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Simbu S, Orchard A, van de Venter M, van Vuuren S. Ibuprofen as an adjuvant to conventional antimicrobials and essential oil compounds against skin pathogens. J Appl Microbiol 2024; 135:lxae186. [PMID: 39068502 DOI: 10.1093/jambio/lxae186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 07/30/2024]
Abstract
AIMS Antimicrobial resistance continues to be a growing concern, resulting in increased use of drug combinations. Antibiotic adjuvants are an emerging strategy that may potentiate an antibiotics efficacy. Ibuprofen's polypharmacological properties have been investigated for their antimicrobial and host-modulating potential. This study aimed to investigate the potential of a novel multidrug combination involving ibuprofen, essential oil compounds (EOCs), and conventional antimicrobials against skin pathogens. METHODS AND RESULTS The minimum inhibitory concentrations of ibuprofen, conventional antimicrobials, and EOCs were determined and then combined and tested against 14 (reference and clinical) skin pathogens. The cytotoxicity was analysed using the MTT assay, whilst the anti-inflammatory effects were evaluated using lipopolysaccharide activated RAW264.7 murine macrophages. Four pairwise (Ibuprofen and antibiotic) (ΣFIC 0.33-0.50) and three triple (Ibuprofen and antibiotic with EOC) (ΣFIC 0.44-0.47) synergistic antimicrobial interactions were identified. These combinations demonstrated cell viability of 77.59%-100%. No combination significantly reduced nitric oxide production. CONCLUSION The results from this study provide insight into the potential of a multidrug combination involving ibuprofen with conventional antimicrobials and EOCs against common skin pathogens.
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Affiliation(s)
- Shivar Simbu
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa
| | - Ané Orchard
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa
| | - Maryna van de Venter
- Department of Biochemistry and Microbiology, Nelson Mandela University, Gqeberha, 6031, South Africa
| | - Sandy van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa
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Mariani F, Gentili C, Pulcinelli V, Martino L, Valentini P, Buonsenso D. State of the Art of Invasive Group A Streptococcus Infection in Children: A Scoping Review of the Literature with a Focus on Predictors of Invasive Infection. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1472. [PMID: 37761433 PMCID: PMC10528266 DOI: 10.3390/children10091472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023]
Abstract
Currently, it remains unclear why some children develop invasive group A Streptococcus (iGAS) and how to manage this condition. Therefore, to explore available works in the literature, we performed a scoping review aiming to analyze the current literature on clinical presentation of different illnesses outcomes of iGAS, with a specific focus on predictors of invasive infection, including an assessment of the prodromal stages of the disease and the possible presence of previous non-invasive GAS infections in children that later developed iGAS. METHODS We conducted a systematic search on PubMed and SCOPUS of all pediatric studies reporting iGAS cases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. For those studies in which multivariable analysis investigating iGAS risk factors was performed, a second review was performed and reported in detail. RESULTS A total of 209 studies were included. Five studies investigated risk factors for iGAS, the most relevant being varicella infection, chronic underlying illness, presence of the speC gene in GAS strains, acetaminophen and ibuprofen use, children nonwhite, living in low-income households, exposure to varicella at home, persistent high fever, having more than one other child in the home, and new use of NSAIDs. Although we observed a progressive increase in the number of papers published on this topic, no trials investigating the benefits of clindamycin or intravenous immunoglobulins were found and low-to-middle-income countries were found to be poorly represented in the current literature. CONCLUSIONS Our scoping review highlights important gaps regarding several aspects of iGAS in children, including prodromic presentation and optimal treatment strategies. There is also little representation of low-middle-income countries. The current literature does not allow the performance of systematic reviews or meta-analyses, but this work should inform healthcare professionals, policy makers, and funding agencies on which studies to prioritize on this topic.
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Affiliation(s)
- Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Carolina Gentili
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Valentina Pulcinelli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Bartoszko JJ, Elias Z, Rudziak P, Lo CKL, Thabane L, Mertz D, Loeb M. Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis. BMJ Open 2022; 12:e063023. [PMID: 36456018 PMCID: PMC9716873 DOI: 10.1136/bmjopen-2022-063023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To quantify the prognostic effects of demographic and modifiable factors in streptococcal toxic shock syndrome (STSS). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE and CINAHL from inception to 19 September 2022, along with citations of included studies. ELIGIBILITY CRITERIA Pairs of reviewers independently screened potentially eligible studies of patients with Group A Streptococcus-induced STSS that quantified the association between at least one prognostic factor and outcome of interest. DATA EXTRACTION AND SYNTHESIS We performed random-effects meta-analysis after duplicate data extraction and risk of bias assessments. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS One randomised trial and 40 observational studies were eligible (n=1918 patients). We found a statistically significant association between clindamycin treatment and mortality (n=144; OR 0.14, 95% CI 0.06 to 0.37), but the certainty of evidence was low. Within clindamycin-treated STSS patients, we found a statistically significant association between intravenous Ig treatment and mortality (n=188; OR 0.34, 95% CI 0.15 to 0.75), but the certainty of evidence was also low. The odds of mortality may increase in patients ≥65 years when compared with patients 18-64 years (n=396; OR 2.37, 95% CI 1.47 to 3.84), but the certainty of evidence was low. We are uncertain whether non-steroidal anti-inflammatory drugs increase the odds of mortality (n=50; OR 4.14, 95% CI 1.13 to 15.14; very low certainty). Results failed to show a significant association between any other prognostic factor and outcome combination (very low to low certainty evidence) and no studies quantified the association between a prognostic factor and morbidity post-infection in STSS survivors. CONCLUSIONS Treatment with clindamycin and within clindamycin-treated patients, IVIG, was each significantly associated with mortality, but the certainty of evidence was low. Future research should focus on morbidity post-infection in STSS survivors. PROSPERO REGISTRATION NUMBER CRD42020166961.
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Affiliation(s)
- Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zeyad Elias
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paulina Rudziak
- Department of Biology, Western University, London, Ontario, Canada
| | - Carson K L Lo
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Departments of Anesthesia and Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Shaikh N, Amara U, Hussein MI, Mahadik S, Elhussain AI, Al Maslamani M, Nashwan AJ. Varicella zoster viral infection complicating into necrotizing fasciitis: A case report. Clin Case Rep 2022; 10:e6408. [PMID: 36225618 PMCID: PMC9529610 DOI: 10.1002/ccr3.6408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/04/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
Necrotizing fasciitis is a rare complication of varicella-zoster viral infection in adults, occurring due to a secondary bacterial infection. A 35-year-old female healthy patient had post-varicella zoster infection with NSAID use as a possible risk factor. She was diagnosed early by clinical and laboratory parameters.
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Affiliation(s)
- Nissar Shaikh
- Surgical Intensive Care DepartmentHamad General Hospital (HGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Umm‐e‐ Amara
- Apollo Institute of Medical Science and ResearchHyderabadIndia
| | | | - Sahar Mahadik
- Medical Education DepartmentHamad Medical Corporation (HMC)DohaQatar
| | | | - Muna Al Maslamani
- Communicable Diseases Center (CDC)Hamad Medical Corporation (HMC)DohaQatar
| | - Abdulqadir J. Nashwan
- Nursing Department, Hazm Mebaireek General Hospital (HMGH)Hamad Medical Corporation (HMC)DohaQatar
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Drug repurposing strategy: An emerging approach to identify potential therapeutics for treatment of bovine mastitis. Microb Pathog 2022; 171:105691. [PMID: 35995254 DOI: 10.1016/j.micpath.2022.105691] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
The current study was designed to characterize methicillin-resistant Staphylococcus aureus (MRSA) isolated from bovine milk, along with its response to antibiotics, and ultimately reverse its mechanism of resistance by modulation with non-antibiotics. The synergistic combination of antibiotics with NSAIDs were tested in-vivo by giving MRSA challenge to rabbits. The current study reported an overall 23.79% prevalence of MRSA. The BLAST alignment of current study sequences revealed 99% similarity with mecA gene of MRSA from NCBI database. The current study isolates were more similar to each other and also with reference sequences as compared to other mecA gene sequences from Turkey, India, and Russia. Antibiogram of MRSA isolates showed a highly resistant response to cefoxitin, amoxicillin, and gentamicin. Amoxicillin, gentamicin, tylosin, vancomycin, and ciprofloxacin elicited a significant response (p < 0.05) in combination with non-antibiotics against tested MRSA isolates. The highest zone of inhibition (ZOI) increase was noted for vancomycin in combination with flunixin meglumine (145.45%) and meloxicam (139.36%); gentamicin with flunixin meglumine (85.71%) and ciprofloxacin with ivermectin (71.13%). Synergistic behavior was observed in the combination of gentamicin with ketoprofen; sulfamethoxazole and oxytetracycline with meloxicam. Hematological analysis showed significant differences (p < 0.05) among lymphocyte count and bilirubin. On histopathological examination of skin tissue, hyperplasia of epithelium, sloughed off epidermis, hyperkeratosis, infiltration of inflammatory cells, and hemorrhages were observed. The highest cure rate was observed in case of gentamicin in combination with ketoprofen as compared to other treatment groups. The current study concluded antibiotics in combination with non-antibiotics as potential therapeutic agents for resistance modulation against MRSA. This study will help to devise treatment and control strategies against bovine mastitis. Although the prospect of using NSAIDs to manage infections caused by MRSA appears to be a promising direction, further studies should be conducted to test these medications using suitable in-vivo models in controlled clinical trials to justify their repurposing as a treatment for MRSA infections.
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Hidradenitis Suppurativa: Where We Are and Where We Are Going. Cells 2021; 10:cells10082094. [PMID: 34440863 PMCID: PMC8392140 DOI: 10.3390/cells10082094] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture and immune responses. Innate pro-inflammatory cytokines (e.g., IL-1β, and TNF-α); mediators of activated T helper (Th)1 and Th17 cells (e.g., IFN-γ, and IL-17); and effector mechanisms of neutrophilic granulocytes, macrophages, and plasma cells are involved. On the other hand, HS lesions contain anti-inflammatory mediators (e.g., IL-10) and show limited activity of Th22 cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction, and scarring. HS pathogenesis is still enigmatic, and a valid animal model for HS is currently not available. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. Available treatments are limited, mostly off-label, and surgical interventions are often required to achieve remission. In this paper, we provide an overview of the current knowledge surrounding HS, including the diagnosis, pathogenesis, treatments, and existing translational studies.
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Emery H, Butt TM, Coates CJ. Nutraceutical intervention protects against bacterial and chemical-induced gastrotoxicity in a non-mammalian model, Galleria mellonella. Food Chem Toxicol 2021; 154:112354. [PMID: 34146620 DOI: 10.1016/j.fct.2021.112354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/26/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022]
Abstract
Preparations of the fungus Cordyceps sinensis and bovine colostrum are considered nutraceuticals due to their anti-inflammatory, repair and gut alimentation properties in mammalian models. To reduce the reliance on rodents in routine experimentation, we gauged the capacity of nutraceuticals to alleviate gastric damage in an insect surrogate, Galleria mellonella. Larvae were reared on standard or supplemented diets - 10% (w/w) colostrum, 10% (w/w) C. sinensis, or 5% + 5% each - prior to receiving an oral dose of the NSAID indomethacin (30 mg/kg) or challenged with the bacterial pathogen Campylobacter jejuni (1-3 x106) via two inoculation routes. Insects reared on a cordyceps-supplemented diet proved most resistant to indomethacin-induced gut leakiness, and displayed stable health indices after C. jejuni challenge (~77% survival). Insects reared on a colostrum-supplemented diet also showed recalcitrance in the gut, but were more sensitive to C. jejuni when injected directly into the body cavity (50% survival). The nutraceutical blend yielded improved health outcomes when compared to the standard diet, but was not as effective as either nutraceutical alone. Our findings represent clear evidence that insects were more resistant to known chemical and microbial agitators when reared on nutraceutical-supplemented diets - toxicological endpoints that are shared with vertebrate studies.
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Affiliation(s)
- Helena Emery
- Department of Biosciences, Faculty of Science and Engineering, Swansea University, Swansea, SA2 8PP, Wales, UK
| | - Tariq M Butt
- Department of Biosciences, Faculty of Science and Engineering, Swansea University, Swansea, SA2 8PP, Wales, UK
| | - Christopher J Coates
- Department of Biosciences, Faculty of Science and Engineering, Swansea University, Swansea, SA2 8PP, Wales, UK.
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Abstract
Necrotizing soft tissue infections occur after traumatic injuries, minor skin lesions, nonpenetrating injuries, natural childbirth, and in postsurgical and immunocompromised patients. Infections can be severe, rapidly progressive, and life threatening. Survivors often endure multiple surgeries and prolonged hospitalization and rehabilitation. Despite subtle nuances that may distinguish one entity from another, clinical approaches to diagnosis and treatment are highly similar. This review describes the clinical and laboratory features of necrotizing soft tissue infections and addresses recommended diagnostic and treatment modalities. It discusses the impact of delays in surgical debridement, antibiotic use, and resuscitation on mortality, and summarizes key pathogenic mechanisms.
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Affiliation(s)
- Dennis L Stevens
- Infectious Diseases Center of Biomedical Research Excellence, Veterans Affairs Medical Center, 500 West Fort Street (Mail Stop 151), Boise, ID 83702, USA
| | - Amy E Bryant
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, 1311 East Central Drive, Meridian, ID 83642, USA.
| | - Ellie Jc Goldstein
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90074, USA; R M Alden Research Laboratory, 2021 Santa Monica Boulevard, Suite #740 East, Santa Monica, CA 90404, USA
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Role of 4-hydroxybutyrate in increased resistance to surgical site infections associated with surgical meshes. Biomaterials 2020; 267:120493. [PMID: 33202331 DOI: 10.1016/j.biomaterials.2020.120493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/26/2022]
Abstract
An increased resistance to surgical site infections has been associated with surgical meshes composed of naturally occurring materials, including poly-4-hydroxybutrate (4HB). 4HB is a naturally occurring short-chain fatty acid that has been shown to promote endogenous expression of the Cramp gene coding for the antimicrobial peptide (AMP) cathelicidin LL-37 in murine bone marrow-derived macrophages. The molecular pathways involved in the 4HB-induced cathelicidin LL-37 expression have not yet been identified. The present study showed that transcriptional activation of the Cramp gene by 4HB is independent of inhibition of histone deacetylase (HDAC) activity, and that upregulation of Cramp is modulated by the G-protein coupled receptor GPR109A. Furthermore, an intracellular signaling cascade that promotes the activation of the MAP kinases, p38 and JNK, and a subsequent NF-κB phosphorylation downstream from p38 is essential for the AMP transcriptional response in 4HB-stimulated macrophages. The findings provide a solid scientific basis and rationale for the decreased incidence of surgical site infections with the use of this type of surgical meshes. Further clinical significance is found in the fact that the 4HB activated molecular pathway includes common targets of frequently used nonsteroidal anti-inflammatory drugs (NSAIDs) and other FDA approved drugs recognizing G-protein coupled receptors.
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Evaluation of containment measures' effect on orthopaedic trauma surgery during the COVID-19 pandemic: a retrospective comparison between 2019 and 2020. INTERNATIONAL ORTHOPAEDICS 2020; 44:2229-2234. [PMID: 32696333 PMCID: PMC7372210 DOI: 10.1007/s00264-020-04712-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023]
Abstract
Background There is no available information about the effect of containment measures on trauma surgery activity. The aim of this study was to analyse and report the containment measures’ impact on trauma surgery activity during the COVID-19 pandemic in order to quickly react and adjust in case of a new sanitary crisis and containment. Methods An original epidemiological study was performed in our trauma centre in France. Data from trauma surgeries performed during the pre-containment (from March 1 to March 16, 2020), containment (from March 17 to April 17, 2020) and reference (from March 1 to April 17, 2019) periods were compared. The primary outcome was the number of patients operated on daily and the daily operating room time. Clinical data, delay for surgery, mechanism of injury and injury pattern were also reviewed. Results There was a statistically significant decrease in the number of patients operated upon daily (− 39,8%, p value < 0.001) and daily operating room time (− 35.5%, p value < 0.001) between the reference and containment periods and between the pre-containment and containment periods (respectively, − 35.0%, p value < 0.001 and − 28.7%, p value 0.002). No differences were reported between the reference and pre-containment periods for daily-operated patients (p value 0.359). Conclusion Containment measures had a direct impact on trauma surgery activity with a decrease of a third of trauma surgery activity. Those results could be useful if a new containment occurred.
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Olagunju AO, Nasirova S, Muganlinskaya N. Streptococcus agalactiae-Induced Soft Tissue Infection in a Nonpregnant Adult After a Gynecological Procedure. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924110. [PMID: 32680980 PMCID: PMC7386829 DOI: 10.12659/ajcr.924110] [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] [Indexed: 11/28/2022]
Abstract
Patient: Female, 24-year-old Final Diagnosis: Necrotizing fasciitis Symptoms: Chest pain • chills • fatigue • fever • neck pain • range of motion limitation • right shoulder pain Medication: — Clinical Procedure: — Specialty: Infectious Diseases • General and Internal Medicine • Obstetrics and Gynecology
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Affiliation(s)
| | - Sabina Nasirova
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
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Non-steroidal anti-inflammatory drugs, pharmacology, and COVID-19 infection. Therapie 2020; 75:355-362. [PMID: 32418728 PMCID: PMC7204680 DOI: 10.1016/j.therap.2020.05.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) have an optional prescription status that has resulted in frequent use, in particular for the symptomatic treatment of fever and non-rheumatic pain. In 2019, a multi-source analysis of complementary pharmacological data showed that using NSAIDs in these indications (potentially indicative of an underlying infection) increases the risk of a severe bacterial complication, in particular in the case of lung infections. First, the clinical observations of the French Pharmacovigilance Network showed that severe bacterial infections can occur even after a short NSAID treatment, and even if the NSAID is associated with an antibiotic. Second, pharmacoepidemiological studies, some of which minimized the protopathic bias, all converged and confirmed the risk. Third, experimental in vitro and in vivo animal studies suggest several biological mechanisms, which strengthens a causal link beyond the well-known risk of delaying the care of the infection (immunomodulatory effects, effects on S. pyogenes infections, and reduced antibiotics efficacy). Therefore, in case of infection, symptomatic treatment with NSAIDs for non-severe symptoms (fever, pain, or myalgia) is not to be recommended, given a range of clinical and scientific arguments supporting an increased risk of severe bacterial complication. Besides, the existence of a safer drug alternative, with paracetamol at recommended doses, makes this recommendation of precaution and common sense even more legitimate. In 2020, such recommendation is more topical than ever with the emergence of COVID-19, especially since it results in fever, headaches, muscular pain, and cough, and is further complicated with pneumopathy, and given experimental data suggesting a link between ibuprofen and the level of expression of angiotensin-converting enzyme 2.
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Clinical Description and Outcomes of Australian Children With Invasive Group A Streptococcal Disease. Pediatr Infect Dis J 2020; 39:379-384. [PMID: 32091492 DOI: 10.1097/inf.0000000000002596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Invasive group A streptococcal disease is a severe infection with a high case fatality rate, estimated to cause more than 150,000 deaths per year worldwide. The clinical presentation of this infection is variable, and early diagnosis can be challenging. There are few data on its short- and longer-term outcomes, especially in children. The aim of this study was to assess the clinical presentation, management and short- and longer-term outcomes of invasive group A streptococcal disease in children in Australia. METHODS We undertook a prospective surveillance study of children with laboratory-confirmed invasive group A streptococcus disease admitted to 7 sentinel tertiary and quaternary pediatric hospitals in Australia between July 2016 and June 2018. We collected demographic and clinical data and contacted patients 6 months after discharge to assess longer-term outcomes. RESULTS We enrolled 181 children, 7 days to 16 years of age. The principal site of invasive infection was blood (126 children, 69.6%), and the most frequent clinical presentation was pneumonia in 46 children (25.4%). Twenty-six children developed streptococcal toxic shock syndrome (14.4%), and 74 had severe disease (40.9%), including 71 admitted to the intensive care unit. Five children died (2.8%). At discharge and 6 months, 29.3% and 15.2% of the children had persisting health problems, respectively. CONCLUSIONS Invasive group A streptococcal infection in Australian children is frequently severe and has a high long-term morbidity burden, highlighting the need for strengthened clinical care pathways, epidemiologic surveillance and prevention strategies.
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Combined Biological Effects of N-Bromotaurine Analogs and Ibuprofen. Part I: Influence on Inflammatory Properties of Macrophages. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1155:1015-1031. [PMID: 31468464 DOI: 10.1007/978-981-13-8023-5_84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Taurine haloamines (N-chlorotaurine, N-bromotaurine) due to their strong antiseptic and anti-inflammatory properties are good candidates for topical application in treatment of skin inflammatory/infectious disorders. Recently, we have demonstrated that more stable N-bromotaurine analogs (N-dibromo-dimethyl taurine, N-monobromo-dimethyl taurine) and bromamine T show strong microbicidal and anti-inflammatory properties at concentrations well tolerated by human cells and tissue. Non-steroidal anti-inflammatory drugs (NSAIDs) with cyclooxygenase (COX) inhibitory activity are commonly used in various inflammatory diseases. However, systemic administration of NSAIDs may result in adverse side effects. For example, the use of ibuprofen in children with varicella is associated with enhanced serum levels of TNF-α and with increased risk of necrotizing soft tissue infections and secondary skin infections caused by invasive streptococci. The aim of this study was to examine combined immunomodulatory effects of bromamines and ibuprofen on J774.A1 macrophages. We have shown that the primary activity of ibuprofen, the inhibition of PGE2 production by activated macrophages was intensified in the presence of bromamines. Most importantly, the stimulatory effect of ibuprofen on production of inflammatory cytokines (TNF-α, IL-6) was inhibited by all tested bromamines. These observations indicate that bromamines may neutralize massive production of TNF-α at sites of inflammation, a side effect of ibuprofen. Therefore, we suggest that systemic administration of ibuprofen (NSAIDs) in treatment of inflammatory/infectious skin diseases should be supported by topical application of bromamines as an adjunctive therapy.
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Combined Biological Effects of N-Bromotaurine Analogs and Ibuprofen. Part II: Influence on a Local Defense System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019. [PMID: 31468465 DOI: 10.1007/978-981-13-8023-5_85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
The stable N-bromotaurine analogs (N-dibromo-dimethyl taurine, N-monobromo-dimethyl taurine), and bromamine T (BAT) show anti-inflammatory and microbicidal properties. These bromamines are good candidates for a treatment of skin infectious/inflammatory diseases as local antiseptics. Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), is commonly used in various infectious/inflammatory diseases due to its analgesic and antipyretic therapeutic effects. However, systemic administration of ibuprofen may also result in adverse side effects. It has been reported that ibuprofen enhances serum levels of TNF-α and worsens secondary skin infections caused by invasive streptococci (S. pyogenes). Recently we have demonstrated that bromamines inhibit the stimulatory effect of ibuprofen on the production of inflammatory cytokines (TNF-α, IL-6). The aim of this study was to examine the combined antibacterial actions of ibuprofen and bromamines against S. pyogenes and their joint effect on the generation of reactive oxygen species (ROS) by activated neutrophils and macrophages. We have shown that the microbicidal activity of bromamines against S. pyogenes was not altered by ibuprofen. On the other hand, co-administration of ibuprofen and bromamines markedly decreased the generation of ROS by activated neutrophils and macrophages. Finally, we discuss how the antioxidant combined effect of bromamines and ibuprofen may affect a local defense system.
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Osowicki J, Azzopardi KI, Baker C, Waddington CS, Pandey M, Schuster T, Grobler A, Cheng AC, Pollard AJ, McCarthy JS, Good MF, Walker MJ, Dale JB, Batzloff MR, Carapetis JR, Smeesters PR, Steer AC. Controlled human infection for vaccination against Streptococcus pyogenes (CHIVAS): Establishing a group A Streptococcus pharyngitis human infection study. Vaccine 2019; 37:3485-3494. [PMID: 31101422 DOI: 10.1016/j.vaccine.2019.03.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 12/17/2022]
Abstract
Group A Streptococcus (GAS) is a highly-adapted and human-restricted pathogen responsible for a high global burden of disease across a diverse clinical spectrum. Vaccine development has been impeded by scientific, regulatory, and commercial obstacles. Human infection studies (HIS) are increasingly contributing to drug, diagnostics, and vaccine development, reducing uncertainty at early stages, especially for pathogens with animal models that incompletely reproduce key elements of human disease. We review the small number of historical GAS HIS and present the study protocol for a dose-ranging inpatient study in healthy adults. The primary objective of the study is to establish a new GAS pharyngitis HIS with an attack rate of at least 60% as a safe and reliable platform for vaccine evaluation and pathogenesis research. According to an adaptive dose-ranging study design, emm75 GAS doses manufactured in keeping with principles of Good Manufacturing Practice will be directly applied by swab to the pharynx of carefully screened healthy adult volunteers at low risk of severe complicated GAS disease. Participants will remain as closely monitored inpatients for up to six days, observed for development of the primary outcome of acute symptomatic pharyngitis, as defined by clinical and microbiological criteria. All participants will be treated with antibiotics and followed as outpatients for six months. An intensive sampling schedule will facilitate extensive studies of host and organism dynamics during experimental pharyngitis. Ethics approval has been obtained and the study has been registered at ClinicalTrials.gov (NCT03361163).
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Affiliation(s)
- Joshua Osowicki
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia.
| | - Kristy I Azzopardi
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ciara Baker
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Claire S Waddington
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia; Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Anneke Grobler
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, The Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Michael F Good
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, Australia
| | - James B Dale
- University of Tennessee Health Science Center, Department of Medicine, Memphis, TN, USA
| | - Michael R Batzloff
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Pierre R Smeesters
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia
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Topete A, Serro A, Saramago B. Dual drug delivery from intraocular lens material for prophylaxis of endophthalmitis in cataract surgery. Int J Pharm 2019; 558:43-52. [DOI: 10.1016/j.ijpharm.2018.12.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 12/28/2022]
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Schmitz M, Roux X, Huttner B, Pugin J. Streptococcal toxic shock syndrome in the intensive care unit. Ann Intensive Care 2018; 8:88. [PMID: 30225523 PMCID: PMC6141408 DOI: 10.1186/s13613-018-0438-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
The streptococcal toxic shock syndrome is a severe complication associated with invasive infections by group A streptococci. In spite of medical progresses in the care of patients with septic shock during the last decades, this condition has remained associated with a high mortality. Early recognition and multidisciplinary management are key to the care of patients with streptococcal toxic shock syndrome, with intensive and appropriate intensive support of failing organs, rapid diagnosis of infectious source(s), and surgical management. The epidemiology and risk factors for streptococcal toxic shock syndrome remain to be better studied, including the possible causal role of exposure to nonsteroidal anti-inflammatory drugs. In this review article, the authors review the current knowledge of streptococcal toxic shock syndrome and discuss the pathophysiology as well as its supportive and specific treatment.
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Affiliation(s)
- Marylin Schmitz
- Division of Intensive Care, Faculty of Medicine Geneva, University Hospitals of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Xavier Roux
- Division of Intensive Care, Faculty of Medicine Geneva, University Hospitals of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Benedikt Huttner
- Division of Infectious Diseases, Faculty of Medicine Geneva, University Hospitals of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Jérôme Pugin
- Division of Intensive Care, Faculty of Medicine Geneva, University Hospitals of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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Zhao-Fleming H, Hand A, Zhang K, Polak R, Northcut A, Jacob D, Dissanaike S, Rumbaugh KP. Effect of non-steroidal anti-inflammatory drugs on post-surgical complications against the backdrop of the opioid crisis. BURNS & TRAUMA 2018; 6:25. [PMID: 30221175 PMCID: PMC6136175 DOI: 10.1186/s41038-018-0128-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/09/2018] [Indexed: 02/27/2023]
Abstract
The USA is currently going through an opioid crisis, associated with tremendous economic and societal impacts. In response to this crisis, healthcare professionals are looking for alternative pain management methods, and non-steroidal anti-inflammatory drugs (NSAIDs) are a sensible choice because of their effectiveness after surgical procedures. However, before surgeons start prescribing NSAIDs in place of opioids, it is crucial to first understand their potential post-surgical complications. The goal of this review is to summarize the data obtained through both animal and human studies, which suggest how a dramatic increase in NSAID use may affect these post-surgical complications. We first provide a short review outlining the mechanisms of action of NSAIDs, followed by a summary of animal studies, which show a trend towards the negative effects of NSAIDs on wound healing and an association between NSAID use and wound infections. Lastly, we present evidence from human studies on the association of NSAIDs with the following complications: anastomotic leaks, necrotizing soft tissue infections, bleeding complications, orthopedic injuries, wound healing, and cancer care. The human studies are much more variable in their conclusions as to whether NSAIDs are beneficial or not, with the only strong evidence showing that NSAIDs inhibit bone healing. This may partially be explained by male and female differences in response to NSAIDs as many animal studies showing the inhibitory effects of NSAIDs were performed on females, while all the human studies were performed with both sexes. We conclude that strong caution should be used in the prescription of NSAIDs, especially in female patients, but larger scale studies are warranted before solid recommendations can be made.
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Affiliation(s)
- Hannah Zhao-Fleming
- 1Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8312, Lubbock, TX 79430 USA.,2Burn Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Audrey Hand
- 1Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8312, Lubbock, TX 79430 USA
| | - Kelly Zhang
- 1Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8312, Lubbock, TX 79430 USA
| | - Robert Polak
- 1Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8312, Lubbock, TX 79430 USA
| | - Armand Northcut
- 1Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8312, Lubbock, TX 79430 USA
| | - Daron Jacob
- 3School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Sharmila Dissanaike
- 1Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8312, Lubbock, TX 79430 USA.,2Burn Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Kendra P Rumbaugh
- 1Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8312, Lubbock, TX 79430 USA.,2Burn Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX USA
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Ture Z, Demiraslan H, Kontas O, Alp E, Doganay M. The role of nonsteroidal anti-inflammatory drugs intramuscular injection in the development and severity of deep soft tissue infection in mice. Fundam Clin Pharmacol 2017; 32:147-154. [PMID: 29172254 DOI: 10.1111/fcp.12336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the role of nonsteroidal anti-inflammatory drugs (NSAID) injection on the severity of local infection and the effect on the progression of soft tissue infection (STI).The mouse model of STI with Group A streptococcus (GAS) was developed and treated with diclofenac sodium (DS) intramuscularly. Mice were divided into five groups: administered DS for 48 h before GAS (Group 1), GAS-DS and maintained DS for 48 h (Group 2), DS for 48 h (Group 3), GAS on zero time (Group 4), and control (Group 5). In vitro, a high concentration (40 mg/L) of DS inhibited GAS growth, whereas a lower concentration (0.4 mg/L) was not effective. Sepsis was observed in animals with DS and GAS inoculation (group 1 and 2). Group 4 had statistically significant higher bacterial load than groups 1 and 2. All groups had a higher inflammation rate than the control group. The median of TNF-alpha and mean IL-6 in the groups 1, 2, and 4 was significantly higher than those in the control group. Even if the animals that were treated with DS injection prior to the GAS inoculation had similar inflammation score, similar cytokine levels and low bacterial load in the tissue, they had a rather high rate of sepsis. In conclusion, DS injection prior to bacterial inoculation might predispose to bacteremia and sepsis.
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Affiliation(s)
- Zeynep Ture
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Hayati Demiraslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Olgun Kontas
- Department of Pathology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Mehmet Doganay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
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Duployez C, Vachée A, Robineau O, Giraud F, Deny A, Senneville E, Wallet F, Loïez C. Familial Transmission of emm12 Group A Streptococcus. Emerg Infect Dis 2017; 23:1745-1746. [PMID: 28930023 PMCID: PMC5621563 DOI: 10.3201/eid2310.170343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Incidence and severity of invasive group A Streptococcus infections are of increasing concern in France and worldwide. The risk for secondary infection of close contacts is known but rarely described. We report a case of intrafamilial and life-threatening transmission of emm12 group A Streptococcus.
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Reichert JC, Habild G, Simon P, Nöth U, Krümpelmann JB. Necrotizing streptococcal myositis of the upper extremity: a case report. BMC Res Notes 2017; 10:407. [PMID: 28807000 PMCID: PMC5556997 DOI: 10.1186/s13104-017-2743-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background Necrotizing myositis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the affected tissue. The myositis is often caused by toxin-producing, virulent bacteria such as group A β-hemolytic streptococcus and associated with severe systemic toxicity. It is rapidly fatal unless diagnosed promptly and treated aggressively. However, necrotizing myositis is often initially misdiagnosed as a more benign soft-tissue infection as such fulminant, invasive muscle infections are rare with no more than 30 cases reported over the last century. Case presentation We illustrate the case of a 74-year-old male Caucasian initially presenting with a progressing swelling and gradually oncoming pain of the upper right extremity. Rapidly, livid discolorations of the skin, blisters, hypoesthesia and severe pain resistant to analgesics treatment developed accompanied by disruption of the arterial blood flow. Due to a manifest compartment syndrome the patient was admitted to theater for fasciotomy of the arm. After multiple revision surgeries wound closure was achieved using a pedicled, fasciocutaneous parascapular flap and a free, ipsilateral anterolateral thigh flap. Microbiological analysis revealed group A β-hemolytic streptococcus, histology a bacterial interstitial myositis with necrotic muscular fibers. Conclusions A high degree of clinical suspicion is necessary to avert potentially disastrous consequences of necrotizing myositis. Timely diagnosis, broad-spectrum antibiotic therapy, and aggressive surgical debridement of affected tissue are keys to the treatment of this serious, often life-threatening infection.
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Affiliation(s)
- Johannes C Reichert
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany. .,Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany.
| | - Götz Habild
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Paul Simon
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Ulrich Nöth
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Jan B Krümpelmann
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
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Le Turnier P, Boutoille D, Joyau C, Veyrac G, Asseray N. Bacterial infections and NSAIDs exposure? Seek septic complications. Eur J Intern Med 2017; 41:e33-e34. [PMID: 28302389 DOI: 10.1016/j.ejim.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/27/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely consumed. Some authors suggested a relationship between more severe infections and NSAIDs exposure, especially skin and soft tissue infections (SSTI). However, their impact during bacterial infections remains unclear. The aim of the study was to report the severity features of patients having bacterial infection who were exposed to NSAIDs prior to their hospitalisation. Cases of infected patients with these characteristics declared to the pharmacovigilance department of a French university hospital from 1 January 2011 to 31 December 2013 were retrospectively reviewed. Forty-one patients were included, mainly male (61%). Median age was 37years. No underlying disease was noted for 68% of cases. Ibuprofen was the most frequent drug (63%). Self-medication concerned 61% of cases. Respiratory tract, osteoarticular and SSTI were the most frequent infected sites. Patients suffered septic complications: dissemination of infection to more than one site (51%), suppuration (59%), and requirement for invasive procedures (32%). Eleven patients (27%) had severity criteria as usually defined (10 severe sepsis and 1 septic shock) and 30 did not. There was no significant difference regarding the rate of septic complications between the severe and non-severe group. Septic complications frequently occurred in patients with NSAIDs exposure, whether or not there was severe sepsis or shock. Further studies investigating the impact of NSAIDs in bacterial infections should consider the septic complications depicted here as clinically relevant endpoints. Moreover, clinicians should seek those complications in case of bacterial infections and NSAIDs use.
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Affiliation(s)
| | | | - Caroline Joyau
- Pharmacovigilance, University Hopital of Nantes, France.
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Bryant AE, Aldape MJ, Bayer CR, Katahira EJ, Bond L, Nicora CD, Fillmore TL, Clauss TRW, Metz TO, Webb-Robertson BJ, Stevens DL. Effects of delayed NSAID administration after experimental eccentric contraction injury - A cellular and proteomics study. PLoS One 2017; 12:e0172486. [PMID: 28245256 PMCID: PMC5330483 DOI: 10.1371/journal.pone.0172486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute muscle injuries are exceedingly common and non-steroidal anti-inflammatory drugs (NSAIDs) are widely consumed to reduce the associated inflammation, swelling and pain that peak 1-2 days post-injury. While prophylactic use or early administration of NSAIDs has been shown to delay muscle regeneration and contribute to loss of muscle strength after healing, little is known about the effects of delayed NSAID use. Further, NSAID use following non-penetrating injury has been associated with increased risk and severity of infection, including that due to group A streptococcus, though the mechanisms remain to be elucidated. The present study investigated the effects of delayed NSAID administration on muscle repair and sought mechanisms supporting an injury/NSAID/infection axis. METHODS A murine model of eccentric contraction (EC)-induced injury of the tibialis anterior muscle was used to profile the cellular and molecular changes induced by ketorolac tromethamine administered 47 hr post injury. RESULTS NSAID administration inhibited several important muscle regeneration processes and down-regulated multiple cytoprotective proteins known to inhibit the intrinsic pathway of programmed cell death. These activities were associated with increased caspase activity in injured muscles but were independent of any NSAID effect on macrophage influx or phenotype switching. CONCLUSIONS These findings provide new molecular evidence supporting the notion that NSAIDs have a direct negative influence on muscle repair after acute strain injury in mice and thus add to renewed concern about the safety and benefits of NSAIDS in both children and adults, in those with progressive loss of muscle mass such as the elderly or patients with cancer or AIDS, and those at risk of secondary infection after trauma or surgery.
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Affiliation(s)
- Amy E. Bryant
- U.S. Department of Veterans Affairs, Office of Research and Development, Boise, ID, United States of America
- University of Washington School of Medicine, Seattle, WA, United States of America
| | - Michael J. Aldape
- U.S. Department of Veterans Affairs, Office of Research and Development, Boise, ID, United States of America
- Northwest Nazarene University, Nampa, ID, United States of America
| | - Clifford R. Bayer
- U.S. Department of Veterans Affairs, Office of Research and Development, Boise, ID, United States of America
| | - Eva J. Katahira
- U.S. Department of Veterans Affairs, Office of Research and Development, Boise, ID, United States of America
| | - Laura Bond
- Boise State University, Boise, ID, United States of America
| | - Carrie D. Nicora
- Pacific Northwest National Laboratory, Richland, WA, United States of America
| | - Thomas L. Fillmore
- Pacific Northwest National Laboratory, Richland, WA, United States of America
| | | | - Thomas O. Metz
- Pacific Northwest National Laboratory, Richland, WA, United States of America
| | | | - Dennis L. Stevens
- U.S. Department of Veterans Affairs, Office of Research and Development, Boise, ID, United States of America
- University of Washington School of Medicine, Seattle, WA, United States of America
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