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Snowdin JW, Mercuro NJ, Madaio MP, Rawlings SA. Case report: Successful treatment of OXA-23 Acinetobacter baumannii neurosurgical infection and meningitis with sulbactam-durlobactam combination therapy. Front Med (Lausanne) 2024; 11:1381123. [PMID: 38813376 PMCID: PMC11135601 DOI: 10.3389/fmed.2024.1381123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Meningitis caused by Acinetobacter species is a rare complication of neurosurgical procedures, although it is associated with high morbidity and mortality. Carbapenem-resistant Acinetobacter is particularly difficult to treat, considering the limited selection and tolerability of effective antimicrobials. Sulbactam-durlobactam was approved by the FDA in 2023 for treatment of hospital-acquired and ventilator-associated pneumonia due to susceptible strains of Acinetobacter, including carbapenem-resistant Acinetobacter baumannii. Here, we present a case of carbapenem-resistant Acinetobacter baumannii neurosurgical infection and meningitis successfully treated with sulbactam-durlobactam combination therapy.
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Affiliation(s)
| | | | | | - Stephen A. Rawlings
- Department of Infectious Diseases, Maine Medical Center, Portland, ME, United States
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Mansouri M, Sadeghpoor M, Abdollahi M, Vafaei AJ, Jalali Nadoushan M, Rasooli I. Synergistic immunoprotection by Oma87 and Bap against Acinetobacter baumannii sepsis model. Int Immunopharmacol 2023; 122:110650. [PMID: 37454632 DOI: 10.1016/j.intimp.2023.110650] [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: 05/20/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Acinetobacter baumannii is the leading cause of nosocomial infection. A surface protein commonly known as biofilm associate protein (Bap) has been identified in a bloodstream isolate of A. baumannii. Bap of A. baumannii is involved in intercellular adhesion within the mature biofilm. Outer membrane protein Acinetobacter 87 kDa (Oma87) or β-barrel assembly machinery A (BamA) has been introduced as an immunogenic outer membrane protein via in silico reverse vaccinology. Current research examines the synergistic effect of immunization of mice with both recombinant proteins viz., Oma87 and Bap. Antibodies were raised to the proteins. The mice were challenged with A. baumannii ATCC 19606 and the bacterial burden was enumerated in the mice's livers, spleens, and lungs followed by histological examination. IgG levels significantly increased, and a significant (p < 0.0001) difference was observed between bacterial burdens in the internal organs of the actively and passively immunized groups. Female BALB/c mice weighing 20-25 g, were divided into 4 groups of 14 mice each viz., control, Oma87, Bap, Oma87-Bap groups. The proteins were individually immunogenic, but the combination of both proteins had a synergistic protection property. This is further supported by the histological examination. Based on the results, the combination of Oma87 and Bap may be considered a promising vaccine candidate against A. baumannii .
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Affiliation(s)
- Mobina Mansouri
- Department of Biology, Faculty of Basic Sciences, Shahed University, Tehran, Iran
| | - Masoomeh Sadeghpoor
- Department of Biology, Faculty of Basic Sciences, Shahed University, Tehran, Iran
| | - Marziyeh Abdollahi
- Department of Biology, Faculty of Basic Sciences, Shahed University, Tehran, Iran
| | - Amir Javad Vafaei
- Department of Biology, Faculty of Basic Sciences, Shahed University, Tehran, Iran
| | | | - Iraj Rasooli
- Department of Biology, Faculty of Basic Sciences, Shahed University, Tehran, Iran; Molecular Microbiology Research Center and Department of Biology, Shahed University, Tehran, Iran.
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Canli K, Bozyel ME, Turu D, Benek A, Simsek O, Altuner EM. Biochemical, Antioxidant Properties and Antimicrobial Activity of Steno-Endemic Origanum onites. Microorganisms 2023; 11:1987. [PMID: 37630547 PMCID: PMC10457892 DOI: 10.3390/microorganisms11081987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
Origanum onites (Lamiaceae) is an Eastern Mediterranean plant that is widely used in Turkish traditional medicine. This study aimed to investigate the biochemical composition, antimicrobial activity, and antioxidant potential of O. onites. In this study, the biochemical composition of the O. onites ethanol extract (OOEt) was analyzed using GC-MS. The antimicrobial activity was investigated using a disk diffusion test and determining minimum inhibitory concentrations (MIC) against 30 microorganism strains, including 28 bacteria (some multidrug-resistant) and 2 fungi. Additionally, the antioxidant activity was evaluated using the DPPH method. The main component identified was carvacrol. OOEt demonstrated antimicrobial activity against a wide range of tested microorganism strains. OOEt displayed the highest activity against E. faecium (a Gram-positive bacterium) at 100 µL with a 52 mm inhibition zone. Additionally, P. aeruginosa DSMZ 50071 and P. fluorescens P1, which are Gram-negative bacteria, were the most sensitive strains with a 24 mm inhibition zone in 100 µL of OOEt. The data obtained from A. baumannii (a multidrug-resistant strain) is particularly striking, as higher activity was observed compared to all positive controls. All tested fungal strains showed more effective results than positive controls. The antioxidant activity of OOEt was found to be stronger than that of the positive control, ascorbic acid. This study determined that O. onites has significant antimicrobial and antioxidant potential.
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Affiliation(s)
- Kerem Canli
- Department of Biology, Faculty of Science, Dokuz Eylül University, Izmir 35390, Türkiye
- Fauna and Flora Research and Application Center, Dokuz Eylül University, Izmir 35390, Türkiye
| | - Mustafa Eray Bozyel
- Department of Biology, Faculty of Science, Dokuz Eylül University, Izmir 35390, Türkiye
| | - Dilay Turu
- Department of Biology, Graduate School of Natural and Applied Science, Dokuz Eylül University, Izmir 35390, Türkiye
| | - Atakan Benek
- Department of Biology, Graduate School of Natural and Applied Sciences, Kastamonu University, Kastamonu 37150, Türkiye
| | - Ozcan Simsek
- Department of Forestry, Yenice Vocational School, Çanakkale Onsekiz Mart University, Çanakkale 17950, Türkiye
| | - Ergin Murat Altuner
- Department of Biology, Faculty of Science, Kastamonu University, Kastamonu 37150, Türkiye
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Junaid M, Thirapanmethee K, Khuntayaporn P, Chomnawang MT. CRISPR-Based Gene Editing in Acinetobacter baumannii to Combat Antimicrobial Resistance. Pharmaceuticals (Basel) 2023; 16:920. [PMID: 37513832 PMCID: PMC10384873 DOI: 10.3390/ph16070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Antimicrobial resistance (AMR) poses a significant threat to the health, social, environment, and economic sectors on a global scale and requires serious attention to addressing this issue. Acinetobacter baumannii was given top priority among infectious bacteria because of its extensive resistance to nearly all antibiotic classes and treatment options. Carbapenem-resistant A. baumannii is classified as one of the critical-priority pathogens on the World Health Organization (WHO) priority list of antibiotic-resistant bacteria for effective drug development. Although available genetic manipulation approaches are successful in A. baumannii laboratory strains, they are limited when employed on newly acquired clinical strains since such strains have higher levels of AMR than those used to select them for genetic manipulation. Recently, the CRISPR-Cas (Clustered regularly interspaced short palindromic repeats/CRISPR-associated protein) system has emerged as one of the most effective, efficient, and precise methods of genome editing and offers target-specific gene editing of AMR genes in a specific bacterial strain. CRISPR-based genome editing has been successfully applied in various bacterial strains to combat AMR; however, this strategy has not yet been extensively explored in A. baumannii. This review provides detailed insight into the progress, current scenario, and future potential of CRISPR-Cas usage for AMR-related gene manipulation in A. baumannii.
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Affiliation(s)
- Muhammad Junaid
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Antimicrobial Resistance Interdisciplinary Group (AmRIG), Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
| | - Krit Thirapanmethee
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Antimicrobial Resistance Interdisciplinary Group (AmRIG), Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
| | - Piyatip Khuntayaporn
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Antimicrobial Resistance Interdisciplinary Group (AmRIG), Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
| | - Mullika Traidej Chomnawang
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Antimicrobial Resistance Interdisciplinary Group (AmRIG), Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
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Liu D, Niu J, Chen G, Xu L. Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study. Infect Drug Resist 2022; 15:7653-7666. [PMID: 36579127 PMCID: PMC9791995 DOI: 10.2147/idr.s392818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose We evaluated the efficacy and administration time of intraventricular (IVT) polymyxin B in the treatment of carbapenem-resistant and multidrug-resistant/extensively drug-resistant (MDR/XDR) Gram-negative bacilli in central nervous system (CNS) infections and investigated prognostic factors. Patients and Methods This retrospective analysis comprised 41 post-surgical carbapenem-resistant CNS infections from October 2016 to October 2021. All patients were treated with effective intravenous antibiotics and IVT polymyxin B. Patient characteristics, therapeutic procedure, symptoms, cerebrospinal fluid (CSF) examination, laboratory tests, and complications were recorded. The effectiveness of IVT polymyxin B was evaluated using temperature, Glasgow Coma Scale, CSF contents, bacterial clearance rate, cure rate, and mortality. Mortality between early (7 days) and late administration of IVT polymyxin B was compared. Prognostic factors were evaluated using the pupillary light reflex and multiloculated hydrocephalus. Results The 41 patients acquired carbapenem-resistant MDR/XDR bacteria, including 24 Klebsiella pneumoniae, 15 Acinetobacter baumannii, 3 Pseudomonas aeruginosa, and 1 Enterobacter cloacae. The bacterial clearance rate was 32/41 (78.0%), and 9 patients (22.0%) with uncured bacterial infections died. Adverse events included 1 case of skin pigmentation. Among the 32 cured patients, 31 received a ventriculoperitoneal shunt, and 1 patient had an extraventricular drainage tube removed. Mortality in the late (>7 days) group was higher (39.1% vs 0%, P < 0.05). The group without pupillary light reflex showed a higher death rate (41.2% vs 8.3%; P < 0.05). The multiloculated hydrocephalus group had a higher mortality rate than that of the normal group (34.8% vs 5.6%, P < 0.05). All 32 cured patients were followed up for 9 to 66 months, and all survived without recurrent infections. Conclusion Intraventricular polymyxin B is an effective treatment for carbapenem-resistant MDR/XDR Gram-negative bacilli, with a 78% cure rate and significant mortality reduction if administered within 7 days of bacterial identification. Multiloculated hydrocephalus and the pupillary light reflex may be used as prognostic indicators of mortality.
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Affiliation(s)
- Dongsheng Liu
- Departments of Neurosurgery of Aviation General Hospital, Beijing, 100012, People’s Republic of China
| | - Jianxing Niu
- Departments of Neurosurgery of Aviation General Hospital, Beijing, 100012, People’s Republic of China
| | - Guoqiang Chen
- Departments of Neurosurgery of Aviation General Hospital, Beijing, 100012, People’s Republic of China,Guoqiang Chen, Departments of Neurosurgery of Aviation General Hospital, No. 3, Anwai Beiyuan, Beiyuan Road, Chaoyang District, Beijing, 10001, People’s Republic of China, Tel +86 13311396583, Fax +86 10-59520156, Email
| | - Long Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100070, People’s Republic of China,Correspondence: Long Xu, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, National Clinical Research Center for Neurological Diseases (NCRC-ND), No. 119 Nansihuanxilu Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86 13911129912, Fax +86 10-59976095, Email
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Prabhakar H. The Menace of Meningitis! Indian J Crit Care Med 2022; 26:1231-1232. [PMID: 36755626 PMCID: PMC9886016 DOI: 10.5005/jp-journals-10071-24368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
How to cite this article: Prabhakar H. The Menace of Meningitis! Indian J Crit Care Med 2022;26(12):1231-1232.
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Affiliation(s)
- Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India,Hemanshu Prabhakar, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India, Phone: +91-011-26593474, e-mail:
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Pandey S, Yao PW, Qian Z, Ji T, Wang K, Gao L. Clinical Characteristics of Hydrocephalus Following the Treatment of Pyogenic Ventriculitis Caused by Multi/Extensive Drug-Resistant Gram-Negative Bacilli, Acinetobacter Baumannii, and Klebsiella Pneumoniae. Front Surg 2022; 9:854627. [PMID: 35592123 PMCID: PMC9110772 DOI: 10.3389/fsurg.2022.854627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveHydrocephalus is common after ventriculitis. This study explores hydrocephalus's clinical characteristics following pyogenic ventriculitis due to multidrug-resistant and extensively drug-resistant Acinetobacter baumannii and Klebsiella pneumoniae.Patients and MethodsWe retrospectively reviewed patients with post-neurosurgical pyogenic ventriculitis due to multidrug-resistant and extensively drug-resistant A. baumannii and K. pneumoniae in our department between January 2014 and June 2020. Once diagnosed, patients received intraventricular lavage followed by daily intraventricular administration of Colistin (polymyxin-E). The patient's clinical/radiographic findings were analyzed and evaluated 6 months after discharge.ResultsIn total, 48 cases were included in this study, and 25% were female. The median age was 45 (SD ± 15) years old. Median intraventricular Colistin administration to acquire sterile cerebrospinal fluid (CSF) was 20 days. Forty-one patients developed hydrocephalus; among them, 18 (43%) had multiloculated hydrocephalus (MLH), 23 (56%) had uni/non-loculated hydrocephalus (ULH/NLH), and 7 (17%) did not develop hydrocephalus. The patients with MLH had (15 days) delayed initiation of intraventricular irrigation (p < 0.022). They had (32 days) longer intraventricular Colistin (p < 0.003) and showed worse outcomes in terms of Glasgow outcome score (GOS) at 6 months follow-up than those without hydrocephalus. The mean score of the MLH group was 1.67 (SD1.23), and ULH/NLH was 2.61 (SD1.4) at p < 0.008.ConclusionMultiloculated hydrocephalus is common in patients receiving delayed intraventricular administration of Colistin and required a longer duration on intraventricular Colistin to treat the pyogenic ventriculitis caused by multidrug/extensive drug-resistant A. baumannii and K. pneumoniae. It is associated with worse clinical outcomes.
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Affiliation(s)
- Sajan Pandey
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Pei Wen Yao
- Medical Department, Nanjing Medical University, Nanjing, China
| | - Zhouqi Qian
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Ji
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Tao Ji
| | - Ke Wang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Ke Wang
| | - Liang Gao
- Medical Department, Nanjing Medical University, Nanjing, China
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Ma C, McClean S. Mapping Global Prevalence of Acinetobacter baumannii and Recent Vaccine Development to Tackle It. Vaccines (Basel) 2021; 9:vaccines9060570. [PMID: 34205838 PMCID: PMC8226933 DOI: 10.3390/vaccines9060570] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/16/2021] [Accepted: 05/22/2021] [Indexed: 12/23/2022] Open
Abstract
Acinetobacter baumannii is a leading cause of nosocomial infections that severely threaten public health. The formidable adaptability and resistance of this opportunistic pathogen have hampered the development of antimicrobial therapies which consequently leads to very limited treatment options. We mapped the global prevalence of multidrug-resistant A. baumannii and showed that carbapenem-resistant A. baumannii is widespread throughout Asia and the Americas. Moreover, when antimicrobial resistance rates of Acinetobacter spp. exceed a threshold level, the proportion of A. baumannii isolates from clinical samples surges. Therefore, vaccines represent a realistic alternative strategy to tackle this pathogen. Research into anti-A. baumannii vaccines have enhanced in the past decade and multiple antigens have been investigated preclinically with varying results. This review summarises the current knowledge of virulence factors relating to A. baumannii–host interactions and its implication in vaccine design, with a view to understanding the current state of A. baumannii vaccine development and the direction of future efforts.
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Martinez J, Razo-Gutierrez C, Le C, Courville R, Pimentel C, Liu C, Fung SE, Tuttobene MR, Phan K, Vila AJ, Shahrestani P, Jimenez V, Tolmasky ME, Becka SA, Papp-Wallace KM, Bonomo RA, Soler-Bistue A, Sieira R, Ramirez MS. Cerebrospinal fluid (CSF) augments metabolism and virulence expression factors in Acinetobacter baumannii. Sci Rep 2021; 11:4737. [PMID: 33637791 PMCID: PMC7910304 DOI: 10.1038/s41598-021-81714-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
In a recent report by the Centers for Disease Control and Prevention (CDC), multidrug resistant (MDR) Acinetobacter baumannii is a pathogen described as an "urgent threat." Infection with this bacterium manifests as different diseases such as community and nosocomial pneumonia, bloodstream infections, endocarditis, infections of the urinary tract, wound infections, burn infections, skin and soft tissue infections, and meningitis. In particular, nosocomial meningitis, an unwelcome complication of neurosurgery caused by extensively-drug resistant (XDR) A. baumannii, is extremely challenging to manage. Therefore, understanding how A. baumannii adapts to different host environments, such as cerebrospinal fluid (CSF) that may trigger changes in expression of virulence factors that are associated with the successful establishment and progress of this infection is necessary. The present in-vitro work describes, the genetic changes that occur during A. baumannii infiltration into CSF and displays A. baumannii's expansive versatility to persist in a nutrient limited environment while enhancing several virulence factors to survive and persist. While a hypervirulent A. baumannii strain did not show changes in its transcriptome when incubated in the presence of CSF, a low-virulence isolate showed significant differences in gene expression and phenotypic traits. Exposure to 4% CSF caused increased expression of virulence factors such as fimbriae, pilins, and iron chelators, and other virulence determinants that was confirmed in various model systems. Furthermore, although CSF's presence did not enhance bacterial growth, an increase of expression of genes encoding transcription, translation, and the ATP synthesis machinery was observed. This work also explores A. baumannii's response to an essential component, human serum albumin (HSA), within CSF to trigger the differential expression of genes associated with its pathoadaptibility in this environment.
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Affiliation(s)
- Jasmine Martinez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Chelsea Razo-Gutierrez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Casin Le
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Robert Courville
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Camila Pimentel
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Christine Liu
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Sammie E Fung
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Marisel R Tuttobene
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Kimberly Phan
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Alejandro J Vila
- Instituto de Biología Molecular Y Celular de Rosario (IBR, CONICET-UNR), Rosario, Argentina
- Área Biofísica, Facultad de Ciencias Bioquímicas Y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Parvin Shahrestani
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Veronica Jimenez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Marcelo E Tolmasky
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA
| | - Scott A Becka
- Research Service and GRECC, Department of Veterans Affairs Medical Center, Louis Stokes Cleveland, Cleveland, OH, USA
| | - Krisztina M Papp-Wallace
- Research Service and GRECC, Department of Veterans Affairs Medical Center, Louis Stokes Cleveland, Cleveland, OH, USA
- Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Biochemistry, Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
| | - Robert A Bonomo
- Research Service and GRECC, Department of Veterans Affairs Medical Center, Louis Stokes Cleveland, Cleveland, OH, USA
- Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Biochemistry, Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
| | - Alfonso Soler-Bistue
- Instituto de Investigaciones Biotecnológicas, Universidad Nacional de San Martín-Consejo Nacional de Investigaciones Científicas Y Técnicas, San Martín, Buenos Aires, Argentina
| | - Rodrigo Sieira
- Fundación Instituto Leloir - IIBBA CONICET, Buenos Aires, Argentina
| | - Maria Soledad Ramirez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92831, USA.
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Chen Y, Liu L, Zhu M. Intraventricular administration of antibiotics by ommaya reservoir for patients with multidrug-resistant Acinetobacter baumannii central nervous system infection. Br J Neurosurg 2020; 35:170-173. [PMID: 32657168 DOI: 10.1080/02688697.2020.1777255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To investigate whether the Ommaya reservoir can be used to treat multiple drug-resistant Acinetobacter baumannii (MDR-AB) infections in the central nervous system (CNS). METHODS Retrospectively analyzed the clinical records and data of 15 MDR-AB CNS infection patients who were treated in our neuro-ICU. Four patients with MDR-AB CNS infection were involved in this study. RESULTS We report the successful treatment of MDR-AB CNS infection by Ommaya reservoirs and intraventricular antibiotic (IVA) administration. Ommaya reservoirs allow serial CSF sampling and IVA injection. Furthermore, debridement can be performed during the operation to insert the Ommaya. CONCLUSION Ommaya reservoirs can be used as an effective treatment approach of MDR-AB or other multidrug-resistant Gram-negative bacteria CNS infections.
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Affiliation(s)
- Yue Chen
- Center of Clinical Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Lei Liu
- Center of Clinical Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Man Zhu
- Center of Clinical Pharmacy, Chinese PLA General Hospital, Beijing, China
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Zhong L, Shi XZ, Su L, Liu ZF. Sequential intraventricular injection of tigecycline and polymyxin B in the treatment of intracranial Acinetobacter baumannii infection after trauma: a case report and review of the literature. Mil Med Res 2020; 7:23. [PMID: 32389124 PMCID: PMC7212555 DOI: 10.1186/s40779-020-00253-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 05/03/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intracranial infection after craniotomy is one of the most serious postoperative complications, especially multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacterial meningitis, and strongly affects the prognosis of patients. Current treatment experience regarding these infections is scarce. CASE PRESENTATION We report a case of severe intracranial infection of XDR Acinetobacter baumannii (A. baumannii) that was treated by intravenous (IV) injection, sequential intraventricular (IVT) injection of tigecycline and polymyxin B, and other anti-infective drugs. Good results were obtained, and the patient was eventually discharged from the hospital. This case is characterized by intracranial infection. CONCLUSIONS The polymyxin B IV + IVT pathway is an ideal treatment strategy for XDR A. baumannii. The tigecycline IVT pathway is also a safe treatment option.
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Affiliation(s)
- Li Zhong
- Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510515, China.,Department of Critical Care Medicine, the First Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, 550001, China
| | - Xue-Zhi Shi
- Department of Critical Care Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou, 510010, China
| | - Lei Su
- Department of Critical Care Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou, 510010, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Southern Theater Command of PLA, Guangzhou, 510010, China
| | - Zhi-Feng Liu
- Department of Critical Care Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou, 510010, China. .,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Southern Theater Command of PLA, Guangzhou, 510010, China.
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Mizrahi CJ, Benenson S, Moscovici S, Candanedo C, Benifla M, Spektor S. Combination Treatment with Intravenous Tigecycline and Intraventricular and Intravenous Colistin in Postoperative Ventriculitis Caused by Multidrug-resistant Acinetobacter baumannii. Cureus 2019; 11:e3888. [PMID: 30911445 PMCID: PMC6424557 DOI: 10.7759/cureus.3888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Nosocomial infections with multidrug-resistant (MDR) pathogens are a life-threatening complication in neurosurgery. An MDR Acinetobacter baumannii (A. baumannii) central nervous system (CNS) infection following neurosurgery has been previously reported and was treated with relative success using intraventricular and/or intravenous (IV) colistin, IV tigecycline, or IV colistin-rifampicin combination therapy. We present a case of MDR A. baumannii in a 13-year-old girl following parietal craniotomy for the resection of a right intraventricular meningioma. Several days after surgery, the patient presented with clinical, radiological, laboratorial, and microbiological evidence of carbapenem-resistant A. baumannii ventriculitis. She was treated with IV colistin and then with combined intraventricular-IV colistin, with partial failure. The combined treatment of IV tigecycline and associated intraventricular and intravenous colistin was started and significant improvement was seen clinically and radiologically, with negative cultures after one week. To the best of our knowledge, this is the first case of a successful combination of intraventricular and IV colistin combined with IV tigecycline after a partial treatment failure with intraventricular and IV colistin alone.
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Affiliation(s)
- Cezar J Mizrahi
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, ISR
| | - Shmuel Benenson
- Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, ISR
| | - Samuel Moscovici
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, ISR
| | - Carlos Candanedo
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, ISR
| | - Mony Benifla
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, ISR
| | - Sergey Spektor
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, ISR
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The Role of Intraventricular Antibiotics in the Treatment of Nosocomial Ventriculitis/Meningitis from Gram-Negative Pathogens: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e637-e650. [DOI: 10.1016/j.wneu.2018.08.138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/22/2022]
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Mrowczynski OD, Langan ST, Rizk EB. Intra-cerebrospinal fluid antibiotics to treat central nervous system infections: A review and update. Clin Neurol Neurosurg 2018; 170:140-158. [DOI: 10.1016/j.clineuro.2018.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/12/2018] [Accepted: 05/10/2018] [Indexed: 12/14/2022]
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Karumathil DP, Nair MS, Gaffney J, Kollanoor-Johny A, Venkitanarayanan K. Trans-Cinnamaldehyde and Eugenol Increase Acinetobacter baumannii Sensitivity to Beta-Lactam Antibiotics. Front Microbiol 2018; 9:1011. [PMID: 29875743 PMCID: PMC5974060 DOI: 10.3389/fmicb.2018.01011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/30/2018] [Indexed: 01/23/2023] Open
Abstract
Multi-drug resistant (MDR) Acinetobacter baumannii is a major nosocomial pathogen causing a wide range of clinical conditions with significant mortality rates. A. baumannii strains are equipped with a multitude of antibiotic resistance mechanisms, rendering them resistant to most of the currently available antibiotics. Thus, there is a critical need to explore novel strategies for controlling antibiotic resistance in A. baumannii. This study investigated the efficacy of two food-grade, plant-derived antimicrobials (PDAs), namely trans-cinnamaldehyde (TC) and eugenol (EG) in decreasing A. baumannii’s resistance to seven β-lactam antibiotics, including ampicillin, methicillin, meropenem, penicillin, aztreonam, amoxicillin, and piperacillin. Two MDR A. baumannii isolates (ATCC 17978 and AB 251847) were separately cultured in tryptic soy broth (∼6 log CFU/ml) containing the minimum inhibitory concentration (MIC) of TC or EG with or without the MIC of each antibiotic at 37°C for 18 h. A. baumannii strains not exposed to the PDAs or antibiotics served as controls. Following incubation, A. baumannii counts were determined by broth dilution assay. In addition, the effect of PDAs on the permeability of outer membrane and efflux pumps in A. baumannii was measured. Further, the effect of TC and EG on the expression of A. baumannii genes encoding resistance to β-lactam antibiotics (blaP), efflux pumps (adeABC), and multi-drug resistant protein (mdrp) was studied using real-time quantitative PCR (RT-qPCR). The experiment was replicated three times with duplicate samples of each treatment and control. The results from broth dilution assay indicated that both TC and EG in combination with antibiotics increased the sensitivity of A. baumannii to all the tested antibiotics (P < 0.05). The two PDAs inhibited the function of A. baumannii efflux pump, (AdeABC), but did not increase the permeability of its outer membrane. Moreover, RT-qPCR data revealed that TC and EG down-regulated the expression of majority of the genes associated with β-lactam antibiotic resistance, especially blaP and adeABC (P < 0.05). The results suggest that TC and EG could potentially be used along with β-lactam antibiotics for controlling MDR A. baumannii infections; however, their clinical significance needs to be determined using in vivo studies.
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Affiliation(s)
- Deepti P Karumathil
- Department of Animal Science, University of Connecticut, Storrs, CT, United States
| | - Meera Surendran Nair
- Department of Animal Science, University of Connecticut, Storrs, CT, United States
| | - James Gaffney
- College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Anup Kollanoor-Johny
- Department of Animal Science, University of Minnesota, Saint Paul, MN, United States
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Chusri S, Sakarunchai I, Kositpantawong N, Panthuwong S, Santimaleeworagun W, Pattharachayakul S, Singkhamanan K, Doi Y. Outcomes of adjunctive therapy with intrathecal or intraventricular administration of colistin for post-neurosurgical meningitis and ventriculitis due to carbapenem-resistant acinetobacter baumannii. Int J Antimicrob Agents 2017; 51:646-650. [PMID: 29241820 DOI: 10.1016/j.ijantimicag.2017.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
The efficacy and safety of intrathecal (ITH) or intraventricular (IVT) colistin in addition to intravenous (IV) colistin for meningitis and ventriculitis due to carbapenem-resistant Acinetobacter baumannii (CRAB) is unclear. In this retrospective observational study of 40 patients with post-neurosurgical meningitis and ventriculitis due to CRAB, 33 patients without concomitant infection received appropriate dosage regimens of IV colistin. Of the 33 patients, 17 received additional ITH/IVT colistin and 16 received only IV colistin. The 14-day, 30-day and in-hospital mortality rates were nominally lower for patients who received ITH/IVT colistin adjunctive therapy versus patients who received only IV colistin (24% vs. 38%, 29% vs. 56% and 29% vs. 56%, respectively). The costs of treatment were significantly lower, the lengths of hospital and intensive care unit (ICU) stay were significantly shorter, and the number of ventilator days was significantly less among patients who received ITH/IVT colistin compared with patients who did not receive ITH/IVT colistin. The initial Acute Physiology and Chronic Health Evaluation (APACHE) II and Glasgow Coma Scale (GCS) scores were associated with 30-day mortality with odds ratios (95% confidence intervals) of 1.21 (1.08-1.46) and 0.77 (0.44-0.85), respectively. Chemical meningitis from ITH/IVT colistin was mild and resolved spontaneously. Treatment of post-neurosurgical CRAB meningitis and ventriculitis with ITH/IVT colistin as an adjunct to IV colistin was associated with shorter lengths of hospital and ICU stay and a trend to lower mortality, especially among severely ill patients.
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Affiliation(s)
- Sarunyou Chusri
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
| | - Ittichai Sakarunchai
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Narongdet Kositpantawong
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Siripen Panthuwong
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Wichai Santimaleeworagun
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand; Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Sutthiporn Pattharachayakul
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Kamonnut Singkhamanan
- Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Microbiology, Fujita Health University, Aichi, Japan
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Mohammed N, Savardekar AR, Patra DP, Narayan V, Nanda A. The 21st-century challenge to neurocritical care: the rise of the superbug Acinetobacter baumannii. A meta-analysis of the role of intrathecal or intraventricular antimicrobial therapy in reduction of mortality. Neurosurg Focus 2017; 43:E8. [DOI: 10.3171/2017.8.focus17443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVENeurosurgical infections due to multidrug-resistant organisms have become a nightmare that neurosurgeons are facing in the 21st century. This is the dawn of the so-called postantibiotic era. There is an urgent need to review and evaluate ways to reduce the high mortality rates due to these infections. The present study evaluates the efficacy of combined intravenous plus intrathecal or intraventricular (IV + IT) therapy versus only intravenous (IV) therapy in treating postneurosurgical Acinetobacter baumannii infections.METHODSThe authors performed a meta-analysis of all peer-reviewed studies from the PubMed, Cochrane Library database, ScienceDirect, and EMBASE in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five studies were finally included in the present analysis: 126 patients were studied who had postneurosurgical A. baumannii infection. The Cochrane collaboration tool was used to evaluate risk of bias, and a test of heterogeneity was performed. The I2 statistic was calculated. The patients were divided into 2 groups: the IV group received only intravenous therapy and the IV + IT group received both intravenous and intrathecal or intraventricular antimicrobial therapy. The outcome was mortality attributed specifically to A. baumannii infection in postneurosurgical cases. The pooled data were analyzed using the Cochran-Mantel-Haenszel method in a fixed-effects model.RESULTSThe total number of patients in the IV-only group was 73, and the number of patients in the IV + IT group was 53. The mean duration of intravenous therapy was 27 days. The mean duration of intrathecal colistin was 21 days. The intravenous dose of colistin ranged from 3.75 to 8.8 MIU per day. The dose of intrathecal colistin ranged between 125,000 and 250,000 IU per day. The overall calculated odds ratio for mortality for the IV + IT group after pooling the data was 0.16 (95% CI 0.06–0.40, p < 0.0001). The patients who received IV + IT therapy had an 84% lower risk of dying due to the infection compared with those who received only IV therapy.CONCLUSIONSThere is an 84% lower risk of mortality in patients who have been treated with combined intrathecal or intraventricular plus intravenous antimicrobial therapy versus those who have been treated with intravenous therapy alone. The intrathecal or intraventricular route should be strongly considered when dealing with postneurosurgical multidrug-resistant A. baumannii infections.
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Hussein K, Bitterman R, Shofty B, Paul M, Neuberger A. Management of post-neurosurgical meningitis: narrative review. Clin Microbiol Infect 2017; 23:621-628. [DOI: 10.1016/j.cmi.2017.05.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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Evaluation of Meropenem Penetration into Cerebrospinal Fluid in Patients with Meningitis After Neurosurgery. World Neurosurg 2016; 98:525-531. [PMID: 27867128 DOI: 10.1016/j.wneu.2016.11.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Meropenem is important for management of postneurosurgical meningitis, but the data about its penetration into cerebrospinal fluid (CSF) are inadequate. This prospective, open-label study investigated the pharmacokinetic profile of meropenem in patients with postneurosurgical meningitis, especially its CSF penetration. METHODS A total of 82 patients with postneurosurgical meningitis were included to receive meropenem intravenously according to a regimen of 2 g every 8 hours, 1 g every 8 hours, or 1 g every 6 hours. After infusion of 4 doses, blood and CSF samples were collected simultaneously at predefined time points. The high-performance liquid chromatography ultraviolet method was used to determine the concentration of meropenem. RESULTS The peak meropenem concentration in blood and CSF was 43.2 ± 5.3 and 2.4 ± 0.3 mg/L in the group who received 2 g every 8 hours; 28.9 ± 2.7 and 1.2 ± 0.2 mg/L in the group who received 1g every 8 hours; and31.5 ± 3.4 and 1.6 ± 0.2 mg/L in the group who received 1g every 6 hours. The maximal percent penetration into CSF was 17.6% ± 7.3%, 14.3% ± 1.7%, and 30.9% ± 24.2%, respectively. CONCLUSIONS Dosing regimens of meropenem 1 g every 6 hours and 2 g every 8 hours provided higher CSF penetration than 1 g every 8 hours. A higher dose and shorter dosing interval of meropenem may be more useful for clearance of pathogens.
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Wang L, Zhang J, Yu X, Wang J, Cheng L, Hu S, Han G. Intrathecal injection of tigecycline in treatment of multidrug-resistant Acinetobacter baumannii meningitis: a case report. Eur J Hosp Pharm 2016; 24:182-184. [PMID: 31156934 DOI: 10.1136/ejhpharm-2016-000972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 11/03/2022] Open
Abstract
The ubiquitous Acinetobacter baumannii is an important and troublesome pathogen of nosocomial infection. Multidrug-resistant A baumannii meningitis is very difficult to treat, usually with high mortality. The disease is generally associated with craniotomy, but rarely with lumbar puncture. However, in our case, a 45-year-old male construction worker suffered multidrug-resistant A baumannii meningitis associated with lumbar puncture. The patient responded poorly to the initial treatment with an intravenous infusion of tigecycline. However, later treatment with an intrathecal injection of tigecycline (concentration 1 mg/mL) at a dose of 10 mg every 12 hours proved to be highly efficacious. Thus, intrathecal injection of tigecycline should be seriously considered as a treatment for multidrug-resistant A baumannii meningitis.
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Affiliation(s)
- Lijiang Wang
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Jirong Zhang
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Xiaoqing Yu
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Jiuzhong Wang
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Lifeng Cheng
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Shuzhen Hu
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
| | - Guangliang Han
- Department of Neurosurgery, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
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Place of Colistin-Rifampicin Association in the Treatment of Multidrug-Resistant Acinetobacter Baumannii Meningitis: A Case Study. Case Rep Infect Dis 2016; 2016:8794696. [PMID: 27064923 PMCID: PMC4811080 DOI: 10.1155/2016/8794696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 11/17/2022] Open
Abstract
Treatment of Acinetobacter baumannii meningitis is an important challenge due to the accumulation of resistance of this bacteria and low meningeal diffusion of several antimicrobial requiring use of an antimicrobial effective combination to eradicate these species. We report a case of Acinetobacter baumannii multidrug-resistant nosocomial meningitis which was successfully treated with intravenous and intrathecal colistin associated with rifampicin.
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22
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Combined therapy for multi-drug-resistant Acinetobacter baumannii infection – is there evidence outside the laboratory? J Med Microbiol 2015. [DOI: 10.1099/jmm.0.000144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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De Bonis P, Lofrese G, Scoppettuolo G, Spanu T, Cultrera R, Labonia M, Cavallo MA, Mangiola A, Anile C, Pompucci A. Intraventricular versus intravenous colistin for the treatment of extensively drug resistant Acinetobacter baumannii meningitis. Eur J Neurol 2015; 23:68-75. [PMID: 26228051 DOI: 10.1111/ene.12789] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Reports on the safety and efficacy of intraventricularly administered (IVT) colistin for the treatment of Acinetobacter baumannii ventriculomeningitis in adults are limited and no comparative studies of IVT colistin versus intravenous (IV) therapy alone have been published. This study compared outcomes of patients with postneurosurgical ventriculomeningitis caused by extensively drug-resistant A. baumannii treated with IV colistin or IV plus IVT colistin. METHODS In an 11-year period, information on 18 consecutive patients with extensively drug-resistant A. baumannii ventriculomeningitis was collected. Infection was defined on the basis of (i) isolation of A. baumannii from the cerebrospinal fluid (CSF); (ii) laboratory evidence of CSF infection; (iii) signs/symptoms of central nervous system (CNS) infection. Patients were divided into group 1 (nine patients, IV colistin alone) and group 2 (nine patients, IV plus IVT colistin). RESULTS Cerebrospinal fluid sterilization was documented for 12 of 18 patients (66.6%). The CSF sterilization rate was 33.3% in group 1 and 100% in group 2 (P = 0.009). The mean time to CSF sterilization was 21 days (range 8-48). Five patients died due to A. baumannii CNS infection (all in group 1), and five deaths were unrelated to A. baumannii ventriculomeningitis. Intensive care unit mean length of stay was shorter in group 2 (20.7 vs. 41.6 days, P = 0.046). Crude relative risk ratio of cumulative incidence of persistent CNS infection in group 1 versus group 2 was 13. No cases of chemical meningitis due to intrathecal colistin administration were encountered. CONCLUSIONS Intraventricular colistin administration is much more effective than IV therapy alone and does not seem to add further toxicity.
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Affiliation(s)
- P De Bonis
- Neurosurgery, Catholic University School of Medicine, Rome, Italy.,Neurosurgery, University Hospital S. Anna, Ferrara, Italy
| | - G Lofrese
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - G Scoppettuolo
- Infectious Diseases, Catholic University School of Medicine, Rome, Italy
| | - T Spanu
- Microbiology, Catholic University School of Medicine, Rome, Italy
| | - R Cultrera
- Infectious Diseases, University Hospital S. Anna, Ferrara, Italy
| | - M Labonia
- Department of Laboratory Medicine and Transfusion Medicine, Hospital for Research and Care Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - M A Cavallo
- Neurosurgery, University Hospital S. Anna, Ferrara, Italy
| | - A Mangiola
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - C Anile
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - A Pompucci
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
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Sambanthamoorthy K, Hickman M, Pattabiraman N, Palys T, Wagar EJ. Modulating Acinetobacter baumannii biofilm development with molecules containing 3,4,5-trimethoxy-N,N',N'-trimethylbenzohydrazide moiety. Bioorg Med Chem Lett 2015; 25:2238-42. [PMID: 25881818 DOI: 10.1016/j.bmcl.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/01/2015] [Accepted: 03/03/2015] [Indexed: 01/27/2023]
Abstract
In recent years, Acinetobacter baumannii has emerged as a major cause of nosocomial infections, including infections of implanted medical devices. The treatment of infections caused by A. baumannii has been severely hampered due to their frequent resistance to currently available antibiotics, and most importantly the ability of A. baumannii to form biofilms, which plays a significant role in both persistence and antibiotic resistance. The inherent resistance of A. baumannii biofilms to host defenses and antimicrobial agents necessitates the search for novel approaches to deter biofilm formation. Here, we report our findings on nine compounds identified from structure-activity relationship (SAR) studies on an antibiofilm compound LP3134 that was reported earlier by Biofouling2014, 30, 17. Compounds were evaluated for antibiofilm and anti-adherence activities against A. baumannii. The ability of the compounds to prevent biofilm development on urinary catheters was studied. Growth curve experiments indicated that compounds did not affect the planktonic growth of A. baumannii. All compounds inhibited A. baumannii biofilm development as well as impacting early adhesion on abiotic surfaces. Seven compounds were able to deter biofilm development on silicone catheters. Due to the continued rise of emerging multidrug-resistant A. baumannii, results from this study provide foundation for further development of these molecules to treat A. baumannii infections in wounds and medical devices.
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Affiliation(s)
- Karthik Sambanthamoorthy
- Wound Infections, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
| | - Mark Hickman
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | | | - Thomas Palys
- Wound Infections, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Eric J Wagar
- Wound Infections, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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Moosavian M, Shoja S, Nashibi R, Ebrahimi N, Tabatabaiefar MA, Rostami S, Peymani A. Post Neurosurgical Meningitis due to Colistin Heteroresistant Acinetobacter baumannii. Jundishapur J Microbiol 2014; 7:e12287. [PMID: 25632326 PMCID: PMC4295316 DOI: 10.5812/jjm.12287] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 09/22/2013] [Accepted: 10/20/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction: Recently Acinetobacter baumannii isolates have emerged as a problematic infectious agent that causes meningitis in neurosurgical patients. Colistin has been used successfully for the treatment of A. baumannii meningitis but colistin resistant isolates have been reported worldwide. Case Presentation: Two isolates of A. baumannii were cultured during a five-day period from cerebrospinal fluid (CSF) samples of a 20-year-old man with a gunshot trauma in the abdomen, which had exited from his back. Antimicrobial susceptibility tests of isolates were performed. Multiplex PCR was performed for detection of blaOXA-23-like, blaOXA-24-like and blaOXA-58-like genes. Metallo-β-lactamase genes such as: blaVIM, blaIMP, blaSPM and blaNDM were sought by singleplex PCR. In order to evaluate the genetic relationship, two isolates were examined by the repetitive extragenic palindromic-polymerase chain reaction (REP_PCR) method. Conclusions: E-test results showed that the isolates were sensitive to colistin and tigecycline with minimum inhibitory concentration of (MIC) 0.25 µg/mL and 1.5 µg/mL, respectively. Secondly the isolates were resistant to colistin with MIC > 256 µg/mL but remained sensitive to tigecycline with MIC 1.5 µg/mL. On the basis of the multiplex PCR, both of the isolates were positive for blaOXA-23-like. Other investigated genes such as blaOXA-24-like, blaOXA-58-like, blaVIM, blaIMP, blaSPM and blaNDM were negative. REP-PCR results showed that two isolates were derived from a single strain and both were the same. The results of our study revealed that the firs isolate of A. baumannii was colistin heteroresistant and was changed to completely resistant during therapy. Diagnosis and treatment of A. baumannii meningitis is very important and to avoid treatment failure we suggest that all A. baumannii isolates obtained from CSF should be evaluated properly for colistin heteroresistance.
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Affiliation(s)
- Mojtaba Moosavian
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Saeed Shoja
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran
- Corresponding author: Saeed Shoja, Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-6113367543, Fax: +98-6113332036, E-mail:
| | - Roohangiz Nashibi
- Infectious and Tropical Diseases Research Center, Razi Hospital, Infectious and Tropical Disease Ward, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Nasim Ebrahimi
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | | | - Soodabeh Rostami
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Amir Peymani
- Microbiology Department, Qazvin University of Medical Sciences, Qazvin, IR Iran
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Intrathecal/intraventricular colistin in external ventricular device-related infections by multi-drug resistant Gram negative bacteria: case reports and review. Infection 2014; 42:801-9. [DOI: 10.1007/s15010-014-0618-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
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Imberti R, Iotti GA, Regazzi M. Intraventricular or intrathecal colistin for the treatment of central nervous system infections caused by multidrug-resistant Gram-negative bacteria. Expert Rev Anti Infect Ther 2014; 12:471-8. [PMID: 24597575 DOI: 10.1586/14787210.2014.896740] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Central nervous system infections caused by Gram-negative bacteria susceptible only to colistin are rare but life-threatening and increasing in prevalence. Given the current antibiotic development pipeline it is likely that the paucity of therapeutic options will continue for the next years. Colistin is an amphipathic bactericidal antibiotic which is administered systemically as colistin methanesulfonate (also known as colistimethate sodium). Colistin methanesulfonate is the inactive prodrug, and in cerebrospinal fluid undergoes spontaneous hydrolysis to colistin (the active form with antimicrobial activity). In this review, we describe and evaluate the clinical and experimental data supporting the use of intraventricular (IVT) or intrathecal (IT) colistin against multidrug-resistant Gram-negative infections of the central nervous system, describe the permeability of the blood-brain barrier to colistin, the pharmacokinetics of colistin after IVT administration of colistin methanesulfonate, its anti-endotoxin activity, discuss the opportunity to administer colistin intraventricularly or intrathecally and the dose regimen, and provide recommendations based on the available evidence.
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Affiliation(s)
- Roberto Imberti
- Direzione Scientifica, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy
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Manepalli S, Gandhi JA, Ekhar VV, Asplund MB, Coelho C, Martinez LR. Characterization of a cyclophosphamide-induced murine model of immunosuppression to study Acinetobacter baumannii pathogenesis. J Med Microbiol 2013; 62:1747-1754. [PMID: 24000227 DOI: 10.1099/jmm.0.060004-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Acinetobacter baumannii is a Gram-negative bacterium that opportunistically infects critically ill hospitalized patients with breaches in skin integrity and airway protection, leading to significant morbidity and mortality. Considering the paucity of well-established animal models of immunosuppression to study A. baumannii pathogenesis, we set out to characterize a murine model of immunosuppression using the alkylating agent cyclophosphamide (CYP). We hypothesized that CYP-induced immunosuppression would increase the susceptibility of C57BL/6 mice to developing A. baumannii-mediated pneumonia followed by systemic disease. We demonstrated that CYP intensified A. baumannii-mediated pulmonary disease, abrogated normal immune cell function and led to altered pro-inflammatory cytokine release. The development of an animal model that mimics A. baumannii infection onset in immunosuppressed individuals is crucial for generating novel approaches to patient care and improving public health strategies to decrease exposure to infection for individuals at risk.
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Affiliation(s)
- Swetha Manepalli
- Department of Biomedical Sciences, Long Island University-Post, Brookville, NY, USA
| | - Jay A Gandhi
- Department of Biomedical Sciences, Long Island University-Post, Brookville, NY, USA
| | - Vaibhav V Ekhar
- Department of Biomedical Sciences, Long Island University-Post, Brookville, NY, USA
| | - Melissa B Asplund
- Department of Biomedical Sciences, Long Island University-Post, Brookville, NY, USA
| | - Carolina Coelho
- PhD Program in Experimental Biology and Biomedicine, Centre for Neuroscience and Cell Biology of Coimbra and Institute of Microbiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luis R Martinez
- Department of Medicine (Division of Infectious Diseases), Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Biomedical Sciences, Long Island University-Post, Brookville, NY, USA
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Moon C, Kwak YG, Kim BN, Kim ES, Lee CS. Implications of postneurosurgical meningitis caused by carbapenem-resistant Acinetobacter baumannii. J Infect Chemother 2013; 19:916-9. [PMID: 23619757 DOI: 10.1007/s10156-013-0608-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/15/2013] [Indexed: 11/27/2022]
Abstract
Acinetobacter baumannii is an important cause of postneurosurgical meningitis. The emergence of carbapenem-resistant strains in this setting has caused a therapeutic challenge. We investigated the clinical implications of postneurosurgical meningitis caused by carbapenem-resistant A. baumannii. In this study, we retrospectively reviewed the medical records of patients more than 16 years of age with A. baumannii meningitis that developed after a neurosurgical procedure at five university-affiliated hospitals between January 2005 and May 2011. Of 40 cases identified, 22 (55.0%) were caused by carbapenem-resistant strains. Of those evaluable 36 patients with A. baumannii meningitis, 14 (38.9%) died of meningitis. Meningitis-related mortality was significantly related to carbapenem resistance (59.1% versus 7.1%; P = 0.002). In patients with meningitis caused by carbapenem-resistant A. baumannii, colistimethate-containing regimens (4/13 versus 7/9; P = 0.040), intrathecal or intraventricular (IT/IVR) administration of antibiotics (2/13 versus 8/9; P = 0.001), and combined intravenous and IT/IVR therapy (2/13 versus 6/9; P = 0.026) were significantly associated with cure. This study shows that use of colistimethate and combined systemic and local administration of antibiotics should be considered for the treatment of meningitis caused by carbapenem-resistant A. baumannii.
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Affiliation(s)
- Chisook Moon
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
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31
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Karaiskos I, Galani L, Baziaka F, Giamarellou H. Intraventricular and intrathecal colistin as the last therapeutic resort for the treatment of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii ventriculitis and meningitis: a literature review. Int J Antimicrob Agents 2013; 41:499-508. [PMID: 23507414 DOI: 10.1016/j.ijantimicag.2013.02.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 02/04/2013] [Indexed: 02/06/2023]
Abstract
Acinetobacter baumannii ventriculitis/meningitis due to the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains has become a clinical entity of considerable importance in recent years. A review of the available literature regarding intraventricular (IVT) or intrathecal (ITH) administration of colistin in MDR and XDR A. baumannii ventriculitis/meningitis was conducted and a total of 83 episodes in 81 patients were identified (71 cases in adults and 10 in children and neonates). Colistin was administered via the IVT and ITH route in 52 and 22 cases, respectively, whilst in 7 cases the exact route was not identified. The median dose of local colistin was 125000 IU (10mg) with a range of 20000 IU (1.6 mg) to 500000 IU (40 mg) in adults, whilst a dose of 2000 IU/kg (0.16 mg/kg) up to 125000 IU (10mg) was used in the paediatric population. The median duration of treatment of IVT/ITH polymyxin E was 18.5 days, whilst the median time to achieve sterilisation of cerebrospinal fluid was 4 days. The rate of successful outcome was 89%, and toxicity related to treatment mainly manifested as reversible chemical ventriculitis/meningitis was reported in nine cases (11%). Nowadays, IVT and ITH colistin represents the last resort treatment of MDR and XDR A. baumannii ventriculitis/meningitis, offering a unique, rather safe and successful mode of therapy.
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Affiliation(s)
- Ilias Karaiskos
- 6th Department of Internal Medicine, Hygeia General Hospital, 4 Erythrou Stavrou Str. & Kifisias Av., Marousi 15123, Athens, Greece
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Clonal diversity and high prevalence of OXA-58 among Acinetobacter baumannii isolates from blood cultures in a tertiary care centre in Turkey. INFECTION GENETICS AND EVOLUTION 2013. [DOI: 10.1016/j.meegid.2012.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McConnell MJ, Actis L, Pachón J. Acinetobacter baumannii: human infections, factors contributing to pathogenesis and animal models. FEMS Microbiol Rev 2012; 37:130-55. [PMID: 22568581 DOI: 10.1111/j.1574-6976.2012.00344.x] [Citation(s) in RCA: 343] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 04/30/2012] [Accepted: 05/03/2012] [Indexed: 11/30/2022] Open
Abstract
Acinetobacter baumannii has emerged as a medically important pathogen because of the increasing number of infections produced by this organism over the preceding three decades and the global spread of strains with resistance to multiple antibiotic classes. In spite of its clinical relevance, until recently, there have been few studies addressing the factors that contribute to the pathogenesis of this organism. The availability of complete genome sequences, molecular tools for manipulating the bacterial genome, and animal models of infection have begun to facilitate the identification of factors that play a role in A. baumannii persistence and infection. This review summarizes the characteristics of A. baumannii that contribute to its pathogenesis, with a focus on motility, adherence, biofilm formation, and iron acquisition. In addition, the virulence factors that have been identified to date, which include the outer membrane protein OmpA, phospholipases, membrane polysaccharide components, penicillin-binding proteins, and outer membrane vesicles, are discussed. Animal models systems that have been developed during the last 15 years for the study of A. baumannii infection are overviewed, and the recent use of these models to identify factors involved in virulence and pathogenesis is highlighted.
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Affiliation(s)
- Michael J McConnell
- Unit of Infectious Disease, Microbiology, and Preventive Medicine, Institute of Biomedicine of Sevilla (IBiS), University Hospital Virgen del Rocío/CSIC/University of Sevilla, Sevilla, Spain.
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Howard A, O'Donoghue M, Feeney A, Sleator RD. Acinetobacter baumannii: an emerging opportunistic pathogen. Virulence 2012; 3:243-50. [PMID: 22546906 PMCID: PMC3442836 DOI: 10.4161/viru.19700] [Citation(s) in RCA: 418] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acinetobacter baumannii is an opportunistic bacterial pathogen primarily associated with hospital-acquired infections. The recent increase in incidence, largely associated with infected combat troops returning from conflict zones, coupled with a dramatic increase in the incidence of multidrug-resistant (MDR) strains, has significantly raised the profile of this emerging opportunistic pathogen. Herein, we provide an overview of the pathogen, discuss some of the major factors that have led to its clinical prominence and outline some of the novel therapeutic strategies currently in development.
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Affiliation(s)
- Aoife Howard
- Department of Biological Sciences, Cork Institute of Technology, Bishopstown, Cork, Ireland
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Bayramoglu G, Kaya S, Besli Y, Cakır E, Can G, Akıneden O, Aydin F, Koksal I. Molecular epidemiology and the clinical significance of Acinetobacter baumannii complex isolated from cerebrospinal fluid in neurosurgical intensive care unit patients. Infection 2011; 40:163-72. [PMID: 22038112 DOI: 10.1007/s15010-011-0215-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 10/05/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was intended to investigate the clinical significance and molecular epidemiology of Acinetobacter baumannii complex (ABC) isolated from cerebrospinal fluid (CSF) in neurosurgical intensive care unit (NSICU) patients, particularly comparing isolates from healthcare workers' (HCW) hands. METHODS We retrospectively reviewed the medical records of 30 patients with CSF cultures positive for ABC seen at our NSICU from the date it first opened, January 2007, to September 2010. Pulsed-field gel electrophoresis (PFGE) typing was performed on 68 strains isolated from 32 patients' CSF and 36 HCWs' hands. RESULTS ABC isolates were considered to be clinically significant in 21 (70.0%) patients but insignificant in the other nine (30.0%) patients. The prolonged (>7 days) use of cephalosporins was more common in patients with clinically significant ABC isolates (p = 0.049). Multiple drug resistance (MDR) was observed in 12 (57.1%) clinically significant isolates. Empirical antimicrobial therapies were not appropriate for nine of these 21 patients (42.8%). Mortality was significantly higher in the clinically significant group than in the clinically insignificant group (18/21 vs. 3/9; p = 0.008). Fifty-three isolates (77.9%) were grouped into 15 clusters, three of which contained possibly related isolates from patients' CSF and staff members' hands. CONCLUSIONS The fact that ABC isolates grown from CSF cultures do not always exhibit infection and have high multiple antibiotic resistance, including to carbapenems, should be borne in mind when planning treatment for these patients. In addition, HCWs' hands may play a significant role in transmission to patients, and compliance with infection control procedures, especially hand washing, must be enhanced in order to avoid ABC infections.
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Affiliation(s)
- G Bayramoglu
- Department of Microbiology and Clinical Microbiology, Karadeniz Technical University, Trabzon, Turkey.
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Alp E, Leblebicioglu H, Doganay M, Voss A. Infection control practice in countries with limited resources. Ann Clin Microbiol Antimicrob 2011; 10:36. [PMID: 22018286 PMCID: PMC3225304 DOI: 10.1186/1476-0711-10-36] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 10/22/2011] [Indexed: 11/10/2022] Open
Abstract
Nosocomial infections and their control are a world-wide challenge. The prevalence of nosocomial infections is generally higher in developing countries with limited resources than industrialized countries. In this paper we aimed to further explain the differences with regard to infection control challenges between Turkey, a country with "limited" resources, and the Netherlands, a country with "reasonable" resources. Infrastructure of hospitals, low compliance of hand hygiene, understaffing, overcrowding, heavy workload, misuse of personal protective equipments, late establishment of infection control programme are major problems in limited-resources countries. These problems cause high infection rates and spread of multi-drug resistant pathogens. To improve the control and prevention of infections in countries with limited resources, a multi-facet approach is needed.
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Affiliation(s)
- Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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Alp E, Kiran B, Altun D, Kalin G, Coskun R, Sungur M, Akin A, Percin D, Doganay M. Changing pattern of antibiotic susceptibility in intensive care units: ten years experience of a university hospital. Anaerobe 2011; 17:422-5. [PMID: 21569859 DOI: 10.1016/j.anaerobe.2011.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 04/22/2011] [Indexed: 11/27/2022]
Abstract
The study was performed to assess microorganisms and antibiotic susceptibility patterns during ten years in intensive care units of a University Hospital. Infection Control Committee has active, prospective surveillance in ICUs for thirteen years. Ten years data of ICUs was evaluated retrospectively from surveillance forms. Microorganisms and their antibiotic resistance were recorded according to the years. During ten years, gram negative microorganisms were the most frequent isolated microorganisms from clinical specimens. Acinetobacter baumannii (21.8%), Pseudomonas aerigunosa (16%), Escherichia coli (10.4%) and Klebsiella pneumoniae (8%) were the most common gram negative microorganisms. However, Staphylococcus aureus was the most prevalent gram positive microorganism, the incidence decreased from 18.6% to 4.8% during ten years. Also antibiotic susceptibility of microorganisms changed during ten years. Carbapenem resistance increased from 44% to 92% in A. baumannii and ciprofloxacin resistance increased in E. coli from 28% to 60% and in K. pneumoniae from 21% to 55% during ten years. However, methicilin resistance decreased in S. aureus from 96% to 54%. In conclusion, antibiotic resistance is growing problem in ICUs. Rationale antibiotic policies and infection control measures will prevent the development of resistance.
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Affiliation(s)
- Emine Alp
- Erciyes University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Turkey.
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Bhargava N, Sharma P, Capalash N. Quorum sensing in Acinetobacter: an emerging pathogen. Crit Rev Microbiol 2010; 36:349-60. [PMID: 20846031 DOI: 10.3109/1040841x.2010.512269] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acinetobacter is emerging as one of the major nosocomial infectious pathogens, facilitated by tolerance to desiccation and multidrug resistance. Quorum sensing (autoinducer-receptor mechanism) plays role in biofilm formation in Acinetobacter, though its role in regulation of other virulence factors is yet to be established. Phylogenetic studies indicate that Acinetobacter baumannii is closely related to Burkholderia ambifaria but its quorum sensing genes (abaI and abaR) were acquired horizontally from Halothiobacillus neapolitanus. The prospects of quorum quenching to control the infections caused by Acinetobacter have also been discussed.
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Affiliation(s)
- Nidhi Bhargava
- Department of Biotechnology, Panjab University, Chandigarh, India
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Tigecycline use in two cases with multidrug-resistant Acinetobacter baumannii meningitis. Int J Infect Dis 2010; 14 Suppl 3:e224-6. [DOI: 10.1016/j.ijid.2009.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/19/2009] [Accepted: 07/30/2009] [Indexed: 11/21/2022] Open
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Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70090-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Camarena L, Bruno V, Euskirchen G, Poggio S, Snyder M. Molecular mechanisms of ethanol-induced pathogenesis revealed by RNA-sequencing. PLoS Pathog 2010; 6:e1000834. [PMID: 20368969 PMCID: PMC2848557 DOI: 10.1371/journal.ppat.1000834] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 02/25/2010] [Indexed: 11/18/2022] Open
Abstract
Acinetobacter baumannii is a common pathogen whose recent resistance to drugs has emerged as a major health problem. Ethanol has been found to increase the virulence of A. baumannii in Dictyostelium discoideum and Caenorhabditis elegans models of infection. To better understand the causes of this effect, we examined the transcriptional profile of A. baumannii grown in the presence or absence of ethanol using RNA-Seq. Using the Illumina/Solexa platform, a total of 43,453,960 reads (35 nt) were obtained, of which 3,596,474 mapped uniquely to the genome. Our analysis revealed that ethanol induces the expression of 49 genes that belong to different functional categories. A strong induction was observed for genes encoding metabolic enzymes, indicating that ethanol is efficiently assimilated. In addition, we detected the induction of genes encoding stress proteins, including upsA, hsp90, groEL and lon as well as permeases, efflux pumps and a secreted phospholipase C. In stationary phase, ethanol strongly induced several genes involved with iron assimilation and a high-affinity phosphate transport system, indicating that A. baumannii makes a better use of the iron and phosphate resources in the medium when ethanol is used as a carbon source. To evaluate the role of phospholipase C (Plc1) in virulence, we generated and analyzed a deletion mutant for plc1. This strain exhibits a modest, but reproducible, reduction in the cytotoxic effect caused by A. baumannii on epithelial cells, suggesting that phospholipase C is important for virulence. Overall, our results indicate the power of applying RNA-Seq to identify key modulators of bacterial pathogenesis. We suggest that the effect of ethanol on the virulence of A. baumannii is multifactorial and includes a general stress response and other specific components such as phospholipase C. Acinetobacter baumannii has recently emerged as a frequent opportunistic pathogen. In the presence of ethanol A. baumannii increases its pathogenicity towards Dictyostelium discoideum and Caenorhabditis elegans, and community-acquired infections of A. baumannii are associated with alcoholism. Ethanol negatively affects both epithelial cells and alters the bacterial physiology. To explore the underlying basis for the increased virulence of A. baumannii in the presence of ethanol we examined the transcriptional profile of this bacterium using the novel methodology known as RNA-Seq. We show that ethanol induces the expression of a phospholipase C, which contributes to A. baumannii cytotoxicity. We also show that many proteins related to stress were induced and that ethanol is efficiently assimilated as a carbon source leading to induction in stationary phase of two different Fe uptake systems and a phosphate transport system. Interestingly, a previous study showed that a mutant in the high-affinity phosphate uptake system was avirulent. Our work contributes to the understanding of A. baumannii pathogenesis and provides a powerful approach that can be extended to other pathogenic bacteria.
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Affiliation(s)
- Laura Camarena
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, Connecticut, United States of America
- Universidad Nacional Autónoma de México, Inst. Inv. Biomédicas, México, D.F., México
| | - Vincent Bruno
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, Connecticut, United States of America
| | - Ghia Euskirchen
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, Connecticut, United States of America
- Department of Genetics, Stanford Univeristy School of Medicine, Stanford, California, United States of America
| | - Sebastian Poggio
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, Connecticut, United States of America
| | - Michael Snyder
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, Connecticut, United States of America
- Department of Genetics, Stanford Univeristy School of Medicine, Stanford, California, United States of America
- * E-mail:
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Metan G, Sariguzel F, Sumerkan B. Factors influencing survival in patients with multi-drug-resistant Acinetobacter bacteraemia. Eur J Intern Med 2009; 20:540-4. [PMID: 19712862 DOI: 10.1016/j.ejim.2009.05.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 04/30/2009] [Accepted: 05/17/2009] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The incidence of multi-drug-resistant (MDR) Acinetobacter strains is increasing and therapeutic options are limited. However, controversy exists regarding the mortality attributable to antimicrobial resistance. The aim of this study was to analyse the clinical features and outcomes of patients with MDR Acinetobacter calcoaceticus-Acinetobacter baumannii complex (Acb complex) bacteraemia and determine the factors influencing survival by using 14-day mortality as the main outcome measure. METHODS An observational study was conducted at a tertiary care hospital in Turkey from February 2007 to March 2008. Only one bacteraemic episode from one patient was included in the study. RESULTS A total of 100 clinically significant Acb complex bacteraemic episodes were detected. The overall mortality was 63% in 14 days. According to univariate analysis, diabetes mellitus, haematological malignancy, unknown source of bacteraemia, septic shock, resistance to carbapenems, and inappropriate empirical therapy were associated with mortality amongst patients with Acb complex bacteraemia. Multivariate analysis showed that diabetes mellitus (RR, 1.68; 95% CI, 1.22-1.76), carbapenem resistance (RR, 1.63; 95% CI, 1.19-1.89), and septic shock (RR, 1.65; 95% CI, 1.23-1.85) were independent risk factors for 14-day mortality. CONCLUSION Although severe underlying diseases play an important role in the clinical outcome of patients with Acb complex bacteraemia, carbapenem resistance and inappropriate therapy are of great concern. Special attention should be paid to infection control practices in the hospitals where MDR Acinetobacter infections are endemic, and well-controlled prospective clinical trials are needed to determine the optimal antimicrobial therapy in critically ill patients suspected of having MDR Acinetobacter bacteraemia.
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Affiliation(s)
- Gokhan Metan
- Department Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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Brain penetration of colistin in mice assessed by a novel high-performance liquid chromatographic technique. Antimicrob Agents Chemother 2009; 53:4247-51. [PMID: 19667287 DOI: 10.1128/aac.00485-09] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A sensitive and reliable liquid chromatographic method was developed and validated for the determination of colistin concentrations in mouse brain homogenate. With a mobile phase consisting of acetonitrile-tetrahydrofuran-water (50:25:25 [vol/vol]) at a flow rate of 1 ml/min, a linear correlation between peak area and colistin concentration was observed over the concentration range of 93.8 to 3,000 ng/g in brain tissue (R2 > 0.994). Intra- and interday coefficients of variation were 5.1 to 8.3% and 5.8 to 8.5%, respectively, and the recovery ranged from 85% to 94%. This assay was then utilized to determine the amount of colistin that permeated the blood-brain barrier over a 2-h period following bolus intravenous administration of colistin sulfate to mice. After a single dose of 5 mg/kg of body weight to mice, brain homogenate concentrations of colistin were very low, relative to plasma colistin concentrations, suggesting that colistin permeability across the healthy blood-brain barrier is negligible during this experimental period.
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Bishburg E, Bishburg K. Minocycline--an old drug for a new century: emphasis on methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii. Int J Antimicrob Agents 2009; 34:395-401. [PMID: 19665876 DOI: 10.1016/j.ijantimicag.2009.06.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/04/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
Abstract
The epidemiology of nosocomial and community-acquired infections has changed in recent years. Methicillin-resistant Staphylococcus aureus (MRSA), especially community-associated MRSA (CA-MRSA), has emerged as a gram-positive organism with an increasing impact in clinical practice. Infections with Acinetobacter baumannii have become a major cause of morbidity and mortality. Minocycline has significant in vitro activity against MRSA and A. baumannii that is comparable with agents currently used against these organisms. The absence of an intravenous (i.v.) minocycline formulation in recent years has limited its use in seriously ill patients infected with these organisms. However, minocycline i.v. has recently been reintroduced to the US market. The objective of this study was to review available information on the chemistry, mechanism of action, in vitro activity, resistance mechanisms, pharmacokinetics, tolerability and efficacy of minocycline against MRSA and A. baumannii. This article provides suggestions for future studies and potential uses of minocycline and is designed to trigger interest in systematic clinical evaluation of minocycline for patients infected with these organisms. In conclusion, minocycline is an old drug that has the potential to become an important part of the armamentarium against emerging infections such as CA-MRSA and A. baumannii. Owing to its promising profile against these clinically important pathogens as well as excellent pharmacokinetic properties, minocycline merits evaluation in serious infections.
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Affiliation(s)
- Eliahu Bishburg
- Division of Infectious Diseases, Beth Israel Medical Center, 201 Lyons Avenue G3, Newark, NJ 07112, USA.
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Kim BN, Peleg AY, Lodise TP, Lipman J, Li J, Nation R, Paterson DL. Management of meningitis due to antibiotic-resistant Acinetobacter species. THE LANCET. INFECTIOUS DISEASES 2009; 9:245-55. [PMID: 19324297 DOI: 10.1016/s1473-3099(09)70055-6] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Acinetobacter meningitis is becoming an increasingly common clinical entity, especially in the postneurosurgical setting, with mortality from this infection exceeding 15%. Infectious Diseases Society of America guidelines for therapy of postneurosurgical meningitis recommend either ceftazidime or cefepime as empirical coverage against Gram-negative pathogens. However, assessment of the pharmacodynamics of these cephalosporins in cerebrospinal fluid suggests that recommended doses will achieve pharmacodynamic targets against fewer than 10% of contemporary acinetobacter isolates. Thus, these antibiotics are poor options for suspected acinetobacter meningitis. From in vitro and pharmacodynamic perspectives, intravenous meropenem plus intraventricular administration of an aminoglycoside may represent a superior, albeit imperfect, regimen for suspected acinetobacter meningitis. For cases of meningitis due to carbapenem-resistant acinetobacter, use of tigecycline is not recommended on pharmacodynamic grounds. The greatest clinical experience rests with use of polymyxins, although an intravenous polymyxin alone is inadvisable. Combination with an intraventricularly administered antibiotic plus removal of infected neurosurgical hardware appears the therapeutic strategy most likely to succeed in this situation. Unfortunately, limited development of new antibiotics plus the growing threat of multidrug-resistant acinetobacter is likely to increase the problems posed by acinetobacter meningitis in the future.
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Affiliation(s)
- Baek-Nam Kim
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Abstract
The global emergence of multidrug-resistant gram-negative bacilli has spurred a renewed interest in polymyxins. Once discarded due to concerns regarding nephrotoxicity and neurotoxicity, polymyxins now hold an important role in the antibiotic armamentarium. However, more reliable information is needed to determine the optimal dosing of these agents. Also, unanswered questions regarding in vitro testing remain, including questions regarding the reliability of automated systems and the establishment of appropriate breakpoints for defining susceptibility. Most contemporary clinical studies examining the use of these agents have involved patients with infections due to multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains. It has been reassuring that polymyxin therapy for resistant bacteria has resulted in clinical responses and toxicity rates similar to those for carbapenem therapy for susceptible isolates. While most surveillance studies demonstrated high rates of susceptibility, several reports noted the emergence of polymyxin-resistant nosocomial pathogens. Polymyxins have assumed an important antibiotic niche for therapy for hospital-acquired infections; further studies defining the optimal use of these agents will likely extend the duration of their clinical usefulness.
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Abstract
Acinetobacter baumannii has emerged as a highly troublesome pathogen for many institutions globally. As a consequence of its immense ability to acquire or upregulate antibiotic drug resistance determinants, it has justifiably been propelled to the forefront of scientific attention. Apart from its predilection for the seriously ill within intensive care units, A. baumannii has more recently caused a range of infectious syndromes in military personnel injured in the Iraq and Afghanistan conflicts. This review details the significant advances that have been made in our understanding of this remarkable organism over the last 10 years, including current taxonomy and species identification, issues with susceptibility testing, mechanisms of antibiotic resistance, global epidemiology, clinical impact of infection, host-pathogen interactions, and infection control and therapeutic considerations.
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Multidrug-resistant Acinetobacter baumannii Pneumonia in Lung Transplant Recipients. J Heart Lung Transplant 2008; 27:804-7. [DOI: 10.1016/j.healun.2008.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 02/01/2008] [Accepted: 03/27/2008] [Indexed: 11/23/2022] Open
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