii is ubiquitous, facultative intracellular, and opportunistic bacterial pathogen. Its unique abilities allow it to survive in a diverse range of environments, including health care settings, leading to nosocomial infections. And its exceptional ability to develop resistance to multiple antibiotics leaves few drug options for treatment. It has been recognized as a leading cause of nosocomial pneumonia and bacteremia over the world. CASE PRESENTATION In this case, a 73-year-old woman presented with a Neer Group VI proximal humeral fracture. Six hours after a successfully performed hemiarthroplasty, she developed continuous fever. Clinical examination revealed that the vitals were regular. Laboratory and radiographic examinations revealed only elevated procalcitonin levels. Blood culture revealed no bacterial or fungal growth. Cooling treatment and empirical broad-spectrum antibiotic therapy showed no apparent effect. CONCLUSIONS We report a postoperative infection caused by Acinetobacter baumannii. The infectious pathogen was identified via molecular DNA sequencing and was initially misidentified as a free-living amoeba species upon microscopic examinations. The patient was mistreated with antiamebic combination therapy. Her symptoms persisted for over 4 months and were eventually followed by her death.
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Affiliation(s)
- Jiaxin Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Huaimin Zhu
- Department of Microbiology and Parasitology, Second Military Medical University, Shanghai, 200433, China
| | - Li Cai
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, 200336, China
| | - Tingting Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jian Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuehua Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ming Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Zhiguang Qiao
- Medical 3D Printing Innovation Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200125, China. .,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, 200030, China.
| | - Chao Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Alfouzan WA, Noel AR, Bowker KE, Attwood MLG, Tomaselli SG, MacGowan AP. Pharmacodynamics of minocycline against Acinetobacter baumannii studied in a pharmacokinetic model of infection. Int J Antimicrob Agents 2017; 50:715-717. [PMID: 28705678 DOI: 10.1016/j.ijantimicag.2017.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/16/2017] [Accepted: 06/24/2017] [Indexed: 11/30/2022]
Abstract
Minocycline (MNO) is an old antibiotic that may have an important role in the treatment of multidrug-resistant Gram-negative bacterial infections as the burden of such infections increases. In this study, a single-compartment dilutional pharmacokinetic model was used to determine the relationship between MNO exposure and antibacterial effect, including the risk of resistance emergence, against strains of Acinetobacter baumannii. The mean ± standard deviation area under the unbound drug concentration-time curve to minimum inhibitory concentration ratio (fAUC/MIC) associated with a 24-h bacteriostatic effect was 16.4 ± 2.6 and with a -1 log reduction in bacterial load at 24 h was 23.3 ± 3.7. None of the strains reached a -2 log reduction over 48 h. Changes in population profiles were noted for two of the three strains studied, especially at fAUC/MIC ratios of >5-15. A reasonable translational pharmacodynamic target for MNO against A. baumannii could be an fAUC/MIC of 20-25. However, if maximum standard 24-h doses of intravenous MNO are used (400 mg/day), many strains would be exposed to MNO concentrations likely to change population profiles and associated with the emergence of resistance. Either MNO combination therapy or an increased MNO dose (>400 mg/day) should be considered when treating A. baumannii infections.
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Affiliation(s)
- Wadha A Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait; Microbiology Unit, Department of Laboratories, Farwaniya Hospital, Farwaniya, Kuwait
| | - A R Noel
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Karen E Bowker
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - M L G Attwood
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - S G Tomaselli
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Alasdair P MacGowan
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
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Ismail N, Zam Z, Hassan SA, Rahman ZA. A Combination of Trimethoprim-sulfamethoxazole and Ceftazidime Showed Good In Vitro Activity against Stenotrophomonas maltophilia. Malays J Med Sci 2017; 24:21-27. [PMID: 28894400 DOI: 10.21315/mjms2017.24.2.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 01/05/2017] [Indexed: 09/29/2022] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen, capable of causing a wide spectrum of infections. Treatment is difficult because it is resistant to many antimicrobial agents, thus reducing the treatment options. The aims of this study were to describe the antimicrobial susceptibility patterns and synergistic effect of selected antimicrobial combinations against S. maltophilia isolates. METHODS This was a descriptive cross-sectional study undertaken in the Hospital Universiti Sains Malaysia from April 2011 to March 2012. S. maltophilia isolated from various clinical specimens were included in the study. Antimicrobial susceptibility testing was done using the epsilometer test (E-test) and interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. In the synergy test, the isolates were tested against six different antimicrobial combinations. RESULTS In total, 84 S. maltophilia isolates were collected and analysed. According to the E-test, the antimicrobial susceptibility of trimethoprim-sulfamethoxazole (TMP-SMX), tigecycline, and ciprofloxacin was 100%, 91.1%, and 88.9% respectively. The antimicrobial combination of TMP-SMX and ceftazidime showed the highest synergistic effect. CONCLUSION TMP-SMX remains the antimicrobial of choice to treat S. maltophilia infection. TMP-SMX and ceftazidime was the most effective combination in vitro.
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Affiliation(s)
- Nabilah Ismail
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zarifah Zam
- Hospital Taiping, Jalan Taming Sari, 34000 Taiping, Perak, Malaysia
| | - Siti Asma Hassan
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zaidah Abdul Rahman
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Prevalence and Fate of Carbapenemase Genes in a Wastewater Treatment Plant in Northern China. PLoS One 2016; 11:e0156383. [PMID: 27227329 PMCID: PMC4882038 DOI: 10.1371/journal.pone.0156383] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/15/2016] [Indexed: 01/09/2023] Open
Abstract
Carbapenemase-producing strains of bacteria, which were primarily found in the medical field, have increasingly been found in the environment, thus posing potential risks to public health. One possible way for carbapenemase genes to enter the environment is via wastewater. Therefore, the goal of this study was to determine the occurrence and fate of five high-risk carbapenemase genes in a wastewater treatment plant (WWTP) in northern China using real-time qPCR. Results showed that the blaKPC-2, blaGES-1, and blaIMP-1 genes prevailed throughout all processing stages (even in the chlorination disinfection unit) in the WWTP, whereas the blaVIM-2 and blaOXA-48 genes were not detected in all samples. Worryingly, considerable amounts of carbapenemase genes ((1.54 ± 0.61) × 103 copies/mL to (2.14± 0.41) × 105 copies/mL) were detected in WWTP effluent samples, while the majority of the carbapenemase genes were transported to the dewatered sludge with concentrations from (6.51 ± 0.14) × 109 copies/g to (6.18 ± 0.63) × 1010 copies/g dry weight. Furthermore, a total of 97 KPC-2-producing strains, belonging to 8 bacterial genera, were isolated from the WWTP. Sequencing of 16S rRNA revealed that most of KPC-2 producing isolates were opportunistic pathogens, including Klebsiella spp. (10.3%), Enterococcus spp. (11.3%), Acinetobacter spp. (19.6%), Escherichia spp. (12.4%), Shigella spp. (17.5%), Stenotrophomonas spp. (10.3%) and Wautersiella spp. (9.3%). Moreover, blaKPC-2 genes were identified for the first time in Paenibacillus spp. isolates (an indigenous bacteria), indicating an increased risk of horizontal transfer between clinical pathogens and environmental bacteria. Indeed, a conjugation experiment demonstrated transfer of the blaKPC-2 gene to an E.coli J53 strain from a Klebsiella strain isolated from the WWTP. To our knowledge, this is the first study to obtain Paenibacillus spp. isolates carrying the carbapenemase gene and to quantify the abundance of carbapenemase genes in the environment.
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In Vitro Activity of Tigecycline Against Acinetobacter baumannii: Global Epidemiology and Resistance Mechanisms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 897:1-14. [DOI: 10.1007/5584_2015_5001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schafer JJ, Goff DA. Establishing the role of tigecycline in an era of antimicrobial resistance. Expert Rev Anti Infect Ther 2014; 6:557-67. [DOI: 10.1586/14787210.6.5.557] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhang J, Ponomareva LV, Marchillo K, Zhou M, Andes DR, Thorson JS. Synthesis and antibacterial activity of doxycycline neoglycosides. JOURNAL OF NATURAL PRODUCTS 2013; 76:1627-36. [PMID: 23987662 PMCID: PMC3814126 DOI: 10.1021/np4003096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A set of 37 doxycycline neoglycosides were prepared, mediated via a C-9 alkoxyamino-glycyl-based spacer reminiscent of that of tigecycline. Subsequent in vitro antibacterial assays against representative drug-resistant Gram negative and Gram positive strains revealed a sugar-dependent activity profile and one doxycycline neoglycoside, the 2'-amino-α-D-glucoside conjugate, to rival that of the parent pharmacophore. In contrast, the representative tetracycline-susceptible strain E. coli 25922 was found to be relatively responsive to a range of doxycycline neoglycosides. This study also extends the use of aminosugars in the context of neoglycosylation via a simple two-step strategy anticipated to be broadly applicable for neoglycorandomization.
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Affiliation(s)
- Jianjun Zhang
- Center for Pharmaceutical Research and Innovation, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, Kentucky 40536-0596, United States
| | - Larissa V. Ponomareva
- Center for Pharmaceutical Research and Innovation, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, Kentucky 40536-0596, United States
| | - Karen Marchillo
- Department of Medicine and Medical Microbiology and Immunology, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, Wisconsin, 53705-2281, United States
| | - Maoquan Zhou
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, Wisconsin 53705-2222, United States
| | - David R. Andes
- Department of Medicine and Medical Microbiology and Immunology, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, Wisconsin, 53705-2281, United States
| | - Jon S. Thorson
- Center for Pharmaceutical Research and Innovation, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, Kentucky 40536-0596, United States
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Sun Y, Cai Y, Liu X, Bai N, Liang B, Wang R. The emergence of clinical resistance to tigecycline. Int J Antimicrob Agents 2013; 41:110-6. [DOI: 10.1016/j.ijantimicag.2012.09.005] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/07/2012] [Accepted: 09/07/2012] [Indexed: 02/09/2023]
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Tekçe YT, Erbay A, Cabadak H, Sen S. Tigecycline as a therapeutic option in Stenotrophomonas maltophilia infections. J Chemother 2012; 24:150-4. [PMID: 22759759 DOI: 10.1179/1120009x12z.00000000022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Trimethoprim-sulfamethoxazole (TMP-SMZ) is recommended as the treatment of choice for Stenotrophomonas maltophilia infections. However, when the administration of TMP-SMZ is not possible, alternative treatment options for S. maltophilia infections has not been clearly established. We compare the efficacy of tigecycline treatment with TMP-SMZ in nosocomial S. maltophilia infections during a 3-year period. For the treatment of S. maltophilia infection, 26 (57.8%) patients received TMP-SMZ and 19 (42.2%) patients received tigecycline. Culture positivity rate was 95.7% in TMP-SMZ group and 70.6% in tigecycline group at the seventh day (P = 0.028), whereas 26.3% versus 18.8% at the fourteenth day (P = 0.700). Clinical improvement was observed 69.2% in TMP-SMZ group and 68.4% in tigecycline group at the fourteenth day (P = 0.954). Mortality rates at the thirtieth day were respectively, 30.8 and 21.1% in TMP-SMZ and tigecycline groups (P = 0.517). There were no significant differences in mortality and clinical response rates between TMP-SMZ and tigecycline treatment. Tigecycline can be considered as an alternative option beyond TMP-SMZ in treatment of S. maltophilia infections.
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Affiliation(s)
- Yasemin Tezer Tekçe
- Department of Infectious Diseases and Clinical Microbiology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
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Wu H, Wang JT, Shiau YR, Wang HY, Lauderdale TLY, Chang SC. A multicenter surveillance of antimicrobial resistance on Stenotrophomonas maltophilia in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 45:120-6. [PMID: 22154599 DOI: 10.1016/j.jmii.2011.09.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/17/2011] [Accepted: 06/29/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in debilitated hosts. Clinical management of S. maltophilia is challenging due to its intrinsic resistance to a variety of antibiotics. This study investigated the trend and prevalence of antimicrobial resistance in S. maltophilia from a nationwide surveillance study in Taiwan. METHODS S. maltophilia isolates were collected biennially between 1998 and 2008 as part of the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program from medical centers and regional hospitals throughout Taiwan. Minimal inhibitory concentrations (MIC) were determined using the Clinical and Laboratory Standards Institute reference broth microdilution method. RESULTS A total of 377 non-duplicate S. maltophilia isolates were collected from 38 hospitals. The majority of the isolates were from the respiratory tract (256, 67.9%), followed by blood (48, 12.7%). Overall, 376 (99.7%) isolates were susceptible to minocycline, 362 (96%) to tigecycline, 311 (82.5%) to trimethoprim/sulfamethoxazole (TMP-SMX), 300 (79.6%) to levofloxacin, 92 (24.4%) to ceftazidime, and 70 (18.6%) to ticarcillin-clavulanic acid. The MIC(50)/MIC(90) of minocycline, tigecycline, TMP-SMX, levofloxacin, ceftazidime, and ticarcillin-clavulanic acid, were ≤0.5/1 μg/mL, 0.25/1 μg/mL, ≤0.25/8 μg/mL, 1/4 μg/mL, 32/128 μg/mL, and 64/128 μg/mL, respectively. A trend of increased non-susceptibility to levofloxacin (p=0.014) was observed over the 10-year study period. Compared to TMP-SMX-susceptible isolates, TMP-SMX-resistant isolates were less susceptible to levofloxacin (54.5% vs. 84.9%, p<0.001). CONCLUSION In this 10-year study, minocycline and TMP-SMX remained the two antimicrobials with better in vitro activities against S. maltophilia than ceftazidime, levofloxacin, and ticarcillin-clavulanic acid. The activity of levofloxacin against S. maltophilia in Taiwan declined during the past 10 years.
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Affiliation(s)
- Hsiu Wu
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Sadeghian A, Pordel M, Safdari H, Fahmidekar MA, Sadeghian H. 11-Chloro-3-methyl-3H-imidazo[4,5-a]acridine (CMIA) as a potent and selective antimicrobial agent against clinical isolates of highly antibiotic-resistant Acinetobacter baumannii. Med Chem Res 2011. [DOI: 10.1007/s00044-011-9933-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Resistance to antimicrobial drugs is increasing at an alarming rate among both gram-positive and gram-negative bacteria. Traditionally, bacteria resistant to multiple antimicrobial agents have been restricted to the nosocomial environment. A disturbing trend has been the recent emergence and spread of resistant pathogens in nursing homes, in the community, and in the hospital. This article reviews the epidemiology, molecular mechanisms of resistance, and treatment options for pathogens resistant to antimicrobial drugs.
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Affiliation(s)
- Luke F Chen
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 102359, Hanes House, Durham, NC 27710, USA.
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Comparative activities of tigecycline and other tetracyclines against nonfermenting Gram-negative bacilli, excluding Acinetobacter spp. Antimicrob Agents Chemother 2011; 55:3961-3. [PMID: 21606223 DOI: 10.1128/aac.00438-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Fraimow HS, Tsigrelis C. Antimicrobial resistance in the intensive care unit: mechanisms, epidemiology, and management of specific resistant pathogens. Crit Care Clin 2011; 27:163-205. [PMID: 21144992 DOI: 10.1016/j.ccc.2010.11.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Infections caused by drug-resistant and multidrug-resistant microbial pathogens pose tremendous challenges to health care systems, including challenges related to the diagnosis, treatment, and containment of these infections. These challenges are amplified in the intensive care unit (ICU), where pressures for selection and emergence of resistance and risks of transmission of resistant pathogens are highest, and where the threat of resistance drives selection of empiric antimicrobial regimens. This article reviews basic concepts of resistance to antibacterial agents including mechanisms and modes of transmission, and discusses management issues for the important drug-resistant pathogens found in the ICU.
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Affiliation(s)
- Henry S Fraimow
- Division of Infectious Diseases, UMDNJ-Robert Wood Johnson Medical School, Cooper University Hospital, 401 Haddon Avenue, Room 274, Camden, NJ 08103, USA.
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Nyč O, Matějková J. Stenotrophomonas maltophilia: Significant contemporary hospital pathogen — review. Folia Microbiol (Praha) 2010; 55:286-94. [DOI: 10.1007/s12223-010-0043-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 02/15/2010] [Indexed: 01/07/2023]
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Comparison of different antimicrobial susceptibility testing methods for Stenotrophomonas maltophilia and results of synergy testing. J Infect Chemother 2010; 16:322-8. [PMID: 20449623 DOI: 10.1007/s10156-010-0068-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
Accurate determination of resistance is important to ensure appropriate antimicrobial therapy in Stenotrophomonas maltophilia infections. This study was undertaken to evaluate the susceptibility results obtained by disc diffusion, E-test, Phoenix system, and reference agar dilution method and also to evaluate the in vitro activity of various antimicrobial combinations against multidrug-resistant S. maltophilia. Susceptibilities to several antimicrobial agents were determined by agar dilution, disc diffusion, and E-test according to the US Clinical Laboratory and Standards Institute (CLSI) guidelines. Results were also evaluated in the in Phoenix system for available agents. Twelve different antibiotic combinations were tested for synergy by the E-test method. Most synergic combinations were confirmed by microdilution checkerboard assay. Tigecycline, trimethoprim/sulfamethoxazole (TMP-SMX) and doxycycline were the most effective drugs against S. maltophilia. Poorest agreement was determined by disc diffusion and E-test against ticarcillin/clavulanate and ciprofloxacin (κ < 0.4), by disc diffusion against colistin (κ < 0.4), and by the Phoenix system against piperacillin/tazobactam (κ < 0.4). Based on these data, disc diffusion seems to be unreliable for ticarcillin/clavulanate, ciprofloxacin, and colistin; E-test for ticarcillin/clavulanate and ciprofloxacin; and the Phoenix system for piperacillin/tazobactam for S. maltophilia susceptibility testing. Synergistic activity was detected predominantly with TMP-SMX + ticarcillin/clavulanate and TMP-SMX + ceftazidime. TMP-SMX + ceftazidime synergy was also supported by the checkerboard method. However, TMP-SMX + ticarcillin/clavulanate combination revealed indifferent effect by the checkerboard assay. As ticarcillin/clavulanate and ciprofloxacin E-test results were beyond the acceptable correlation limits, synergy testing performed with these agents was considered as unreliable. Further studies are required to standardize susceptibility testing, especially for colistin, ticarcillin/clavulanate, and ciprofloxacin for S. maltophilia. TMP-SMX-containing drug combinations seemed to be more synergistic on multidrug-resistant S. maltophilia; however, these results merit further evaluation.
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Antimicrobial susceptibilities of a worldwide collection of Stenotrophomonas maltophilia isolates tested against tigecycline and agents commonly used for S. maltophilia infections. Antimicrob Agents Chemother 2010; 54:2735-7. [PMID: 20368399 DOI: 10.1128/aac.01774-09] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antimicrobial susceptibilities were determined for 1,586 isolates of Stenotrophomonas maltophilia from globally diverse medical centers using the Clinical Laboratory Standards Institute broth microdilution method. The combination trimethoprim-sulfamethoxazole (96.0% of isolates susceptible at < or =2 microg/ml trimethoprim and 38 microg/ml sulfamethoxazole) and tigecycline (95.5% of isolates sussceptible at < or =2 microg/ml) were the only antimicrobials tested with >94% susceptibility in all regions. Susceptibility rates for other commonly used were lower than expected and varied geographically. This in vitro data supports tigecycline as a potential candidate for clinical investigations into S. maltophilia infections.
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Skibeli V, Aaløkken I, Lingaas E, Midtvedt T, Solberg C, Melby K. Tigesyklin – et nytt antibiotikum. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1624-6. [DOI: 10.4045/tidsskr.09.0722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
During an island-wide PCR-based surveillance study of beta-lactam resistance in multidrug-resistant (MDR) Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter calcoaceticus-baumannii complex isolates obtained from 17 different hospitals, 10 KPC-positive Acinetobacter isolates were identified. DNA sequencing of the bla(KPC) gene identified KPC-2, -3, and -4 and a novel variant, KPC-10. This is the first report of a KPC-type beta-lactamase identified in Acinetobacter species.
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Chen LF, Chopra T, Kaye KS. Pathogens Resistant to Antibacterial Agents. Infect Dis Clin North Am 2009; 23:817-45, vii. [DOI: 10.1016/j.idc.2009.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Looney WJ, Narita M, Mühlemann K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. THE LANCET. INFECTIOUS DISEASES 2009; 9:312-23. [PMID: 19393961 DOI: 10.1016/s1473-3099(09)70083-0] [Citation(s) in RCA: 346] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the debilitated host. S maltophilia is not an inherently virulent pathogen, but its ability to colonise respiratory-tract epithelial cells and surfaces of medical devices makes it a ready coloniser of hospitalised patients. S maltophilia can cause blood-stream infections and pneumonia with considerable morbidity in immunosuppressed patients. Management of infection is hampered by high-level intrinsic resistance to many antibiotic classes and the increasing occurrence of acquired resistance to the first-line drug co-trimoxazole. Prevention of acquisition and infection depends upon the application of modern infection-control practices, with emphasis on the control of antibiotic use and environmental reservoirs.
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Affiliation(s)
- W John Looney
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Principe L, D'Arezzo S, Capone A, Petrosillo N, Visca P. In vitro activity of tigecycline in combination with various antimicrobials against multidrug resistant Acinetobacter baumannii. Ann Clin Microbiol Antimicrob 2009; 8:18. [PMID: 19460166 PMCID: PMC2693502 DOI: 10.1186/1476-0711-8-18] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 05/21/2009] [Indexed: 12/17/2022] Open
Abstract
Background Infections sustained by multidrug-resistant (MDR) and pan-resistant Acinetobacter baumannii have become a challenging problem in Intensive Care Units. Tigecycline provided new hope for the treatment of MDR A. baumannii infections, but isolates showing reduced susceptibility have emerged in many countries, further limiting the therapeutic options. Empirical combination therapy has become a common practice to treat patients infected with MDR A. baumannii, in spite of the limited microbiological and clinical evidence supporting its efficacy. Here, the in vitro interaction of tigecycline with seven commonly used anti-Acinetobacter drugs has been assessed. Methods Twenty-two MDR A. baumannii isolates from Intensive Care Unit (ICU) patients and two reference strains for the European clonal lineages I and II (including 3, 15 and 6 isolates that were resistant, intermediate and susceptible to tigecycline, respectively) were tested. Antimicrobial agents were: tigecycline, levofloxacin, piperacillin-tazobactam, amikacin, imipenem, rifampicin, ampicillin-sulbactam, and colistin. MICs were determined by the broth microdilution method. Antibiotic interactions were determined by chequerboard and time-kill assays. Only antibiotic combinations showing synergism or antagonism in both chequerboard and time-kill assays were accepted as authentic synergistic or antagonistic interactions, respectively. Results Considering all antimicrobials in combination with tigecycline, chequerboard analysis showed 5.9% synergy, 85.7% indifference, and 8.3% antagonism. Tigecycline showed synergism with levofloxacin (4 strains; 16.6%), amikacin (2 strains; 8.3%), imipenem (2 strains; 8.3%) and colistin (2 strains; 8.3%). Antagonism was observed for the tigecycline/piperacillin-tazobactam combination (8 strains; 33.3%). Synergism was detected only among tigecycline non-susceptible strains. Time-kill assays confirmed the synergistic interaction between tigecycline and levofloxacin, amikacin, imipenem and colistin for 5 of 7 selected isolates. No antagonism was confirmed by time-kill assays. Conclusion This study demonstrates the in vitro synergistic activity of tigecycline in combination with colistin, levofloxacin, amikacin and imipenem against five tigecycline non-susceptible A. baumannii strains, opening the way to a more rationale clinical assessment of novel combination therapies to combat infections caused by MDR and pan-resistant A. baumannii.
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Affiliation(s)
- Luigi Principe
- National Institute for Infectious Diseases Lazzaro Spallanzani, Via Portuense 292, Rome 00149, Italy.
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Karageorgopoulos DE, Falagas ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. THE LANCET. INFECTIOUS DISEASES 2009; 8:751-62. [PMID: 19022191 DOI: 10.1016/s1473-3099(08)70279-2] [Citation(s) in RCA: 303] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Institutional outbreaks caused by Acinetobacter baumannii strains that have acquired multiple mechanisms of antimicrobial drug resistance constitute a growing public-health problem. Because of complex epidemiology, infection control of these outbreaks is difficult to attain. Identification of potential common sources of an outbreak, through surveillance cultures and epidemiological typing studies, can aid in the implementation of specific control measures. Adherence to a series of infection control methods including strict environmental cleaning, effective sterilisation of reusable medical equipment, attention to proper hand hygiene practices, and use of contact precautions, together with appropriate administrative guidance and support, are required for the containment of an outbreak. Effective antibiotic treatment of A baumannii infections, such as ventilator-associated pneumonia and bloodstream infections, is also of paramount importance. Carbapenems have long been regarded as the agents of choice, but resistance rates have risen substantially in some areas. Sulbactam has been successfully used in the treatment of serious A baumannii infections; however, the activity of this agent against carbapenem-resistant isolates is decreasing. Polymyxins show reliable antimicrobial activity against A baumannii isolates. Available clinical reports, although consisting of small-sized studies, support their effectiveness and mitigate previous concerns for toxicity. Minocycline, and particularly its derivative, tigecycline, have shown high antimicrobial activity against A baumannii, though relevant clinical evidence is still scarce. Several issues regarding the optimum therapeutic choices for multidrug-resistant A baumannii infections need to be clarified by future research.
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In vitro activity of tigecycline against resistant micro-organisms isolated from burn patients. Burns 2008; 34:1033-6. [DOI: 10.1016/j.burns.2008.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Accepted: 03/06/2008] [Indexed: 11/20/2022]
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Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008; 46:1254-63. [PMID: 18444865 DOI: 10.1086/529198] [Citation(s) in RCA: 659] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multidrug-resistant Acinetobacter baumannii is recognized to be among the most difficult antimicrobial-resistant gram-negative bacilli to control and treat. Increasing antimicrobial resistance among Acinetobacter isolates has been documented, although definitions of multidrug resistance vary in the literature. A. baumannii survives for prolonged periods under a wide range of environmental conditions. The organism causes outbreaks of infection and health care-associated infections, including bacteremia, pneumonia, meningitis, urinary tract infection, and wound infection. Antimicrobial resistance greatly limits the therapeutic options for patients who are infected with this organism, especially if isolates are resistant to the carbapenem class of antimicrobial agents. Because therapeutic options are limited for multidrug-resistant Acinetobacter infection, the development or discovery of new therapies, well-controlled clinical trials of existing antimicrobial regimens and combinations, and greater emphasis on the prevention of health care-associated transmission of multidrug-resistant Acinetobacter infection are essential.
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Affiliation(s)
- Lisa L Maragakis
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Karageorgopoulos DE, Kelesidis T, Kelesidis I, Falagas ME. Tigecycline for the treatment of multidrug-resistant (including carbapenem-resistant) Acinetobacter infections: a review of the scientific evidence. J Antimicrob Chemother 2008; 62:45-55. [PMID: 18436554 DOI: 10.1093/jac/dkn165] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES New antibacterial agents are required for the treatment of infections caused by multidrug-resistant (MDR) Acinetobacter spp. Whether tigecycline constitutes an effective treatment option or not, is not well established. We sought to evaluate the available evidence regarding the microbiological activity and clinical effectiveness of tigecycline for MDR (including the subset of carbapenem-resistant) Acinetobacter spp. METHODS We searched PubMed for relevant articles and extracted/evaluated the available evidence. RESULTS We identified 22 microbiological studies reporting data for 2384 Acinetobacter spp. (1906 Acinetobacter baumannii). Susceptibility of at least 90% of the Acinetobacter isolates to tigecycline (with an MIC breakpoint of susceptibility < or =2 mg/L) was noted in 9/18 studies reporting data on MDR Acinetobacter and in 7/15 studies reporting specific data on carbapenem-resistant Acinetobacter. In an additional study reporting data for both resistance categories, adequate susceptibility of Acinetobacter spp. was observed by one (broth microdilution) of the methods employed. The effectiveness of tigecycline for MDR Acinetobacter infections was evaluated in eight identified clinical studies, reporting retrospective data regarding 42 severely ill patients, among whom 31 had respiratory tract infection (in 4 cases with secondary bacteraemia) and 4 had bacteraemia. Tigecycline therapy (in combination with other antibiotics in 28 patients) was effective in 32/42 cases. In three cases, resistance to tigecycline developed during treatment. CONCLUSIONS Tigecycline showed considerable, though not consistent, antimicrobial activity against MDR (including carbapenem-resistant) Acinetobacter spp. However, data to support its clinical use, particularly for ventilator-associated pneumonia or bacteraemia, caused by these pathogens, are still limited.
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Vila J, Pachón J. Therapeutic options for Acinetobacter baumannii infections. Expert Opin Pharmacother 2008; 9:587-99. [PMID: 18312160 DOI: 10.1517/14656566.9.4.587] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Acinetobacter baumannii is an important cause of nosocomial infections, mainly in patients in intensive care units. This microorganism, although with slight differences depending on the country, presents resistance to multiple antimicrobial agents, occasionally including resistance to colistin: hence, it can be considered the paradigm of nosocomial multiresistant bacteria. This review analyzes the evolution of antimicrobial resistance and the molecular bases associated with the increase in antimicrobial resistance, as well as the current treatment of Acinetobacter infections. Although controversy remains, the pooled data suggest that infections by A. baumannii may be associated with considerable attributable mortality. Moreover, in cases of pneumonia and bacteraemia, inappropriate treatment is associated with, among other factors, mortality. Therefore, treatment should be carefully considered.
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Affiliation(s)
- Jordi Vila
- Hospital Clinic, Department of Clinical Microbiology, Villarroel, 170; 08036 Barcelona, Spain.
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Sader HS, Mallick R, Kuznik A, Fritsche TR, Jones RN. Use of in vitro susceptibility and pathogen prevalence data to model the expected clinical success rates of tigecycline and other commonly used antimicrobials for empirical treatment of complicated skin and skin-structure infections. Int J Antimicrob Agents 2007; 30:514-20. [DOI: 10.1016/j.ijantimicag.2007.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 07/24/2007] [Accepted: 07/26/2007] [Indexed: 01/22/2023]
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Cercenado E. Tigecycline: a new antimicrobial agent against multiresistant bacteria. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/14750708.4.3.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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