1
|
Dagan A, Epstein D, Neuberger A, Isenberg J. Amikacin treatment in urinary tract infection patients: evaluating the risk of acute kidney injury - a retrospective cohort study. J Chemother 2024:1-5. [PMID: 38372170 DOI: 10.1080/1120009x.2024.2319454] [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: 01/14/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
The rise in ESBL-producing and carbapenem-resistant Gram-negative bacterial infections is alarming. Aminoglycosides remain attractive for treating urinary tract infections (UTIs). However, aminoglycosides-associated acute kidney injury (AKI) raises concerns, especially in patients with underlying renal impairment. We conducted a retrospective cohort study to evaluate the risk of AKI in patients with UTI empirically treated with amikacin. Among 395 patients (median age 41.9 years [IQR 28.3-67.1], 342 [86.6%] female), 162 (41.0%) received amikacin and 233 (59.0%) were empirically treated with other antibiotics. AKI incidence was low (5.6%) and not associated with amikacin exposure (OR 0.56, 95% CI 0.22-1.43, p = 0.23), even in those with pre-existing renal impairment or AKI on admission. The clinical outcomes (including cure by the third day, AKI, maximal creatinine, length of stay, mortality, and readmission) did not differ between the groups. Once-daily amikacin may offer a safe UTI treatment option amid increasing multi-drug resistance.
Collapse
Affiliation(s)
- Avner Dagan
- Department of Internal Medicine "H", Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ami Neuberger
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Department of Internal Medicine "D", Rambam Health Care Campus, Haifa, Israel
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Jonathan Isenberg
- Hemato-oncology Department, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
2
|
Chekli Y, Stevick RJ, Kornobis E, Briolat V, Ghigo JM, Beloin C. Escherichia coli Aggregates Mediated by Native or Synthetic Adhesins Exhibit Both Core and Adhesin-Specific Transcriptional Responses. Microbiol Spectr 2023; 11:e0069023. [PMID: 37039668 PMCID: PMC10269875 DOI: 10.1128/spectrum.00690-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 04/12/2023] Open
Abstract
Bacteria can rapidly tune their physiology and metabolism to adapt to environmental fluctuations. In particular, they can adapt their lifestyle to the close proximity of other bacteria or the presence of different surfaces. However, whether these interactions trigger transcriptomic responses is poorly understood. We used a specific setup of E. coli strains expressing native or synthetic adhesins mediating bacterial aggregation to study the transcriptomic changes of aggregated compared to nonaggregated bacteria. Our results show that, following aggregation, bacteria exhibit a core response independent of the adhesin type, with differential expression of 56.9% of the coding genome, including genes involved in stress response and anaerobic lifestyle. Moreover, when aggregates were formed via a naturally expressed E. coli adhesin (antigen 43), the transcriptomic response of the bacteria was more exaggerated than that of aggregates formed via a synthetic adhesin. This suggests that the response to aggregation induced by native E. coli adhesins could have been finely tuned during bacterial evolution. Our study therefore provides insights into the effect of self-interaction in bacteria and allows a better understanding of why bacterial aggregates exhibit increased stress tolerance. IMPORTANCE The formation of bacterial aggregates has an important role in both clinical and ecological contexts. Although these structures have been previously shown to be more resistant to stressful conditions, the genetic basis of this stress tolerance associated with the aggregate lifestyle is poorly understood. Surface sensing mediated by different adhesins can result in various changes in bacterial physiology. However, whether adhesin-adhesin interactions, as well as the type of adhesin mediating aggregation, affect bacterial cell physiology is unknown. By sequencing the transcriptomes of aggregated and nonaggregated cells expressing native or synthetic adhesins, we characterized the effects of aggregation and adhesin type on E. coli physiology.
Collapse
Affiliation(s)
- Yankel Chekli
- Institut Pasteur, Université Paris Cité, CNRS UMR 6047, Genetics of Biofilms Laboratory, Paris, France
| | - Rebecca J. Stevick
- Institut Pasteur, Université Paris Cité, CNRS UMR 6047, Genetics of Biofilms Laboratory, Paris, France
| | - Etienne Kornobis
- Hub de Bioinformatique et Biostatistique-Département Biologie Computationnelle, Institut Pasteur, USR 3756 CNRS, Paris, France
- Plate-forme Technologique Biomics—Centre de Ressources et Recherches Technologiques, Institut Pasteur, Paris, France
| | - Valérie Briolat
- Hub de Bioinformatique et Biostatistique-Département Biologie Computationnelle, Institut Pasteur, USR 3756 CNRS, Paris, France
- Plate-forme Technologique Biomics—Centre de Ressources et Recherches Technologiques, Institut Pasteur, Paris, France
| | - Jean-Marc Ghigo
- Institut Pasteur, Université Paris Cité, CNRS UMR 6047, Genetics of Biofilms Laboratory, Paris, France
| | - Christophe Beloin
- Institut Pasteur, Université Paris Cité, CNRS UMR 6047, Genetics of Biofilms Laboratory, Paris, France
| |
Collapse
|
3
|
Telles JP, Diegues MS, Migotto KC, de Souza Borges O, Reghini R, Gavazza BV, Pinto L, Caruso P, E Silva ILF, Schmidt S, de Lima Moreira F. Failure to predict amikacin elimination in critically ill patients with cancer based on the estimated glomerular filtration rate: applying PBPK approach in a therapeutic drug monitoring study. Eur J Clin Pharmacol 2023:10.1007/s00228-023-03516-1. [PMID: 37256410 DOI: 10.1007/s00228-023-03516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE The aim of this work was to integrate the Therapeutic Drug Monitoring (TDM) with the model-informed precision dosing (MIPD) approach, using Physiologically-based Pharmacokinetic/Pharmacodynamic (PBPK/PD) modelling and simulation, to explore the relationship between amikacin exposure and estimated glomerular filtration rate (GFR) in critically ill patients with cancer. METHODS In the TDM study, samples from 51 critically-ill patients with cancer treated with amikacin were analysed. Patients were stratified according to renal function based on GFR status. A full-body PBPK model with 12 organs model was developed using Simcyp V. 21, including steady-state volume of distribution of 0.21 L/kg and renal clearance of 6.9 L/h in healthy adults. PK parameters evaluated were within the 2-fold error range. RESULTS During the validation step, predicted vs observed amikacin clearance values after single infusion dose in patients with normal renal function, mild and moderate renal impairment were 7.6 vs 8.1 L/h (7.5 mg/kg dose); 3.8 vs 4.5 L/h (1500 mg dose) and 2.2 vs 3.1 L/h (25 mg/kg dose), respectively. However, predicted vs observed amikacin clearance after a single dose infusion of 1400 mg in critically-ill patients with cancer were 1.46 vs 1.63 (P = 0.6406) L/h (severe), 2.83 vs 1.08 (P < 0.05) L/h (moderate), 4.23 vs 2.49 (P = 0.0625) L/h (mild) and 7.41 vs 3.36 (P < 0.05) L/h (normal renal function). CONCLUSION This study demonstrated that estimated GFR did not predict amikacin elimination in critically-ill patients with cancer. Further studies are necessary to find amikacin PK covariates to optimize the pharmacotherapy in this population. Therefore, TDM of amikacin is imperative in cancer patients.
Collapse
Affiliation(s)
- João Paulo Telles
- Department of Infectious Diseases, AC Camargo Cancer Center, Professor Antonio Prudente Street, N. 211, São Paulo-SP, 01509-001, Brazil.
| | | | | | | | - Rodrigo Reghini
- Department of Infectious Diseases, AC Camargo Cancer Center, Professor Antonio Prudente Street, N. 211, São Paulo-SP, 01509-001, Brazil
| | - Brenda Vianna Gavazza
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Leonardo Pinto
- Laboratory of Immunopathology, Nucleus of Biological Sciences Research, Federal University of Ouro Preto, Ouro Preto-MG, Brazil
| | - Pedro Caruso
- Department of Intensive Care Unit, AC Camargo Cancer Center, São Paulo-SP, Brazil
| | - Ivan Leonardo França E Silva
- Department of Infectious Diseases, AC Camargo Cancer Center, Professor Antonio Prudente Street, N. 211, São Paulo-SP, 01509-001, Brazil
| | - Stephan Schmidt
- Department of Pharmaceutics Lake Nona, University of Florida, Orlando-FL, USA
| | | |
Collapse
|
4
|
Usui M, Yoshii Y, Thiriet-Rupert S, Ghigo JM, Beloin C. Intermittent antibiotic treatment of bacterial biofilms favors the rapid evolution of resistance. Commun Biol 2023; 6:275. [PMID: 36928386 PMCID: PMC10020551 DOI: 10.1038/s42003-023-04601-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
Bacterial antibiotic resistance is a global health concern of increasing importance and intensive study. Although biofilms are a common source of infections in clinical settings, little is known about the development of antibiotic resistance within biofilms. Here, we use experimental evolution to compare selection of resistance mutations in planktonic and biofilm Escherichia coli populations exposed to clinically relevant cycles of lethal treatment with the aminoglycoside amikacin. Consistently, mutations in sbmA, encoding an inner membrane peptide transporter, and fusA, encoding the essential elongation factor G, are rapidly selected in biofilms, but not in planktonic cells. This is due to a combination of enhanced mutation rate, increased adhesion capacity and protective biofilm-associated tolerance. These results show that the biofilm environment favors rapid evolution of resistance and provide new insights into the dynamic evolution of antibiotic resistance in biofilms.
Collapse
Affiliation(s)
- Masaru Usui
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan.
- Institut Pasteur, Université de Paris Cité, UMR CNRS 6047, Genetics of Biofilms Laboratory, 75015, Paris, France.
| | - Yutaka Yoshii
- Institut Pasteur, Université de Paris Cité, UMR CNRS 6047, Genetics of Biofilms Laboratory, 75015, Paris, France
| | - Stanislas Thiriet-Rupert
- Institut Pasteur, Université de Paris Cité, UMR CNRS 6047, Genetics of Biofilms Laboratory, 75015, Paris, France
| | - Jean-Marc Ghigo
- Institut Pasteur, Université de Paris Cité, UMR CNRS 6047, Genetics of Biofilms Laboratory, 75015, Paris, France
| | - Christophe Beloin
- Institut Pasteur, Université de Paris Cité, UMR CNRS 6047, Genetics of Biofilms Laboratory, 75015, Paris, France.
| |
Collapse
|
5
|
de Carvalho FRT, Telles JP, Tuon FFB, Rabello Filho R, Caruso P, Correa TD. Antimicrobial Stewardship Programs: A Review of Strategies to Avoid Polymyxins and Carbapenems Misuse in Low Middle-Income Countries. Antibiotics (Basel) 2022; 11:antibiotics11030378. [PMID: 35326841 PMCID: PMC8944697 DOI: 10.3390/antibiotics11030378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 01/27/2023] Open
Abstract
Antibiotics misuse and overuse are concerning issues worldwide, especially in low middle-income countries. These practices contribute to the increasing rates of antimicrobial resistance. One efficient strategy to avoid them is antimicrobial stewardship programs. In this review, we focus on the possible approaches to spare the prescription of polymyxins and carbapenems for the treatment of Acinetobacter baumannii, carbapenem-resistant Enterobacterales, and Pseudomonas aeruginosas infections. Additionally, we highlight how to implement cumulative antibiograms and biomarkers to a sooner de-escalation of antibiotics.
Collapse
Affiliation(s)
- Fabrício Rodrigues Torres de Carvalho
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil;
- Correspondence: (F.R.T.d.C.); (J.P.T.)
| | - João Paulo Telles
- Department of Infectious Diseases, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil
- School of Medicine, Pontifical Catholic University, Curitiba 80215-901, PR, Brazil;
- Department of Infectious Diseases, Hospital Universitario Evangelico Mackenzie, Curitiba 80730-420, PR, Brazil
- Correspondence: (F.R.T.d.C.); (J.P.T.)
| | | | - Roberto Rabello Filho
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
| | - Pedro Caruso
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil;
| | - Thiago Domingos Correa
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
| |
Collapse
|
6
|
Tuon FF, Dantas LR, Suss PH, Tasca Ribeiro VS. Pathogenesis of the Pseudomonas aeruginosa Biofilm: A Review. Pathogens 2022; 11:pathogens11030300. [PMID: 35335624 PMCID: PMC8950561 DOI: 10.3390/pathogens11030300] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/08/2022] [Accepted: 02/24/2022] [Indexed: 01/21/2023] Open
Abstract
Pseudomonas aeruginosa is associated with several human infections, mainly related to healthcare services. In the hospital, it is associated with resistance to several antibiotics, which poses a great challenge to therapy. However, one of the biggest challenges in treating P. aeruginosa infections is that related to biofilms. The complex structure of the P. aeruginosa biofilm contributes an additional factor to the pathogenicity of this microorganism, leading to therapeutic failure, in addition to escape from the immune system, and generating chronic infections that are difficult to eradicate. In this review, we address several molecular aspects of the pathogenicity of P. aeruginosa biofilms.
Collapse
|
7
|
Laupland KB, Ramanan M, Shekar K, Kirrane M, Clement P, Young P, Edwards F, Bushell R, Tabah A. Is intensive care unit mortality a valid survival outcome measure related to critical illness? Anaesth Crit Care Pain Med 2021; 41:100996. [PMID: 34902631 DOI: 10.1016/j.accpm.2021.100996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE Use of death as an outcome of intensive care unit (ICU) admission may be biased by differential discharge decisions. OBJECTIVE To determine the validity of ICU survival status as an outcome measure of all cause case-fatality. METHODS A retrospective cohort of first admissions among adults to four ICUs in North Brisbane, Australia was assembled. Death in ICU (censored at discharge or 30 days) was compared with 30-day overall case-fatality. RESULTS The 30-day overall case-fatality was 8.1% (2436/29,939). One thousand six hundred and thirty-one deaths occurred within the ICU stay and 576 subsequent during hospital post-ICU discharge within 30-days; ICU and hospital case-fatality rates were 5.4% and 7.4%, respectively. An additional 229 patients died after hospital separation within 30 days of ICU admission of which 110 (48.0%) were transferred to another acute care hospital, 80 (34.9%) discharged home, and 39 (17.0%) transferred to an aged care/chronic care/rehabilitation facility. Patients who died after ICU discharge were older, had higher APACHE III scores, were more likely to be elective surgical patients, and were less likely to be out of state residents or managed in a tertiary referral hospital. Limiting determination of case-fatality to ICU information alone would correctly detect 95% (780/821) of all-cause mortality at day 3, 90% (1093/1213) at day 5, 75% (1524/2019) at day 15, 72% (1592/2244) at day 21, and 67% (1631/2436) at day 30 of follow-up. CONCLUSIONS Use of ICU case-fatality significantly underestimates the true burden and biases assessment of determinants of critical illness-related mortality in our region.
Collapse
Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Mahesh Ramanan
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Kiran Shekar
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Marianne Kirrane
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Pierre Clement
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Patrick Young
- Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Rachel Bushell
- Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Alexis Tabah
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| |
Collapse
|
8
|
Ito CAS, Bail L, Arend LNVS, Nogueira KDS, Tuon FF. The activity of ceftazidime/avibactam against carbapenem-resistant Pseudomonas aeruginosa. Infect Dis (Lond) 2021; 53:386-389. [PMID: 33423568 DOI: 10.1080/23744235.2020.1867763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Carmen Antonia Sanches Ito
- Division of Microbiology, Universidade Estadual de Ponta Grossa do Paraná, Paraná, Brazil; Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Larissa Bail
- Division of Microbiology, Universidade Estadual de Ponta Grossa do Paraná, Paraná, Brazil; Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Lavinia Nery Villa Stangler Arend
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Laboratório Central do Estado do Paraná - LACEN, Paraná, Brazil
| | - Keite da Silva Nogueira
- Hospital de Clínicas, Universidade Federal do Paraná, Paraná, Brazil; Basic Pathology Department, Universidade Federal do Paraná, Paraná, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| |
Collapse
|
9
|
Oliveros Rodríguez H, Buitrago G, Castellanos Saavedra P. Use of matching methods in observational studies with critical patients and renal outcomes. Scoping review. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The use of matching techniques in observational studies has been increasing and is not always used appropriately. Clinical experiments are not always feasible in critical patients with renal outcomes, and observational studies are an important alternative.
Objective: Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and assessing renal outcomes.
Methods: Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and 2020 up to week 10, which studied different exposures in the critically ill patient with renal outcomes and used propensity matching methods.
Results: Most publications are cohort studies 94 (94. 9 %), five studies (5. 1 %) were cross-sectional. The main pharmacological intervention was the use of antibiotics in seven studies (7. 1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10. 1%). The balance between the baseline characteristics assessed by standardized means, in only 28 studies (28. 2%). Most studies 95 (96 %) used logistic regression to calculate the propensity index.
Conclusion: Major inconsistencies were observed in the use of methods and in the reporting of findings. A summary is made of the aspects to be considered in the use of the methods and reporting of the findings with the matching by propensity index.
Collapse
|
10
|
Re: 'The renal safety of a single dose of gentamicin in patients with sepsis in the emergency department' - Author's reply. Clin Microbiol Infect 2020; 27:301-302. [PMID: 32827716 DOI: 10.1016/j.cmi.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/08/2020] [Indexed: 11/22/2022]
|