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Nguyen DD, Ho NT, Dover LG, Vo AHM, Ly HTT, Doan PM, Nguyen HT, Luu NTT, Pham AN, Tran HTT. Novel Variant and Known Mutation in 23S rRNA Gene of Mycoplasma pneumoniae, Northern Vietnam, 2023. Emerg Infect Dis 2024; 30:1034-1036. [PMID: 38573165 PMCID: PMC11060462 DOI: 10.3201/eid3005.231632] [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] [Indexed: 04/05/2024] Open
Abstract
During a 2023 outbreak of Mycoplasma pneumoniae-associated community-acquired pneumonia among children in northern Vietnam, we analyzed M. pneumoniae isolated from nasopharyngeal samples. In almost half (6 of 13) of samples tested, we found known A2063G mutations (macrolide resistance) and a novel C2353T variant on the 23S rRNA gene.
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Luo X, Han S, Wang Y, Du P, Li X, Thai PK. Significant differences in usage of antibiotics in three Chinese cities measured by wastewater-based epidemiology. WATER RESEARCH 2024; 254:121335. [PMID: 38417269 DOI: 10.1016/j.watres.2024.121335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 03/01/2024]
Abstract
Antibiotic use, particularly inappropriate use by irrational prescribing or over-the-counter purchases, is of great concern for China as it facilitates the spread of antibiotic resistances. In this study, we applied wastewater-based epidemiology (WBE) to monitor the total consumption of eight common antibiotics in three cities in northern, eastern and southern China. Wastewater samples were successively collected from 17 wastewater treatment plants including weekdays and weekends spanning four seasons between 2019 and 2021. The concentration of antibiotics and their corresponding metabolites showed a significant correlation, confirming the measured antibiotics were actually consumed. Different seasonal trends in antibiotic use were found among the cities. It was more prevalent in the winter in the northern city Beijing, with the high antibiotic consumption attributed to peak influenza occurrence in the city. This is clear evidence of irrational prescription of antibiotics since it's known that antibiotics do little to treat influenza. In terms of overall consumption, Foshan is significantly lower, thanks to warmer climate and higher use of herbal tea as a prevention measure. WBE estimates of antibiotic consumption were relatively comparable with other data sources, with azithromycin as the top antibiotic measured here. The studied cities had higher WBE estimated antibiotics consumption than results of previous studies in the literature. Monitoring antibiotic use in different areas and periods through WBE in combination with complementary information, can better inform appropriate antibiotic guideline policies in various regions and nations.
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Affiliation(s)
- Xiaozhe Luo
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China
| | - Sheng Han
- Fujian Water Resource Investment and Development Group Co., Ltd., 350001, Fuzhou, China
| | - Yue Wang
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China
| | - Peng Du
- Beijing Key Laboratory of Urban Hydrological Cycle and Sponge City Technology, College of Water Sciences, Beijing Normal University, Beijing 100875, PR China.
| | - Xiqing Li
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Queensland 4102, Australia
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Ding G, Zhang X, Vinturache A, van Rossum AMC, Yin Y, Zhang Y. Challenges in the treatment of pediatric Mycoplasma pneumoniae pneumonia. Eur J Pediatr 2024:10.1007/s00431-024-05519-1. [PMID: 38634891 DOI: 10.1007/s00431-024-05519-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 04/19/2024]
Abstract
Mycoplasma pneumoniae (MP) is an important cause of community-acquired pneumonia in children and young adolescents. Despite macrolide antibiotics effectiveness as a first-line therapy, persistence of fever and/or clinical deterioration sometimes may complicate treatment and may even lead to severe systemic disease. To date, there is no consensus on alternative treatment options, optimal dosage, and duration for treating severe, progressive, and systemic MP pneumonia after macrolide treatment failure. Macrolide-resistant MP pneumonia and refractory MP pneumonia are the two major complex conditions that are clinically encountered. Currently, the vast majority of MP isolates are resistant to macrolides in East Asia, especially China, whereas in Europe and North America, whereas in Europe and North America prevalence is substantially lower than in Asia, varying across countries. The severity of pneumonia and extrapulmonary presentations may reflect the intensity of the host's immune reaction or the dissemination of bacterial infection. Children infected with macrolide-resistant MP strains who receive macrolide treatment experience persistent fever with extended antibiotic therapy and minimal decrease in MP-DNA load. Alternative second-line agents such as tetracyclines (doxycycline or minocycline) and fluoroquinolones (ciprofloxacin or levofloxacin) may lead to clinical improvement after macrolide treatment failure in children. Refractory MP pneumonia reflects a deterioration of clinical and radiological findings due to excessive immune response against the infection. Immunomodulators such as corticosteroids and intravenous immunoglobulin (IVIG) have shown promising results in treatment of refractory MP pneumonia, particularly when combined with appropriate antimicrobials. Corticosteroid-resistant hyperinflammatory MP pneumonia represents a persistent or recrudescent fever despite corticosteroid therapy with intravenous methylprednisolone at standard dosage. CONCLUSION This report summarizes the clinical significance of macrolide-resistant and refractory MP pneumonia and discusses the efficacy and safety of alternative drugs, with a stepwise approach to the management of MP pneumonia recommended from the viewpoint of clinical practice. WHAT IS KNOWN • Although MP pneumonia is usually a benign self-limited infection with response macrolides as first line therapy, severe life-threatening cases may develop if additional treatment strategies are not effectively implemented. • Macrolide-resistant and refractory MP pneumonia are two conditions that may complicate the clinical course of MP pneumonia, increasing the risk for exacerbation and even death. WHAT IS NEW • This report summarizes the clinical relevance of macrolide-resistant and refractory MP pneumonia and discusses the efficacy and safety of alternative drug therapies. • A practical stepwise approach to the management of MP pneumonia is developed based on a comprehensive analysis of existing evidence and expert opinion.
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Affiliation(s)
- Guodong Ding
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Xiaobo Zhang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Angela Vinturache
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Annemarie M C van Rossum
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China.
| | - Yongjun Zhang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Wang L, Liu L, Cheng S, Zhu J, Xie H, Zhao W. In vitro and in vivo study of andrographolide nanoparticles for the treatment of Mycoplasma pneumoniae pneumonia. Biochem Biophys Res Commun 2024; 698:149540. [PMID: 38266313 DOI: 10.1016/j.bbrc.2024.149540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE(S) The emergence of antibiotic resistance has led to suboptimal treatment outcomes for Mycoplasma pneumoniae pneumonia (MPP). Exploring naturally occurring drug components that are both effective against MPP and non-toxic may be a promising choice. This study aimed to investigate the therapeutic effect of andrographolide nanoparticles on pneumonia caused by Mycoplasma pneumoniae infection. METHODS Andrographolide alginate-poloxamer nanoparticles (AND-ALG-POL/NPs) were obtained by wet medium grinding, and the characterization and in vitro release of the prepared andrographolide nanoparticles were examined by high performance liquid chromatography, particle size analyzer, zeta potential meter and transmission electron microscopy. The cytotoxicity and anti-inflammatory effects of AND-ALG-POL/NPs were evaluated in vitro by MP-infected lung epithelial cells BEAS-2B. Symptoms of pneumonia, total cell count, total protein content and inflammatory factor levels in BALF were assessed by MP-induced pneumonia in BALB/c mice treated with AND-ALG-POL/NPs, and histopathological studies were performed on lung tissues from experimental animals. RESULTS The results showed that the prepared AND-ALG-POL/NPs were homogeneous spherical with a diameter of 180 ± 23 nm, a zeta potential of (-14.4 ± 2.1) mV, an average encapsulation rate of 87.74 ± 0.87 %, and an average drug loading of 13.17 ± 0.54 %. AND-ALG-POL/NPs were capable of slow release in vitro and showed significant inhibitory ability against MP (P < 0.001). However, AND-ALG-POL/NPs were not cytotoxic to normal cells and alleviated MP infection-induced apoptosis and elevated inflammatory factors. In the in vivo experiments, AND-ALG-POL/NPs alleviated the symptoms of pneumonia in MPP mice, reduced the abnormally elevated total cell count, total protein content and inflammatory factor levels in BALF, and alleviated lung tissue edema, inflammatory cell infiltration and apoptosis (P < 0.001). Meanwhile, the therapeutic effects of AND-ALG-POL/NPs on MPP were similar to those of azithromycin (AZM) and higher than those of andrographolide (AND) free monotherapy (P < 0.001). CONCLUSION In summary, the prepared AND-ALG-POL/NPs can effectively inhibit MPP in vitro and in vivo, and the effect is similar to that of AZM. Therefore, AND- ALG - POL/NPs have the potential to replace AZM as a potential drug for the treatment of MPP.
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Affiliation(s)
- Liling Wang
- Department of Paediatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Liwei Liu
- Department of Paediatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shen Cheng
- Department of Paediatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiawen Zhu
- Department of Paediatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huanlai Xie
- Department of Paediatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wentan Zhao
- Department of Paediatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Shin S, Koo S, Yang YJ, Lim HJ. Characteristics of the Mycoplasma pneumoniae Epidemic from 2019 to 2020 in Korea: Macrolide Resistance and Co-Infection Trends. Antibiotics (Basel) 2023; 12:1623. [PMID: 37998825 PMCID: PMC10669541 DOI: 10.3390/antibiotics12111623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
Mycoplasma pneumoniae, a major etiological agent of community-acquired pneumonia, exhibits distinct cyclic epidemic patterns recurring every three to five years. Several cases of co-infection with severe acute respiratory syndrome coronavirus 2 have been reported globally, resulting in unfavorable clinical manifestations. This study investigated the epidemiological features of the recent M. pneumoniae outbreak (May 2019-April 2020) using retrospective data from the last five years. Molecular test data for macrolide resistance and co-infection were obtained from the Seegene Medical Foundation. National medical expenditure and hospitalization rates were analyzed using data from The Health Insurance Review and Assessment Service of Korea. The macrolide resistance rate was 69.67%, peaking at 71.30% during the epidemic period, which was considerably higher than the 60.89% rate during non-epidemic periods. The co-infection rate with other respiratory pathogens was 88.49%; macrolide-resistant M. pneumoniae strains showed a 2.33% higher co-infection rate than the susceptible strains. The epidemic period had 15.43% higher hospitalization and 78.27% higher medical budget expenditure per patient than non-epidemic periods. The increased rates of macrolide resistance and co-infection observed in macrolide-resistant M. pneumoniae during the epidemic period highlight the importance of monitoring future outbreaks, especially considering macrolide resistance and the risk of co-infection with other pathogens.
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Affiliation(s)
- Soyoun Shin
- Daejeon & Chungcheong Reference Lab., Seegene Medical Foundation, Daejeon 35203, Republic of Korea;
| | - Sunhoe Koo
- Daejeon & Chungcheong Reference Lab., Seegene Medical Foundation, Daejeon 35203, Republic of Korea;
| | - Yong-Jin Yang
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul 04805, Republic of Korea; (Y.-J.Y.); (H.-J.L.)
| | - Ho-Jae Lim
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul 04805, Republic of Korea; (Y.-J.Y.); (H.-J.L.)
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Lee HY, Chen CC, Pi CC, Chen CJ. Aspergillus oryzae Fermentation Extract Alleviates Inflammation in Mycoplasma pneumoniae Pneumonia. Molecules 2023; 28:molecules28031127. [PMID: 36770796 PMCID: PMC9920650 DOI: 10.3390/molecules28031127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
The filamentous fungus Aspergillus oryzae, also known as koji mold, has been used for centuries in the production of fermented foods in East Asia. A. oryzae fermentation can produce enzymes and metabolites with various bioactivities. In this study, we investigated whether A. oryzae fermentation extract (AOFE) has any effect on Mycoplasma pneumoniae (Mp) pneumonia. We performed solid-state fermentation of A. oryzae and obtained the ethanol extract. AOFE was analyzed by HPLC, and the major component was identified to be kojic acid. In vitro, AOFE suppressed Mp growth and invasion into A549 lung epithelial cells as determined by the gentamicin protection assay. AOFE treatment also suppressed Mp-stimulated production of tumor necrosis factor (TNF)-α and interleukin (IL)-6 at mRNA and protein levels in murine MH-S alveolar macrophages. In a mouse model of Mp pneumonia, Mp infection induced a marked pulmonary infiltration of neutrophils, which was significantly reduced in mice pre-treated orally with AOFE. AOFE administration also suppressed the production of proinflammatory cytokines and chemokines in the lungs. Collectively, our results show that AOFE has the potential to be developed into a preventive/therapeutic agent for Mp pneumonia.
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Affiliation(s)
- Hui-Yu Lee
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 10617, Taiwan
| | | | - Chia-Chen Pi
- King’s Ground Biotech Co., Ltd., Pintung 91252, Taiwan
| | - Chun-Jen Chen
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 10617, Taiwan
- Correspondence:
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Zhu Z, Rahman Z, Aamir M, Shah SZA, Hamid S, Bilawal A, Li S, Ishfaq M. Insight into TLR4 receptor inhibitory activity via QSAR for the treatment of Mycoplasma pneumonia disease. RSC Adv 2023; 13:2057-2069. [PMID: 36712602 PMCID: PMC9833105 DOI: 10.1039/d2ra06178c] [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: 10/01/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023] Open
Abstract
Mycoplasma pneumoniae (MP) is one of the most common pathogenic organisms causing upper and lower respiratory tract infections, lung injury, and even death in young children. Toll-like receptors (TLRs) play an important role in innate immunity by allowing the host to recognize pathogens invading the body. Previous studies demonstrated that TLR4 is a potential therapeutic target for the treatment of MP pneumonia. Therefore, the present study aimed to screen biologically active ingredients that target the TLR4 receptor pathway. We first used molecular docking to screen out the active compounds inhibiting the TLR4 pathway, and then used regression and classification machine learning algorithms to establish a quantitative structure-activity relationship (QSAR) model to predict the biological activity of the screened compounds. A total of 78 molecules were used in QSAR modelling, which were retrieved from the ChEMBL database. The QSAR models had acceptable correlation coefficients of R 2 on the training and testing dataset in the range of 0.96 to 0.91 and 0.93 to 0.76, respectively. The multiclass classification models showed accuracy on training and testing data within ranges of 1.0 to 0.70, 0.96 to 0.63, and log loss ranges from 0.27 to 8.63, respectively. In addition, molecular descriptors and fingerprints have been studied as structural elements involved in increased and decreased inhibitory activities. These results provide a quantitative analysis of QSAR and classification models applicable for high-throughput screening, as well as insights into the mechanisms of inhibition of TLR4 antagonists.
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Affiliation(s)
- Zemin Zhu
- College of Computer Science, Huanggang Normal UniversityHuanggang 438000China+86 15972855212
| | - Ziaur Rahman
- College of Computer Science, Huanggang Normal UniversityHuanggang 438000China+86 15972855212
| | - Muhammad Aamir
- College of Computer Science, Huanggang Normal UniversityHuanggang 438000China+86 15972855212
| | - Syed Zahid Ali Shah
- Department of Pathology, Faculty of Veterinary and Animal Sciences, The Islamia University of Bahawalpur-PakistanPakistan
| | - Sattar Hamid
- The University of Agriculture PeshawarKhyber Pakhtunkhwa25130Pakistan
| | - Akhunzada Bilawal
- College of Food Science, Northeast Agricultural UniversityHarbinChina
| | - Sihong Li
- Key Laboratory of Applied Technology on Green-Eco-Healthy Animal Husbandry of Zhejiang Province, College of Animal Science and Technology, College of Veterinary Medicine, Zhejiang A&F UniversityHangzhou 311300China
| | - Muhammad Ishfaq
- College of Computer Science, Huanggang Normal UniversityHuanggang 438000China+86 15972855212
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Xu L, Zhao Z, Mai H, Tan X, Du Y, Fang C. Clinical and chest computed tomography features associated with severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing: A multicenter, retrospective, observational study. Medicine (Baltimore) 2022; 101:e32117. [PMID: 36550834 PMCID: PMC9771292 DOI: 10.1097/md.0000000000032117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chlamydia psittaci pneumonia is a rare disease with varying clinical presentations. Here, we aimed to investigate the clinical and chest computed tomography (CT) features of severe psittacosis pneumonia. Clinical data of 35 patients diagnosed with psittacosis pneumonia were retrospectively analyzed using metagenomic next-generation sequencing. The patients were classified into severe (n = 20) and non-severe (n = 15) groups. The median age of patients was 54 years, and 27 patients (77.1%) had a definite history of bird contact. Severe patients had more underlying comorbidities and were more prone to dyspnea and consciousness disorders than non-severe patients. The neutrophil count and D-dimer, lactate dehydrogenase, interleukin (IL)-2, IL-6, and IL-10 levels were higher, whereas the lymphocyte, CD3 + T cell, and CD4 + T cell counts, CD4+/CD8 + T cell ratio, and albumin level were substantially lower in severe patients than in non-severe patients. Chest CT findings of severe patients revealed large areas of pulmonary consolidation, and ground-glass opacities were observed in some patients, with a higher risk of involving multiple lobes of the lungs and pleural effusion. One patient died of multiple organ failure, whereas the condition of the other 34 patients improved, and they were discharged from the hospital. Patients with severe psittacosis pneumonia often have underlying comorbidities and are prone to developing dyspnea, consciousness disorder, and lesions in both lungs. Serum D-dimer, IL-2, IL-6, and IL-10 levels and lymphocyte, CD3 + T cell, and CD4 + T cell counts are associated with disease severity.
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Affiliation(s)
- Limin Xu
- Department of Geriatrics, Huizhou First People’s Hospital, Huizhou, People’s Republic of China
| | - Ziwen Zhao
- Department of Pulmonary and Critical Care Medicine, Guangzhou First People’s Hospital Affiliated to South China University of Technology, Guangzhou, People’s Republic of China
| | - Hui Mai
- Department of Geriatrics, Huizhou First People’s Hospital, Huizhou, People’s Republic of China
| | - Xiaoying Tan
- Department of Geriatrics, Huizhou First People’s Hospital, Huizhou, People’s Republic of China
| | - Yubin Du
- Department of Geriatrics, Huizhou First People’s Hospital, Huizhou, People’s Republic of China
| | - Changquan Fang
- Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, People’s Republic of China
- *Correspondence: Changquan Fang, Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, People’s Republic of China (e-mail: )
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Wang X, Li M, Luo M, Luo Q, Kang L, Xie H, Wang Y, Yu X, Li A, Dong M, Huang F, Gong C. Mycoplasma pneumoniae triggers pneumonia epidemic in autumn and winter in Beijing: a multicentre, population-based epidemiological study between 2015 and 2020. Emerg Microbes Infect 2022; 11:1508-1517. [PMID: 35582916 PMCID: PMC9176688 DOI: 10.1080/22221751.2022.2078228] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this paper is to explore the characteristics of Mycoplasma pneumoniae (MP) epidemics in Beijing, China. Patients with acute respiratory tract infection (ARTI) were enrolled from 35 sentinel hospitals in Beijing, 2015–2020. Their medical records were reviewed and respiratory specimens were collected for assay for nucleic acids of 24 respiratory pathogens, including MP. The genotypes of MP were analysed using a real-time PCR method. The domain V of 23s rRNA gene was sequenced to identify macrolide-resistant mutations. A total of 41,677 specimens of ARTI patients were included, with an MP positive rate of 6.16%. MP prevalence mainly occurred between August and January, and peaked in October. The increase in the MP detection rate was coincident with the elevation of the reported number of patients with pneumonia in the 35 sentinel hospitals. One or more respiratory pathogens were co-detected in 27.1% of the MP-positive patients. Type 1 MP remained predominant, and the macrolide-resistant rate of MP had exceeded over 90%. A2063G mutation accounted for 99.0% of macrolide-resistant MP infections. MP epidemic in Beijing mainly occurred between August and January with a remarkable high macrolide-resistant rate. MP is one of the important contributors to the pneumonia epidemic in autumn and winter in Beijing.
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Affiliation(s)
- Xue Wang
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Maozhong Li
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Ming Luo
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Qin Luo
- College of Public Health, Capital Medical University, Beijing, People's Republic of China
| | - Lu Kang
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Hui Xie
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Yiting Wang
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Xiali Yu
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Aihua Li
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Mei Dong
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Fang Huang
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
| | - Cheng Gong
- Beijing Center for Disease Prevention and Control, Institute for Immunization and Prevention, Beijing, People's Republic of China
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Comparison between Ceftriaxone and Sulbactam-Ampicillin as Initial Treatment of Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11101291. [PMID: 36289949 PMCID: PMC9598877 DOI: 10.3390/antibiotics11101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Current guidelines recommend the use of ceftriaxone and sulbactam-ampicillin for the initial treatment of community-acquired pneumonia (CAP). However, there are no clear data on these guidelines. Therefore, this systematic review and meta-analysis aims to evaluate the effectiveness of ceftriaxone and sulbactam-ampicillin in the initial treatment of CAP. The Embase, Scopus, PubMed, Ichushi, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched from inception to July 2022. The studies included patients who received ceftriaxone or sulbactam-ampicillin as the initial antibiotic therapy for CAP. The mortality and clinical cure rates were evaluated. Of the 2152 citations identified for screening, four studies were included. Results of the pooled analysis indicated no significant differences in the mortality and clinical cure rates between patients treated with ceftriaxone and those treated with sulbactam-ampicillin (mortality, odds ratio [OR]: 1.85, 95% confidence interval [CI]: 0.57–5.96; clinical cure rate, OR: 1.08, 95% CI: 0.18–6.44). This study supports the guidelines for CAP treatment, though further studies are needed to obtain a deeper understanding.
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Macrolide versus Non-Macrolide in Combination with Steroids for the Treatment of Lobar or Segmental Mycoplasma pneumoniae Pneumonia Unresponsive to Initial Macrolide Monotherapy. Antibiotics (Basel) 2022; 11:antibiotics11091233. [PMID: 36140012 PMCID: PMC9495205 DOI: 10.3390/antibiotics11091233] [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: 08/25/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
In the last few decades, macrolide-resistant Mycoplasma pneumoniae (MRMP) has been increasing in proportion. This study aimed to evaluate the treatment outcomes of children with lobar or segmental MP pneumonia unresponsive to the initial 3−5-day macrolide therapy, who then switched to either a non-macrolide, macrolide + steroid, or a non-macrolide + steroid regimen, according to the 2019 KSPID and KAPARD guideline during the 2019−2020 Mycoplasma epidemic in South Korea. A total of 190 patients <18 years old were admitted during the study period for MP lobar or segmental pneumonia, and 16.8% (n = 32/190) were responsive to the initial macrolide monotherapy, whereas 83.2% (158/190) were refractory. The median age of the patients was 7 (interquartile range [IQR], 5−9) years old and 46.2% (n = 73/158) were male. The overall treatment success rates of non-macrolide, macrolide + steroid, and non-macrolide + steroid groups were 46.2%, 80.8%, and 100.0%, respectively. Patients in the non-macrolide + steroid group had the shortest fever duration after a regimen change of 1 (IQR, 0−3) day compared with patients in the non-macrolide group and macrolide + steroid group; 2 (IQR, 1−4) days and 2 (IQR, 1−3.3) days (p = 0.004), respectively. Follow-up CRP (ß, 0.169; CI, 0.050−0.287; p = 0.006), macrolide + steroid therapy (ß, −1.694; CI, −2.463−−0.925; p < 0.001), and non-macrolide+ steroid therapy (ß, −2.224; CI, −3.321−−1.127; p < 0.001) were shown to be significantly associated with the duration of fever after admission. To conclude, in patients with severe MP pneumonia that failed to respond to the initial macrolide therapy, a non-macrolide + steroid had the highest treatment success rate and a shorter duration of fever.
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Xu L, Wang C, Peng X, Jiao Y, Zhao C, Zhang L, Ma L. Empirical Antibiotic Treatment Strategies for Community-Acquired Pneumonia: A Network Meta-analysis. J Glob Antimicrob Resist 2022; 30:1-9. [DOI: 10.1016/j.jgar.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022] Open
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Jiang Z, Zhou R, Leung PHM, Deng Z, Li S. An attenuated multiple genetic mutant of Mycoplasma pneumoniae imparts good immuno-protection against M. pneumoniae pneumonia in BALB/c mice. Microb Pathog 2022; 165:105463. [PMID: 35240287 DOI: 10.1016/j.micpath.2022.105463] [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: 09/28/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/19/2022]
Abstract
Mycoplasma pneumoniae (M. pneumoniae) is the causative agent of both upper and lower respiratory infections that can lead to pneumonia, extrapulmonary complications and devastating sequela. With the increasing rate of macrolide-resistant strains, the severe clinical consequence of refractory mycoplasma pneumonia in children health calls for the need of vaccine research for this pathogen. In this report, the immunomodulatory effectiveness of a live attenuated M. pneumoniae vaccine was evaluated. The vaccine strain was a mutant strain of M. pneumoniae, MUT129, obtained after multiple passages of M129 strain in PPLO broth. The SNP/InDel detection results showed that mutations were present in genes encoding the adhesion organelle-associated proteins and lipoproteins of M. pneumoniae MUT129. Upon intranasal challenge of BALB/c mice with 1 × 107 CFU of MUT129, there were very small amount of Mycoplasma antigens and almost no M. pneumoniae present in the lung tissues of BALB/c mice. Besides, there was almost no inflammatory cell infiltration in the lung tissue. Results of the M. pneumoniae challenge study showed that mice immunized with MUT129 presented with less inflammation, lower detectable number of M. pneumoniae in the lungs when compared with the unimmunized mice. These results indicated that the live attenuated vaccine can efficiently prevent the proliferation of M. pneumonia in the lungs, reduce but not completely prevent the pulmonary inflammatory response.
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Affiliation(s)
- Zhulin Jiang
- Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Runjie Zhou
- Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Polly H M Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Zhongliang Deng
- Hengyang Medical College, University of South China, Hengyang, 421001, China.
| | - Shuihong Li
- Hengyang Medical College, University of South China, Hengyang, 421001, China.
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Peng Y, Chen Z, Li Y, Lu Q, Li H, Han Y, Sun D, Li X. Combined therapy of Xiaoer Feire Kechuan oral liquid and azithromycin for mycoplasma Pneumoniae pneumonia in children: A systematic review & meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 96:153899. [PMID: 35026500 DOI: 10.1016/j.phymed.2021.153899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/05/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia (MPP) has high morbidity with an increased global burden. Xiaoer Feire Kechuan (XEFRKC) oral liquid comprises multiple herbal medicines and possesses numerous broad-spectrum antibacterial activities for MPP. Therefore, treatment options with XEFRKC to provide new clinical evidence for children with MPP needs to be explored. PURPOSE This study aimed to evaluate the clinical efficacy and safety of combined treatment of XEFRKC with azithromycin (XEFRKC + azithromycin) for treating the MPP in children. METHODS We conducted a comprehensive search in 7 databases to find the randomized controlled trials (RCTs) of XEFRKC + azithromycin treatment. Two researchers independently review the retrieval, extraction, and quality assessment of the dataset. In addition, we conducted the effect model to analyze the data and performed the meta-regression with sensitivity analysis to assess the heterogeneity and stability. RESULTS A total of 30 RCTs with 2997 participants were included in this review. The results of primary outcomes showed that the XEFRKC + azithromycin therapy was significantly different with the azithromycin in response rate (RR = 1.18, 95% CI: 1.13 to 1.22), fever disappearance time (MD = -1.01, 95% CI: -1.18 to -0.84), cough disappearance time (MD = -2.18, 95% CI: -2.69 to -1.67), and pulmonary rales disappearance time (MD = -1.3, 95% CI: -1.71 to -0.88). For secondary outcomes and safety as well, XEFRKC + azithromycin had a significant difference compared with azithromycin. Meta-regression results showed that multiple covariables were not the source of heterogeneity. Moreover, sensitivity analysis showed that the stability of the meta-analysis results remained robust. CONCLUSIONS For MPP in children, the XEFRKC + azithromycin therapy may be the better option compared with azithromycin alone. However, the accuracy of safety needs to be confirmed and verified with more high-quality RCTs.
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Affiliation(s)
- Yingying Peng
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China
| | - Zhe Chen
- Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yanjiao Li
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China
| | - Qiu Lu
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China
| | - Huanmin Li
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China
| | - Yaowei Han
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China
| | - Dan Sun
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China
| | - Xinmin Li
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China.
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Matsui H, Sugimura M, Inoue-Tsuda M, Iwabuchi K, Hanaki H. Development of an immunochromatographic test for the detection of Mycoplasma pneumoniae GroES antigen. J Microbiol Methods 2021; 191:106359. [PMID: 34744002 DOI: 10.1016/j.mimet.2021.106359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/12/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022]
Abstract
Mycoplasma pneumoniae frequently causes community-acquired pneumonia in children; β-lactam antibiotics are ineffective against this bacterium because of its lack of a cell wall. Hence, a rapid and simple detection method is required to ensure appropriate treatment. In this study, we developed a rapid and simple immunochromatography-based detection method using monoclonal antibodies that react with the co-chaperone GroES of M. pneumoniae. Mice were immunized with recombinant GroES, and hybridoma cells producing anti-GroES monoclonal antibodies were established. For the development of the immunochromatographic test, antibody pairs with superior reactivity and specificity were selected. The developed immunochromatographic test could detect 0.1 ng/mL of recombinant GroES within 20 min. Moreover, no cross-reaction was observed with other microorganisms, including six Mycoplasma species, 20 other bacterial species, and one yeast species. Macrolide-resistant and -susceptible M. pneumoniae clinical isolates were detected at approximately 104 to 105 colony-forming units/mL. The study indicates that immunochromatographic tests targeting GroES are useful for rapid and simple detection of M. pneumoniae.
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Affiliation(s)
- Hidehito Matsui
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo 108-8641, Japan
| | - Makoto Sugimura
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo 108-8641, Japan
| | - Megumi Inoue-Tsuda
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo 108-8641, Japan
| | - Kazuya Iwabuchi
- Department of Immunology, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara-shi, Kanagawa 252-0373, Japan
| | - Hideaki Hanaki
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo 108-8641, Japan.
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Feng M, Zhuo C, Zhu X. Long Noncoding RNA HOXA Cluster Anti-Sense RNA 2 Inhibits Mycoplasma pneumoniae-Induced Inflammation by Regulating the Nuclear Factor-KappaB Signaling Pathway. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mycoplasma pneumoniae (MP) is the primary cause of community-acquired lung inflammation. The MP-induced manifestations of pneumonia are associated with the release of pro-inflammatory cytokines; however, the mechanisms of MP-induced inflammation have not been fully clarified.
The purpose of the present study was to determine whether long noncoding RNA HOXA cluster anti-sense RNA 2 (lncRNA HOXA-AS2) is involved in MP-induced inflammation. A model of MP-induced cellular inflammation was established using the human BEAS-2B lung epithelial cell line and lncRNA HOXA-AS2
levels were detected using reverse transcription-quantitative (RT-q) PCR. MTT and flow cytometric analysis were used to assess cell viability and apoptosis, respectively. The secretion of pro-inflammatory factors including tumor necrosis factor (TNF)-α, interleukin (IL)-1β
and IL-6 were measured by ELISA, and protein levels of phosho- (p-)p65 and p-NF-κB inhibitor α (p-IκBα) were detected by western blotting. The results suggest that MP infection significantly decreases the level of lncRNA HOXA-AS2 in BEAS-2B
cells. lncRNA HOXA-AS2 overexpression significantly enhanced cell viability, inhibited apoptosis, decreased pro-inflammatory factor expression (TNF-α, IL-β and IL-6) and inhibited NF-κB pathway activation in MP-stimulated BEAS-2B cells. Conversely, lncRNA
HOXA-AS2-knockdown resulted in the opposite effects. In conclusion, lncRNA HOXA-AS2 is involved in MP infection-induced inflammation and regulates the NF-κB signaling pathway.
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Affiliation(s)
- Mei Feng
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P. R.China
| | - Chengjie Zhuo
- Department of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P. R. China
| | - Xuefen Zhu
- Department of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P. R. China
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17
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Bi Y, Ma Y, Zhuo J, Zhang L, Yin L, Sheng H, Luan J, Li T. Risk of Mycoplasma pneumoniae-related hepatitis in MP pneumonia pediatric patients: a predictive model construction and assessment. BMC Pediatr 2021; 21:287. [PMID: 34154565 PMCID: PMC8218438 DOI: 10.1186/s12887-021-02732-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A predictive model for risk of Mycoplasma pneumoniae (MP)-related hepatitis in MP pneumonia pediatric patients can improve treatment selection and therapeutic effect. However, currently, no predictive model is available. METHODS Three hundred seventy-four pneumonia pediatric patients with/without serologically-confirmed MP infection and ninety-three health controls were enrolled. Logistic regressions were performed to identify the determinant variables and develop predictive model. Predictive performance and optimal diagnostic threshold were evaluated using area under the receiver operating characteristic curve (AUROC). Stratification analysis by age and MP-IgM titer was used to optimize model's clinical utility. An external validation set, including 84 MP pneumonia pediatric patients, was used to verify the predictive efficiency. After univariate analysis to screen significant variables, monocyte count (MO), erythrocyte distribution width (RDW) and platelet count (PLT) were identified as independent predictors in multivariate analysis. RESULTS We constructed MRP model: MO [^109/L] × 4 + RDW [%] - PLT [^109/L] × 0.01. MRP achieved an AUROC of 0.754 and the sensitivity and specificity at cut-off value 10.44 were 71.72 and 61.00 %, respectively in predicting MP-related hepatitis from MP pneumonia. These results were verified by the external validation set, whereas it merely achieved an AUROC of 0.540 in pneumonia without MP infection. The AUROC of MRP was 0.812 and 0.787 in infants and toddlers (0-36 months) and low MP-IgM titer subgroup (1:160-1:320), respectively. It can achieve an AUROC of 0.804 in infants and toddler with low MP-IgM titer subgroup. CONCLUSIONS MRP is an effective predictive model for risk of MP-related hepatitis in MP pneumonia pediatric patients, especially infants and toddlers with low MP-IgM titer.
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Affiliation(s)
- Yuna Bi
- Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Cheeloo College of Medicine, Shandong University, 238#, Jing 10 East Road, Jinan, Shandong, China
| | - Yan Ma
- Department of Pediatrics, Cheeloo College of Medicine, Shandong Provincial Third Hospital, Shandong University, 12#, Wuyingshan Middle Road, Jinan, 250014, Shandong, China
| | - Jinhua Zhuo
- Department of Clinical Laboratory, Cheeloo College of Medicine, Shandong Provincial Third Hospital, Shandong University, 12#, Wuyingshan Middle Road, Jinan, 250014, Shandong, China
| | - Lili Zhang
- Department of Pediatrics, Affiliated Hospital of Yangzhou University, 45#, Taizhou Road, Yangzhou, Jiangsu, China
| | - Liyan Yin
- Department of Pediatrics, Cheeloo College of Medicine, Shandong Provincial Third Hospital, Shandong University, 12#, Wuyingshan Middle Road, Jinan, 250014, Shandong, China
| | - Hongling Sheng
- Department of Pediatrics, Cheeloo College of Medicine, Shandong Provincial Third Hospital, Shandong University, 12#, Wuyingshan Middle Road, Jinan, 250014, Shandong, China
| | - Jie Luan
- Department of Pediatrics, Cheeloo College of Medicine, Shandong Provincial Third Hospital, Shandong University, 12#, Wuyingshan Middle Road, Jinan, 250014, Shandong, China
| | - Tao Li
- Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324#, Jing 5 Road, 250021, Jinan, China.
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Clinical Evaluation of a Novel Point-of-Care Assay To Detect Mycoplasma pneumoniae and Associated Macrolide-Resistant Mutations. J Clin Microbiol 2021; 59:e0324520. [PMID: 33910960 DOI: 10.1128/jcm.03245-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The recent increase in macrolide-resistant Mycoplasma pneumoniae in Asia has become a continuing problem. A point-of-care testing method that can quickly detect M. pneumoniae and macrolide-resistant mutations (MR mutations) is critical for proper antimicrobial use. Smart Gene (Mizuho Medy Co., Ltd., Tosu City, Saga, Japan) is a compact and inexpensive fully automatic gene analyzer that combines amplification with PCR and the quenching probe method to specify the gene and MR mutations simultaneously. We performed a clinical evaluation of this device and its reagents on pediatric patients with suspected M. pneumoniae respiratory infections and evaluated the impact of the assay on antimicrobial selection. Using real-time PCR as a comparison control, the sensitivity of Smart Gene was 97.8% (44/45), its specificity was 93.3% (98/105), and its overall concordance rate was 94.7% (142/150). The overall concordance rate of Smart Gene diagnosis of MR mutations in comparison with sequence analysis was 100% (48/48). The ratio of MR mutations was significantly higher at high-level medical institutions than at a primary medical clinic (P = 0.023), and changes in antibiotic therapy to drugs other than macrolides were significantly more common in patients with MR mutations (P = 0.00024). Smart Gene demonstrated excellent utility in the diagnosis of M. pneumoniae and the selection of appropriate antimicrobials for MR mutations at primary medical institutions, which play a central role in community-acquired pneumonia care. The use of this device may reduce referrals to high-level medical institutions for respiratory infections, thereby reducing the medical and economic burdens on patients.
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Mahmood M, Javaid A, Shahid F, Ashfaq UA. Rational design of multimeric based subunit vaccine against Mycoplasma pneumonia: Subtractive proteomics with immunoinformatics framework. INFECTION GENETICS AND EVOLUTION 2021; 91:104795. [PMID: 33667723 DOI: 10.1016/j.meegid.2021.104795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/14/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
Mycoplasma pneumoniae is the prevalent cause of acquired respiratory infections around the globe. A multi-epitope vaccine (MEV) must be developed to combat infections of M. pneumoniae because there is no specific disease-modifying treatment or vaccination is present. The objective of this research is to design a vaccine that targets M. pneumoniae top five highly antigenic proteins using a combination of immunological techniques and molecular docking. T-cell (HTL & CTL), B-cell, and IFN-γ of target proteins were forecasted and highly conservative epitopes were chosen for further study. For designing of final vaccine, 4LBL, 7CTL, and 5HTL epitopes were joined by linkers of KK, AAY, and GPGPG. The N-end of the vaccine was linked to an adjuvant (Cholera enterotoxin subunit B) with a linker named EAAAK to enhance immunogenicity. After the addition of adjuvants and linkers, the size of the construct was 395 amino acids. The epitopes of IFN-γ and B-cells illustrate that the model construct is optimized for cell-mediated immune or humoral responses. To ensure that the final design is safer and immunogenic, properties like non-allergens, antigenicity, and various physicochemical properties were evaluated. Molecular docking of the vaccine with the toll-like receptor 4 (TLR4) was conducted to check the compatibility of the vaccine with the receptor. Besides, in-silico cloning was utilized for validation of the credibility and proper expression of the vaccine. Furthermore, to confirm that the multi-epitope vaccine created is protective and immunogenic, this research requires experimental validation.
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Affiliation(s)
- Marvah Mahmood
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Anam Javaid
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Farah Shahid
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Usman Ali Ashfaq
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan.
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Li S, Xue G, Zhao H, Feng Y, Yan C, Cui J, Xie X, Yuan J. Quantitative proteomics analysis of Mycoplasma pneumoniae identifies potential macrolide resistance determinants. AMB Express 2021; 11:26. [PMID: 33580372 PMCID: PMC7881084 DOI: 10.1186/s13568-021-01187-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Mycoplasma pneumoniae is one of the leading causes of community-acquired pneumonia in children and adolescents. Because of the wide application of macrolides in clinical treatment, macrolide-resistant M. pneumoniae strains have become increasingly common worldwide. However, the molecular mechanisms underlying drug resistance in M. pneumoniae are poorly understood. In the present work, we analyzed the whole proteomes of macrolide-sensitive and macrolide-resistant strains of M. pneumoniae using a tandem mass tag-labeling quantitative proteomic technique, Data are available via ProteomeXchange with identifier PXD022220. In total, 165 differentially expressed proteins were identified, of which 80 were upregulated and 85 were downregulated in the drug-resistant strain compared with the sensitive strain. Functional analysis revealed that these proteins were predominantly involved in protein and peptide biosynthesis processes, the ribosome, and transmembrane transporter activity, which implicates them in the mechanism(s) of resistance of M. pneumoniae to macrolides. Our results provide new insights into drug resistance in M. pneumoniae and identify potential targets for further studies on resistance mechanisms in this bacterium.
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21
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Mycoplasma pneumoniae Infections: Pathogenesis and Vaccine Development. Pathogens 2021; 10:pathogens10020119. [PMID: 33503845 PMCID: PMC7911756 DOI: 10.3390/pathogens10020119] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 12/16/2022] Open
Abstract
Mycoplasma pneumoniae is a major causative agent of community-acquired pneumonia which can lead to both acute upper and lower respiratory tract inflammation, and extrapulmonary syndromes. Refractory pneumonia caused by M. pneumonia can be life-threatening, especially in infants and the elderly. Here, based on a comprehensive review of the scientific literature related to the respective area, we summarize the virulence factors of M. pneumoniae and the major pathogenic mechanisms mediated by the pathogen: adhesion to host cells, direct cytotoxicity against host cells, inflammatory response-induced immune injury, and immune evasion. The increasing rate of macrolide-resistant strains and the harmful side effects of other sensitive antibiotics (e.g., respiratory quinolones and tetracyclines) in young children make it difficult to treat, and increase the health risk or re-infections. Hence, there is an urgent need for development of an effective vaccine to prevent M. pneumoniae infections in children. Various types of M. pneumoniae vaccines have been reported, including whole-cell vaccines (inactivated and live-attenuated vaccines), subunit vaccines (involving M. pneumoniae protein P1, protein P30, protein P116 and CARDS toxin) and DNA vaccines. This narrative review summarizes the key pathogenic mechanisms underlying M. pneumoniae infection and highlights the relevant vaccines that have been developed and their reported effectiveness.
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Dai FF, Liu FQ, Chen X, Yang J, Wang K, Guo CY. The treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. J Clin Pharm Ther 2021; 46:705-710. [PMID: 33403672 DOI: 10.1111/jcpt.13331] [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: 09/28/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE In recent years, the resistance of Mycoplasma pneumoniae to macrolide antibiotics has increased significantly. The health systems are facing significant challenges in carrying out the diagnosis and treatment of refractory Mycoplasma pneumoniae pneumonia in children. Levofloxacin is suitable for treating infectious diseases in various systems but limited in children due to arthropathy issues in weight-bearing joints. This study aimed to evaluate the efficacy and safety of levofloxacin in children with macrolide-resistant Mycoplasma pneumoniae pneumonia. METHODS We retrospectively enrolled six confirmed cases of refractory Mycoplasma pneumoniae pneumonia who were admitted in the paediatric respiratory ward of Shandong provincial hospital Affiliated to Shandong first Medical University between 1st January 2020 and 29th February 2020. Levofloxacin was given to the patients through the intravenous or oral route as per the following dosages :<5 years, 8-10 mg/kg q12 h; >5 years, 8-10 mg/kg, qd for 10 days. The clinical data were collected and analysed. RESULTS AND DISCUSSION The average age of the enrolled cases was six years and nine months (range, four years, and seven months to eleven years and seven months). All cases were found to be drug-resistant and were treated with azithromycin combined with antibacterial drugs. Levofloxacin was used in the patient's refractory to macrolide antibiotics. The temperature of five cases returned to normal 1-2 days after treatment with levofloxacin, and the imaging of the four cases showed expected improvements. The gastrointestinal symptoms, neurological manifestations, joint symptoms, blood parameters, liver and kidney functions, and exercise conditions of the children were closely monitored. The follow-up time of the patients ranged from one week to five months. No drug-related adverse reactions were observed in patients during treatment or during follow-up. WHAT IS NEW AND CONCLUSION The clinical symptoms and imaging significantly improved after treatment with levofloxacin, and no drug-related adverse reactions were observed. Levofloxacin proved to be an effective and safe drug in the treatment of children with macrolide-resistant mycoplasma pneumonia. This study will provide a reference for evaluating the efficacy and safety of levofloxacin in the paediatric population.
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Affiliation(s)
- Fang-Fang Dai
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Feng-Qin Liu
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Xing Chen
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Juan Yang
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Ke Wang
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Chun-Yan Guo
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
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Mycoplasma pneumoniae: Atypical Pathogen in Community Acquired Pneumonia. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.4.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma pneumoniae is a one of most common reasons of respiratory tract infections in both adolescents and children with severity ranged from moderate to high. Many facts in the previous years regarding infections were induced via this organism having extra pathogenic mechanisms. Clinically, resistance to macrolide has produced internationally and represents a treatment trouble. Antimicrobial sensitivity checking out techniques have been applied, and novel antibiotics which are effective towards M. pneumoniae are present processing development. That evaluate concentrates on the several trends occurring in the previous quite a few years which beautify the grasp of that microorganism, which is one of the smallest pathogenic bacteria; however, is of extreme medical significance.
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Chernova OA, Chernov VM, Mouzykantov AA, Baranova NB, Edelstein IA, Aminov RI. Antimicrobial drug resistance mechanisms among Mollicutes. Int J Antimicrob Agents 2020; 57:106253. [PMID: 33264670 DOI: 10.1016/j.ijantimicag.2020.106253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 07/08/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
Representatives of the Mollicutes class are the smallest, wall-less bacteria capable of independent reproduction. They are widespread in nature, most are commensals, and some are pathogens of humans, animals and plants. They are also the main contaminants of cell cultures and vaccine preparations. Despite limited biosynthetic capabilities, they are highly adaptable and capable of surviving under various stress and extreme conditions, including antimicrobial selective pressure. This review describes current understanding of antibiotic resistance (ABR) mechanisms in Mollicutes. Protective mechanisms in these bacteria include point mutations, which may include non-target genes, and unique gene exchange mechanisms, contributing to transfer of ABR genes. Better understanding of the mechanisms of emergence and dissemination of ABR in Mollicutes is crucial to control these hypermutable bacteria and prevent the occurrence of highly ABR strains.
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Affiliation(s)
- Olga A Chernova
- Kazan Institute of Biochemistry and Biophysics, FRC Kazan Scientific Centre of RAS, Kazan, Russian Federation
| | - Vladislav M Chernov
- Kazan Institute of Biochemistry and Biophysics, FRC Kazan Scientific Centre of RAS, Kazan, Russian Federation
| | - Alexey A Mouzykantov
- Kazan Institute of Biochemistry and Biophysics, FRC Kazan Scientific Centre of RAS, Kazan, Russian Federation
| | - Natalya B Baranova
- Kazan Institute of Biochemistry and Biophysics, FRC Kazan Scientific Centre of RAS, Kazan, Russian Federation
| | - Inna A Edelstein
- Smolensk State Medical University, Ministry of Health of Russian Federation, Smolensk, Russian Federation
| | - Rustam I Aminov
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK; Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russian Federation.
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Tsai TA, Tsai CK, Kuo KC, Yu HR. Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:557-565. [PMID: 33268306 DOI: 10.1016/j.jmii.2020.10.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 01/14/2023]
Abstract
Mycoplasma pneumoniae is a common pathogen that causes community-acquired pneumonia. In the past, M. pneumoniae was sensitive to macrolide antibiotics, and M. pneumoniae pneumonia (MPP) was usually a benign and self-limiting disease. However, despite use of the appropriate antibiotics, persistent fever and clinical deterioration may occur, leading to severe disease. Two major complicated conditions that may be clinically encountered are macrolide-resistant MPP and refractory MPP. Regarding the epidemics in Taiwan, before 2017, the mean rate of macrolide resistance was below 30%. Notably, since 2018, the prevalence of macrolide-resistant MPP in Taiwan has increased rapidly. Macrolide-resistant MPP shows persistent fever and/or no radiological regression to macrolide antibiotics and may even progress to severe and complicated pneumonia. Tetracyclines (doxycycline or minocycline) or fluoroquinolones are alternative treatments for macrolide-resistant MPP. Refractory MPP is characterized by an excessive immune response against the pathogen. In this context, corticosteroids have been suggested as an immunomodulator for downregulating the overactive host immune reaction. Overuse of macrolides may contribute to macrolide resistance, and thereafter, an increase in macrolide-resistant MPP. Delayed effective antimicrobial treatment is associated with prolonged and/or more severe disease. Thus, the appropriate prescription of antibiotics, as well as the rapid and accurate diagnosis of MPP, is important. The exact starting point, dose, and duration of the immunomodulator are yet to be established. We discuss these important issues in this review.
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Affiliation(s)
- Ti-An Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chang-Ku Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuang-Che Kuo
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hong-Ren Yu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Yu J, Wang G, Davidson A, Chow I, Chiu A. Antibiotics Utilization for Community Acquired Pneumonia in a Community Hospital Emergency Department. J Pharm Pract 2020; 35:62-69. [PMID: 32912068 DOI: 10.1177/0897190020953032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A local health authority in Canada implemented its own Antimicrobial Stewardship Program (ASP) which provide guidelines to clinicians to utilize when treating infectious diseases such as community-acquired pneumonia (CAP). Objectives: The primary objective is to describe antibiotic usage patterns at the community hospital's emergency department (ED) and to analyze the patterns in relation to ASP goals of reducing risk of infections, adverse drug events and antibiotic resistance, and to identify potential areas of improvement. METHODS This retrospective chart review included 156 adult patients with a diagnosis of CAP admitted to a community hospital ED from December 1, 2015 to November 30, 2016. RESULTS 50.6% patients were prescribed moxifloxacin across all severity of CAP patients. Low and moderate severity CAP patients were most often prescribed antibiotic duration > 7 days. In low, moderate and high severity CAP patients who were treated using ceftriaxone, 100%, 88.9% and 66.6% patients were treated with ceftriaxone 2000 mg daily respectively. CONCLUSIONS Antibiotic prescribing patterns suggest fluoroquinolones were frequently being over-prescribed, ceftriaxone dosages were often too high, and duration of antibiotics for low and moderate severity CAP were too long. More efforts are needed to promote appropriate antibiotic usage and optimize patient care.
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Affiliation(s)
| | - Gillian Wang
- Peace Arch Hospital (PAH), White Rock, British Columbia, Canada
| | - Ann Davidson
- Peace Arch & Delta Hospitals, White Rock, British Columbia, Canada
| | - Ivy Chow
- Peace Arch Hospital, Antimicrobial Stewardship, White Rock, British Columbia, Canada
| | - Ada Chiu
- Peace Arch Hospital, Emergency Department, White Rock, British Columbia, Canada
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Liu Y, Zhang Y, Zhao W, Liu X, Hu F, Dong B. Pharmacotherapy of Lower Respiratory Tract Infections in Elderly-Focused on Antibiotics. Front Pharmacol 2019; 10:1237. [PMID: 31736751 PMCID: PMC6836807 DOI: 10.3389/fphar.2019.01237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023] Open
Abstract
Lower respiratory tract infections (LRTIs) refer to the inflammation of the trachea, bronchi, bronchioles, and lung tissue. Old people have an increased risk of developing LRTIs compared to young adults. The prevalence of LRTIs in the elderly population is not only related to underlying diseases and aging itself, but also to a variety of clinical issues, such as history of hospitalization, previous antibacterial therapy, mechanical ventilation, antibiotic resistance. These factors mentioned above have led to an increase in the prevalence and mortality of LRTIs in the elderly, and new medical strategies targeting LRTIs in this population are urgently needed. After a systematic review of the current randomized controlled trials and related studies, we recommend novel pharmacotherapies that demonstrate advantages for the management of LRTIs in people over the age of 65. We also briefly reviewed current medications for respiratory communicable diseases in the elderly. Various sources of information were used to ensure all relevant studies were included. We searched Pubmed, MEDLINE (OvidSP), EMBASE (OvidSP), and ClinicalTrials.gov. Strengths and limitations of these drugs were evaluated based on whether they have novelty of mechanism, favorable pharmacokinetic/pharmacodynamic profiles, avoidance of interactions and intolerance, simplicity of dosing, and their ability to cope with challenges which was mainly evaluated by the primary and secondary endpoints. The purpose of this review is to recommend the most promising antibiotics for treatment of LRTIs in the elderly (both in hospital and in the outpatient setting) based on the existing results of clinical studies with the novel antibiotics, and to briefly review current medications for respiratory communicable diseases in the elderly, aiming to a better management of LRTIs in clinical practice.
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Affiliation(s)
- Yang Liu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Yan Zhang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Wanyu Zhao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Xiaolei Liu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Fengjuan Hu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
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Li Q, Li ZY, Zhang J, Guo WN, Xu XM, Sun FX, Xu H. Xiyanping Plus Azithromycin Chemotherapy in Pediatric Patients with Mycoplasma pneumoniae Pneumonia: A Systematic Review and Meta-Analysis of Efficacy and Safety. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:2346583. [PMID: 31558910 PMCID: PMC6735175 DOI: 10.1155/2019/2346583] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Xiyanping injection (XYP) is a well-known Chinese medicinal preparation reputed as a most effective alternative to antibiotics. XYP has been widely used in combination therapies to treat various infectious diseases, among which XYP plus azithromycin (AZM) chemotherapy is often used for the treatment of Mycoplasma pneumoniae pneumonia in pediatric patients (p-MPP) in China. OBJECTIVE The present study just aimed to confirm whether XYP can improve the clinical efficacy and safety of AZM chemotherapy for p-MPP by performing meta-analysis and systematic review. METHODS A meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The randomized controlled trials (RCTs) concerning XYP plus AZM chemotherapy for p-MPP were selected, for which the main outcomes included overall response rate (ORR), antipyretic time, cough disappearance time, lung wet Rales disappearance time, hospitalization duration, and adverse drug reactions (ADRs). Based on the data extracted, the meta-analysis was conducted by using a standard data extraction form. RESULTS Nine RCTs involving 963 patients were included for meta-analysis. More concretely, the combination therapy showed the risk ratio (RR) and 95% confidence intervals (CI) of ORR and ADRs as (RR, 1.21 [95% CI, 1.15, 1.28]) and (RR, 0.37 [95% CI, 0.27, 0.51]), respectively. And other major outcomes were as follows: hospitalization durations (standard mean difference (SMD), -1.32 [95% CI, -1.48, -1.16]), antipyretic time (SMD, -1.26 [95% CI, -1.70, -0.83]), cough disappearance time (SMD, -1.07 [95% CI, -1.38, -0.75]), and the disappearance time of lung wet Rales (SMD, -0.83 [95% CI, -1.07, -0.60]). With statistically significant differences in various aspects, the combination therapy plus XYP displayed obvious advantages in contrast to AZM alone. CONCLUSION Overall, XYP might reduce the incidence of ADRs and significantly improve the clinical efficacy for p-MPP receiving AZM chemotherapy.
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Affiliation(s)
- Qiao Li
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Zhi-Yong Li
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Jie Zhang
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Wen-Na Guo
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Xiao-Meng Xu
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Fa-Xin Sun
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
| | - Hui Xu
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China
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Xu Z, Wang Z, Luan Y, Li Y, Liu X, Peng X, Octavia S, Payne M, Lan R. Genomic epidemiology of erythromycin-resistant Bordetella pertussis in China. Emerg Microbes Infect 2019; 8:461-470. [PMID: 30898080 PMCID: PMC6455148 DOI: 10.1080/22221751.2019.1587315] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Macrolides such as erythromycin are the empirical treatment of Bordetella pertussis infections. China has experienced an increase in erythromycin-resistant B. pertussis isolates since they were first reported in 2013. Here, we undertook a genomic study on Chinese B. pertussis isolates from 2012 to 2015 to elucidate the origins and phylogenetic relationships of erythromycin-resistant B. pertussis isolates in China. A total of 167 Chinese B. pertussis isolates were used for antibiotic sensitivity testing and multiple locus variable-number tandem repeat (VNTR) analysis (MLVA). All except four isolates were erythromycin-resistant and of the four erythromycin-sensitive isolates, three were non-ptxP1. MLVA types (MT), MT55, MT104 and MT195 were the predominant types. Fifty of those isolates were used for whole genome sequencing and phylogenetic analysis. Genome sequencing and phylogenetic analysis revealed three independent erythromycin-resistant lineages and all resistant isolates carried a mutation in the 23S rRNA gene. A novel fhaB3 allele was found uniquely in Chinese ptxP1 isolates and these Chinese ptxP1-ptxA1-fhaB3 had a 5-fold higher mutation rate than the global ptxP1-ptxA1 B. pertussis population. Our results suggest that the evolution of Chinese B. pertussis is likely to be driven by selection pressure from both vaccination and antibiotics. The emergence of the new non-vaccine fhaB3 allele in Chinese B. pertussis population may be a result of selection from vaccination, whereas the expansion of ptxP1-fhaB3 lineages was most likely to be the result of selection pressure from antibiotics. Further monitoring of B. pertussis in China is required to better understand the evolution of the pathogen.
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Affiliation(s)
- Zheng Xu
- a School of Biotechnology and Biomolecular Sciences , University of New South Wales , Sydney , Australia
| | - Zengguo Wang
- b Xi'an Center for Disease Prevention and Control , Xi'an , People's Republic of China.,c Department of Infectious Diseases , Xi'an Children's Hospital , Xi'an , People's Republic of China
| | - Yang Luan
- b Xi'an Center for Disease Prevention and Control , Xi'an , People's Republic of China
| | - Yarong Li
- c Department of Infectious Diseases , Xi'an Children's Hospital , Xi'an , People's Republic of China
| | - Xiaoguai Liu
- c Department of Infectious Diseases , Xi'an Children's Hospital , Xi'an , People's Republic of China
| | - Xiaokang Peng
- c Department of Infectious Diseases , Xi'an Children's Hospital , Xi'an , People's Republic of China
| | - Sophie Octavia
- a School of Biotechnology and Biomolecular Sciences , University of New South Wales , Sydney , Australia
| | - Michael Payne
- a School of Biotechnology and Biomolecular Sciences , University of New South Wales , Sydney , Australia
| | - Ruiting Lan
- a School of Biotechnology and Biomolecular Sciences , University of New South Wales , Sydney , Australia
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Vilela Rodrigues TC, Jaiswal AK, de Sarom A, de Castro Oliveira L, Freire Oliveira CJ, Ghosh P, Tiwari S, Miranda FM, de Jesus Benevides L, Ariston de Carvalho Azevedo V, de Castro Soares S. Reverse vaccinology and subtractive genomics reveal new therapeutic targets against Mycoplasma pneumoniae: a causative agent of pneumonia. ROYAL SOCIETY OPEN SCIENCE 2019; 6:190907. [PMID: 31417766 PMCID: PMC6689572 DOI: 10.1098/rsos.190907] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/04/2019] [Indexed: 05/03/2023]
Abstract
Pneumonia is an infectious disease caused by bacteria, viruses or fungi that results in millions of deaths globally. Despite the existence of prophylactic methods against some of the major pathogens of the disease, there is no efficient prophylaxis against atypical agents such as Mycoplasma pneumoniae, a bacterium associated with cases of community-acquired pneumonia. Because of the morphological peculiarity of M. pneumoniae, which leads to an increased resistance to antibiotics, studies that prospectively investigate the development of vaccines and drug targets appear to be one of the best ways forward. Hence, in this paper, bioinformatics tools were used for vaccine and pharmacological prediction. We conducted comparative genomic analysis on the genomes of 88 M. pneumoniae strains, as opposed to a reverse vaccinology analysis, in relation to the capacity of M. pneumoniae proteins to bind to the major histocompatibility complex, revealing seven targets with immunogenic potential. Predictive cytoplasmic proteins were tested as potential drug targets by studying their structures in relation to other proteins, metabolic pathways and molecular anchorage, which identified five possible drug targets. These findings are a valuable addition to the development of vaccines and the selection of new in vivo drug targets that may contribute to further elucidating the molecular basis of M. pneumoniae-host interactions.
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Affiliation(s)
| | - Arun Kumar Jaiswal
- Department of Microbiology, Immunology and Parasitology, Federal University of Triângulo Mineiro, Minas Gerais, Brazil
- Department of Genetics, Ecology and Evolution, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Alissa de Sarom
- Department of Microbiology, Immunology and Parasitology, Federal University of Triângulo Mineiro, Minas Gerais, Brazil
| | - Letícia de Castro Oliveira
- Department of Microbiology, Immunology and Parasitology, Federal University of Triângulo Mineiro, Minas Gerais, Brazil
- Department of Genetics, Ecology and Evolution, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Carlo José Freire Oliveira
- Department of Microbiology, Immunology and Parasitology, Federal University of Triângulo Mineiro, Minas Gerais, Brazil
| | - Preetam Ghosh
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Sandeep Tiwari
- Department of Genetics, Ecology and Evolution, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Fábio Malcher Miranda
- Department of Genetics, Ecology and Evolution, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Leandro de Jesus Benevides
- Bioinformatics Laboratory - LABINFO, National Laboratory of Scientific Computation - LNCC/MCTI, Rio de Janeiro, Brazil
| | | | - Siomar de Castro Soares
- Department of Microbiology, Immunology and Parasitology, Federal University of Triângulo Mineiro, Minas Gerais, Brazil
- Author for correspondence: Siomar de Castro Soares e-mail:
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First Description of Macrolide-Resistant Mycoplasma pneumoniae in Adults with Community-Acquired Pneumonia in Italy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7168949. [PMID: 31008110 PMCID: PMC6441498 DOI: 10.1155/2019/7168949] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/03/2019] [Indexed: 12/28/2022]
Abstract
Background Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP). This cross-sectional study aimed to determine the prevalence of macrolide-resistant M. pneumoniae strains in a convenience series of 234 adult hospitalised and nonhospitalised subjects with a diagnosis of CAP in January 2013 to April 2015 in South Italy. Methods Respiratory samples were subjected to real-time PCR. In M. pneumoniae-positive samples, domain V of 23S rRNA was sequenced to detect resistance-conferring point mutations. P1 major adhesion protein typing and multiple loci variable-number tandem repeat analysis (MLVA) were also performed. Results Of the 234 samples, 15 (6.4%) were positive for M. pneumoniae. Three of these had a macrolide-resistant genotype: two and one had A2063G and A2064G mutations, respectively. Fourteen of the 15 strains were subtyped: half had subtype 1 and half had subtype 2. Eight strains underwent MLVA profiling: one each had the J, A, and Z type. The remainder was unclassifiable. Conclusions This novel discovery of macrolide-resistant M. pneumoniae strains in adults with CAP in Italy suggests that there may be increasing circulation of these strains in the population. To facilitate rapid optimization of the antibiotic strategy in Italy, macrolide resistance should be monitored by a surveillance system that is based on molecular methods.
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Feldman C, Shaddock E. Epidemiology of lower respiratory tract infections in adults. Expert Rev Respir Med 2018; 13:63-77. [DOI: 10.1080/17476348.2019.1555040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica Shaddock
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gupta S, Lodha R, Kabra SK. Antimicrobial Therapy in Community-Acquired Pneumonia in Children. Curr Infect Dis Rep 2018; 20:47. [PMID: 30238375 DOI: 10.1007/s11908-018-0653-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Empirical antibiotic therapy remains the cornerstone of treatment in community-acquired pneumonia (CAP). However, the best option for empirical antibiotics for treatment on an ambulatory basis, as well as in those requiring hospitalization, is still unclear. This review tries to answer the question regarding the most appropriate antibiotics in different settings in children with CAP as well as duration of therapy. RECENT FINDINGS Recent studies have provided insights regarding use of oral antibiotics in children with mild to moderate CAP, and severe CAP with lower chest retractions but no hypoxia. In view of rapidly emerging resistance among various causative pathogens, several new drugs have been currently approved, or are under trial for CAP in children. Current knowledge suggests that the choice of antibiotics for ambulatory treatment of CAP is oral amoxicillin with a duration of 3-5 days. Children with CAP with lower chest retractions but no hypoxia can be treated with oral amoxicillin. Severe pneumonia can be treated with intravenous antibiotics consisting of penicillin/ampicillin with or without an aminoglycoside. Several new drugs have been developed and approved for use in CAP caused by multidrug-resistant organisms, but these should be used judiciously to avoid emergence of further resistance. Future research is needed regarding the safety and efficacy of newer drugs in children.
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Affiliation(s)
- Samriti Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Ameliorative Effects of Infantile Feire Kechuan Oral Solution on Mycoplasma Pneumoniae Pneumonia in Infant Mouse and Rat Models. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:8139040. [PMID: 30305831 PMCID: PMC6166364 DOI: 10.1155/2018/8139040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/08/2018] [Accepted: 08/16/2018] [Indexed: 11/17/2022]
Abstract
Mycoplasma pneumoniae (MP) infection is a major pathogen of community-acquired pneumonia (CAP) in children worldwide. Infantile Feire Kechuan Oral Solution (IFKOS) has been used for the treatment of MP pneumonia clinically in China for many years. The present study was designed to investigate the therapeutic effect of IFKOS on MP pneumonia and explore the potential mechanism of the actions. The infant BALB/c mouse and Wistar rat models of MP infection were successfully established to confirm the therapeutic effects of IFKOS, followed by assays for related cytokines and investigations of the IgM response involved. The results showed that IFKOS exhibited an inhibitory effect on pulmonary index (PI) and effectively reduced the degree of lesions in the lungs. The lethal rate of mice was significantly decreased while survival time of mice was dramatically increased by IFKOS treatment in comparison to infection control, respectively. IFKOS treatment (40, 20, and 10ml/kg) significantly decreased the level of MP-IgM in a dose-dependent manner, whereas IFKOS showed no obvious inhibitory effect on the increase of relative expression of MP-DNA. In addition, the elevated IL-2 and TNF-α levels were significantly reduced and the decreased IL-6 level was significantly enhanced by IFKOS treatment. Our study demonstrates that IFKOS has inhibitory effect on MP infection in infant mouse and rat models of MP pneumonia and protective effect from lethal MP challenge in infant murine model. These anti-MP effects might be related to suppression of the IgM response and a reversal the imbalance of Th1/Th2 cytokines induced by MP infection.
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Zhou L, Wang W, Peng X, Li B, Li J, Liu J, Yang L. Clinical features of Mycoplasma pneumoniae infection in respiratory tract in children in middle south of China. EUR J INFLAMM 2018. [DOI: 10.1177/2058739218772246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mycoplasma pneumoniae (MP) is the smallest microorganisms which can survive independently in the world. It is a pathogen between the bacteria and the virus, mainly violates the respiratory system. Nasopharyngeal aspirates were collected from children with respiratory infection from April 2013 to November 2016 in a hospital in Jiangxi, China. A total of 4350 children were enrolled and nine viruses and eight bacteria, including MP, were tested by polymerase chain reaction (PCR) and culture. The total positivity rate of any viruses and bacteria was 73.6%; bacteria-positive detection rate was 34.5%; virus-positive detection rate was 49.1%; and mixed-positive detection rate was 45.4%. A total of 596 cases were identified as MP-positive, among which 274 cases were MP-positive only. MP was detected throughout the year and across all age groups. When compared with those of the respiratory syncytial virus (RSV)-positive only group, the MP-positive only group was consisted of older children and presented a higher percentage of fever, a longer duration of fever, and a lower percentage of wheezing. High load of MP-positive only group was detected mainly in preschool and school-aged children. Longer fever duration and severe cough symptoms were observed in the high load of MP-positive only group with high levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), and D-dimer. The MP-positive only group with high load could be an etiological agent of severe respiratory tract infections.
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Affiliation(s)
- Lili Zhou
- Department of Respiratory Medicine, Women and Children’s Hospital, Ganzhou, China
| | - Wei Wang
- Health School of Ganzhou, Ganzhou, China
| | - Xuyun Peng
- Department of Respiratory Medicine, Women and Children’s Hospital, Ganzhou, China
| | - Bingfei Li
- Department of Respiratory Medicine, Women and Children’s Hospital, Ganzhou, China
| | - Jing Li
- Department of Respiratory Medicine, Women and Children’s Hospital, Ganzhou, China
| | - Jianping Liu
- Department of Respiratory Medicine, Women and Children’s Hospital, Ganzhou, China
| | - Lin Yang
- Department of Respiratory Medicine, Women and Children’s Hospital, Ganzhou, China
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Lee H, Yun KW, Lee HJ, Choi EH. Antimicrobial therapy of macrolide-resistantMycoplasma pneumoniaepneumonia in children. Expert Rev Anti Infect Ther 2017; 16:23-34. [DOI: 10.1080/14787210.2018.1414599] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea
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Athlin S, Lidman C, Lundqvist A, Naucler P, Nilsson AC, Spindler C, Strålin K, Hedlund J. Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017. Infect Dis (Lond) 2017; 50:247-272. [PMID: 29119848 DOI: 10.1080/23744235.2017.1399316] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.
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Affiliation(s)
- Simon Athlin
- a Department of Infectious Diseases , Örebro University Hospital , Örebro , Sweden.,b Faculty of Medicin and Health , Örebro University , Örebro , Sweden
| | - Christer Lidman
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anders Lundqvist
- e Department of Infectious Diseases , Södra Älvsborgs Hospital , Borås , Sweden
| | - Pontus Naucler
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anna C Nilsson
- f Infectious Disease Research Unit, Department of Translational Medicine , Lund University , Malmö , Sweden
| | - Carl Spindler
- d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Kristoffer Strålin
- b Faculty of Medicin and Health , Örebro University , Örebro , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,g Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Jonas Hedlund
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
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Synthesis and antibacterial activity of novel lincomycin derivatives. IV. Optimization of an N-6 substituent. J Antibiot (Tokyo) 2017; 70:1112-1121. [PMID: 29115289 DOI: 10.1038/ja.2017.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/07/2017] [Accepted: 10/07/2017] [Indexed: 11/08/2022]
Abstract
The design and synthesis of lincomycin derivatives modified at the C-6 and C-7 positions are described. A substituent at the C-7 position is a 5-aryl-1,3,4-thiadiazol-2-yl-thio group that generates antibacterial activities against macrolide-resistant Streptococcus pneumoniae and Streptococcus pyogenes carrying an erm gene. An additional modification at the C-6 position was explored in application of information regarding pirlimycin and other related compounds. These dual modifications were accomplished by using methyl α-thiolincosaminide as a starting material. As a result of these dual modifications, the antibacterial activities were improved compared with those of compounds with a single modification at the C-7 position. The antibacterial activities of selected compounds in this report against macrolide-resistant S. pneumoniae and S. pyogenes with an erm gene were superior to those of telithromycin.
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Yin YD, Wang R, Zhuo C, Wang H, Wang MG, Xie CM, She DY, Yuan X, Wang RT, Cao B, Liu YN. Macrolide-resistant Mycoplasma pneumoniae prevalence and clinical aspects in adult patients with community-acquired pneumonia in China: a prospective multicenter surveillance study. J Thorac Dis 2017; 9:3774-3781. [PMID: 29268385 DOI: 10.21037/jtd.2017.09.75] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Drug resistant Mycoplasma pneumoniae (MP) is a rising issue in the management of community-acquired pneumonia (CAP). Epidemiological monitoring is essential for identifying resistant patterns of MP isolates against various antibiotics in adult CAP patients. Methods This is a prospectively designed multicenter study conducted on adult patients with CAP visiting six teaching hospitals in the cities of Beijing, Shanghai and Guangzhou between September 2010 and June 2012. Results A total of 520 adult patients (mean age: 45.7±26.2 years) with CAP visiting teaching hospitals in the cities of Beijing, Shanghai and Guangzhou were included. Of the 520 patients, only 75 (14.42%) were confirmed MP positive by means of culture and real-time PCR methods. Quinolones were the most common initially prescribed antimicrobial, followed by β-lactams and β-lactams plus quinolones. Macrolide resistance was as high as 80% and 72% against erythromycin (ERY) and azithromycin (AZM) respectively, which were associated with the A2063G transition mutation in domain V of the 23S ribosomal RNA (rRNA) gene. Six strains with mild to moderate ERY-resistant level were still susceptible to AZM. Tetracycline (TET), minocycline (MIN) and quinolones [moxifloxacin (MOX) and fluoroquinolones] had no signs of resistance. Conclusions High resistance was observed with macrolides, whereas, none of the MP strains were resistant to fluoroquinolones and TET. Hence, macrolide resistant MP (MRMP)_infections could be well treated with fluoroquinolones. However, few isolated strains had minimal inhibitory concentration (MIC) values on the edge of resistance to quinolones, alarming a quinolone-resistant MP in the near future.
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Affiliation(s)
- Yu-Dong Yin
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Rui Wang
- Department of Clinical Pharmacology, PLA General Hospital, Beijing 100853, China
| | - Chao Zhuo
- State Key Laboratory of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510000, China
| | - Hui Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Ming-Gui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Can-Mao Xie
- Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-sen University, Guangzhou 510080, China
| | - Dan-Yang She
- Department of Respiratory Diseases, PLA General Hospital, Beijing 100853, China
| | - Xin Yuan
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of the Academy of Military Medical Science, Beijing 100071, China
| | - Ren-Tao Wang
- Department of Respiratory Diseases, PLA General Hospital, Beijing 100853, China
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - You-Ning Liu
- Department of Respiratory Diseases, PLA General Hospital, Beijing 100853, China
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