1
|
Sharma S, Syal A, Gupta M, Tahlan A, Kaur B. Reversible Myelosuppresion With Prolonged Usage of Linezolid in Treatment of Methicillin-Resistant Staphylococcus aureus. Cureus 2020; 12:e10890. [PMID: 33194459 PMCID: PMC7654556 DOI: 10.7759/cureus.10890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Bone marrow suppression has a wide variety of causes. One of the overlooked causes is linezolid, a drug that is now being extensively used in the management of not only soft tissue infections but also hospital-acquired infections. Methicillin-resistant Staphylococcus aureus (MRSA) is widely being treated with linezolid. It becomes imperative that we comprehensively understand the hematological adverse effect profile of this drug. A reversible myelosuppression is seen with its extended use, though a number of risk factors like renal impairment are usually present. A prompt diagnosis can help us to timely discontinue the drug. We report one such case of an elderly patient with septic arthritis of the knee who developed pancytopenia after 32 days of linezolid therapy. Withdrawal of the drug led to a complete recovery of the blood counts in 21 days.
Collapse
Affiliation(s)
- Sanjana Sharma
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Arshi Syal
- Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Anita Tahlan
- Pathology, Government Medical College and Hospital, Chandigarh, IND
| | - Baldeep Kaur
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND.,General Medicine, Government Medical College and Hospital, Chandigarh, IND
| |
Collapse
|
2
|
Antonoplis A, Zang X, Huttner MA, Chong KKL, Lee YB, Co JY, Amieva MR, Kline KA, Wender PA, Cegelski L. A Dual-Function Antibiotic-Transporter Conjugate Exhibits Superior Activity in Sterilizing MRSA Biofilms and Killing Persister Cells. J Am Chem Soc 2018; 140:16140-16151. [PMID: 30388366 PMCID: PMC6430714 DOI: 10.1021/jacs.8b08711] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
New strategies are urgently needed to target MRSA, a major global health problem and the leading cause of mortality from antibiotic-resistant infections in many countries. Here, we report a general approach to this problem exemplified by the design and synthesis of a vancomycin-d-octaarginine conjugate (V-r8) and investigation of its efficacy in addressing antibiotic-insensitive bacterial populations. V-r8 eradicated MRSA biofilm and persister cells in vitro, outperforming vancomycin by orders of magnitude. It also eliminated 97% of biofilm-associated MRSA in a murine wound infection model and displayed no acute dermal toxicity. This new dual-function conjugate displays enhanced cellular accumulation and membrane perturbation as compared to vancomycin. Based on its rapid and potent activity against biofilm and persister cells, V-r8 is a promising agent against clinical MRSA infections.
Collapse
Affiliation(s)
- Alexandra Antonoplis
- Department of Chemistry, Stanford University, Stanford, California 94305, United States
| | - Xiaoyu Zang
- Department of Chemistry, Stanford University, Stanford, California 94305, United States
| | - Melanie A. Huttner
- Department of Chemistry, Stanford University, Stanford, California 94305, United States
| | - Kelvin K. L. Chong
- Singapore Centre for Environmental Life Science Engineering (SCELSE), School of Biological Sciences, Nanyang Technological University, Singapore 637551
- Nanyang Technological University Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore 637553
| | - Yu B. Lee
- Singapore Centre for Environmental Life Science Engineering (SCELSE), School of Biological Sciences, Nanyang Technological University, Singapore 637551
| | - Julia Y. Co
- Department of Pediatrics, Division of Infectious Diseases, Stanford University, Stanford, California 94305, United States
| | - Manuel R. Amieva
- Department of Pediatrics, Division of Infectious Diseases, Stanford University, Stanford, California 94305, United States
- Department of Microbiology & Immunology, Stanford University, Stanford, California 94305, United States
| | - Kimberly A. Kline
- Singapore Centre for Environmental Life Science Engineering (SCELSE), School of Biological Sciences, Nanyang Technological University, Singapore 637551
| | - Paul A. Wender
- Department of Chemistry, Stanford University, Stanford, California 94305, United States
- Department of Chemical and Systems Biology, Stanford University, Stanford, California 94305, United States
| | - Lynette Cegelski
- Department of Chemistry, Stanford University, Stanford, California 94305, United States
| |
Collapse
|
3
|
Townsend J, Keller S, Tibuakuu M, Thakker S, Webster B, Siegel M, Psoter KJ, Mansour O, Perl TM. Outpatient Parenteral Therapy for Complicated Staphylococcus aureus Infections: A Snapshot of Processes and Outcomes in the Real World. Open Forum Infect Dis 2018; 5:ofy274. [PMID: 30488039 PMCID: PMC6251475 DOI: 10.1093/ofid/ofy274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/23/2018] [Indexed: 12/23/2022] Open
Abstract
Background In the United States, patients discharged on outpatient parenteral antimicrobial therapy (OPAT) are often treated by home health companies (HHCs) or skilled nursing facilities (SNFs). Little is known about differences in processes and outcomes between these sites of care. Methods We performed a retrospective study of 107 patients with complicated Staphylococcus aureus infections discharged on OPAT from 2 academic medical centers. Clinical characteristics, site of posthospital care, process measures (lab test monitoring, clinic follow-up), adverse events (adverse drug events, Clostridium difficile infection, line events), and clinical outcomes at 90 days (cure, relapse, hospital readmission) were collected. Comparisons between HHCs and SNFs were conducted. Results Overall, 33% of patients experienced an adverse event during OPAT, and 64% were readmitted at 90 days. Labs were received for 44% of patients in SNFs and 56% of patients in HHCs. At 90 days after discharge, a higher proportion of patients discharged to an SNF were lost to follow-up (17% vs 3%; P = .03) and had line-related adverse events (18% vs 2%; P < .01). Patients discharged to both sites of care experienced similar clinical outcomes, with favorable outcomes occurring in 61% of SNF patients and 70% of HHC patients at 90 days. There were no differences in rates of relapse, readmission, or mortality. Conclusions Patients discharged to SNFs may be at higher risk for line events than patients discharged to HHCs. Efforts should be made to strengthen basic OPAT processes, such as lab monitoring and clinic follow-up, at both sites of care.
Collapse
Affiliation(s)
- Jennifer Townsend
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara Keller
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin Tibuakuu
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Sameer Thakker
- Johns Hopkins University Medical School, Baltimore, Maryland
| | - Bailey Webster
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Maya Siegel
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin J Psoter
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Omar Mansour
- Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Trish M Perl
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
4
|
Abstract
Device-related infections with this pathogen frequently require prolonged parenteral therapy. Corynebacterium striatum is an emerging multidrug-resistant bacteria. We retrospectively identified 179 isolates in a clinical database. Clinical relevance, in vitro susceptibility, and length of parenteral antimicrobial drug use were obtained from patient records. For patients with hardware- or device-associated infections, those with C. striatum infections were matched with patients infected with coagulase-negative staphylococci for case–control analysis. A total of 87 (71%) of 121 isolates were resistant to all oral antimicrobial drugs tested, including penicillin, tetracycline, clindamycin, erythromycin, and ciprofloxacin. When isolated from hardware or devices, C. striatum was pathogenic in 38 (87%) of 44 cases. Patients with hardware-associated C. striatum infections received parenteral antimicrobial drugs longer than patients with hardware-associated coagulase-negative staphylococci infections (mean ± SD 69 ± 5 days vs. 25 ± 4 days; p<0.001). C. striatum commonly shows resistance to antimicrobial drugs with oral bioavailability and is associated with increased use of parenteral antimicrobial drugs.
Collapse
|
5
|
Thompson JM, Saini V, Ashbaugh AG, Miller RJ, Ordonez AA, Ortines RV, Wang Y, Sterling RS, Jain SK, Miller LS. Oral-Only Linezolid-Rifampin Is Highly Effective Compared with Other Antibiotics for Periprosthetic Joint Infection: Study of a Mouse Model. J Bone Joint Surg Am 2017; 99:656-665. [PMID: 28419033 PMCID: PMC6181281 DOI: 10.2106/jbjs.16.01002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The medical treatment of periprosthetic joint infection (PJI) involves prolonged systemic antibiotic courses, often with suboptimal clinical outcomes including increased morbidity and health-care costs. Oral and intravenous monotherapies and combination antibiotic regimens were evaluated in a mouse model of methicillin-resistant Staphylococcus aureus (MRSA) PJI. METHODS Oral linezolid with or without oral rifampin, intravenous vancomycin with oral rifampin, intravenous daptomycin or ceftaroline with or without oral rifampin, oral doxycycline, or sham treatment were administered at human-exposure doses for 6 weeks in a mouse model of PJI. Bacterial burden was assessed by in vivo bioluminescent imaging and ex vivo counting of colony-forming units (CFUs), and reactive bone changes were evaluated with radiographs and micro-computed tomography (μCT) imaging. RESULTS Oral-only linezolid-rifampin and all intravenous antibiotic-rifampin combinations resulted in no recoverable bacteria and minimized reactive bone changes. Although oral linezolid was the most effective monotherapy, all oral and intravenous antibiotic monotherapies failed to clear infection or prevent reactive bone changes. CONCLUSIONS Combination antibiotic-rifampin regimens, including oral-only linezolid-rifampin and the newer ceftaroline-rifampin combinations, were highly effective and more efficacious than monotherapies when used against a preclinical MRSA PJI. CLINICAL RELEVANCE This study provides important preclinical evidence to better optimize future antibiotic therapy against PJIs. In particular, the oral-only linezolid-rifampin option might reduce venous access complications and health-care costs.
Collapse
Affiliation(s)
- John M. Thompson
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vikram Saini
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alyssa G. Ashbaugh
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert J. Miller
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvaro A. Ordonez
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger V. Ortines
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yu Wang
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S. Sterling
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjay K. Jain
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lloyd S. Miller
- Department of Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.), Department of Pediatrics (V.S., A.A.O., and S.K.J.), Center for Infection and Inflammation Imaging Research (V.S., A.A.O., and S.K.J.), Department of Dermatology (A.G.A., R.J.M., R.V.O., Y.W., and L.S.M.), and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
6
|
Jensen IS, Lodise TP, Fan W, Wu C, Cyr PL, Nicolau DP, DuFour S, Sulham KA. Use of Oritavancin in Acute Bacterial Skin and Skin Structure Infections Patients Receiving Intravenous Antibiotics: A US Hospital Budget Impact Analysis. Clin Drug Investig 2016; 36:157-68. [PMID: 26692006 PMCID: PMC4740574 DOI: 10.1007/s40261-015-0365-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background and Objective Nearly 10 % of all US hospital admissions are attributed to acute bacterial skin and skin structure infections (ABSSSIs). While most antibacterials used to treat these infections require multi-day and multi-dose regimens, a single-dose treatment is now available. The objective of this analysis is to estimate the annual budget impact of using single-dose oritavancin in patients with moderate to severe ABSSSIs receiving intravenous methicillin-resistant Staphylococcus aureus (MRSA)-active antibacterials from a US hospital perspective. Methods A decision-analytic model based on current clinical practice was developed to estimate the economic impact of oritavancin. Utilization of antibacterials and rates of hospital admission were derived from the Premier Research Database. Demographic and clinical data were informed by the published literature and 2014 wholesale drug acquisition costs were used. Other costs were based on the published literature and Medicare National Limitation amounts. All costs were inflated to 2014 US dollars. Two base-case scenarios were considered: one for hospitals with ambulatory services and one for hospitals without ambulatory services. Results For a US hospital with ambulatory services with 1000 ABSSSI patients receiving intravenous MRSA antibiotics annually, use of oritavancin in 26 % of patients is estimated to reduce the total annual budget by 12.9 % (US$1.23 million), or approximately US$1234.67 per patient. Total inpatient costs will be reduced by 22.3 % (US$1.40 million) and outpatient costs will increase slightly by 1.7 % (US$55,310). Pharmaceutical cost increases are offset by savings in the inpatient setting from fewer hospital admissions. Hospitals without ambulatory services are estimated to receive overall cost savings of 9.3 % (US$0.63 million). Conclusion Use of single-dose oritavancin in select ABSSSI patients with suspected or confirmed MRSA involvement is estimated to save US hospitals approximately 9.3–12.9 % per year by reducing hospital admissions and lowering drug administration burden. Electronic supplementary material The online version of this article (doi:10.1007/s40261-015-0365-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Thomas P Lodise
- Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - Weihong Fan
- The Medicines Company, 8 Sylvan Way, Parsippany, NJ, USA
| | - Chining Wu
- ICON Health Economics, Cambridge, MA, USA
| | | | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - Scott DuFour
- Pharmaceutical Services and Ambulatory Infusion Center, Beaumont Health System, Troy, MI, USA
| | | |
Collapse
|
7
|
Potashman MH, Stokes M, Liu J, Lawrence R, Harris L. Examination of hospital length of stay in Canada among patients with acute bacterial skin and skin structure infection caused by methicillin-resistant Staphylococcus aureus. Infect Drug Resist 2016; 9:19-33. [PMID: 26869806 PMCID: PMC4734821 DOI: 10.2147/idr.s93112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Skin infections, particularly those caused by resistant pathogens, represent a clinical burden. Hospitalization associated with acute bacterial skin and skin structure infections (ABSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) is a major contributor to the economic burden of the disease. This study was conducted to provide current, real-world data on hospitalization patterns for patients with ABSSSI caused by MRSA across multiple geographic regions in Canada. PATIENTS AND METHODS This retrospective cohort study evaluated length of stay (LOS) for hospitalized patients with ABSSSI due to MRSA diagnosis across four Canadian geographic regions using the Discharge Abstract Database. Patients with ICD-10-CA diagnosis consistent with ABSSSI caused by MRSA between January 2008 and December 2014 were selected and assigned a primary or secondary diagnosis based on a prespecified ICD-10-CA code algorithm. RESULTS Among 6,719 patients, 3,273 (48.7%) and 3,446 (51.3%) had a primary and secondary diagnosis, respectively. Among patients with a primary or secondary diagnosis, the cellulitis/erysipelas subtype was most common. The majority of patients presented with 0 or 1 comorbid condition; the most common comorbidity was diabetes. The mean LOS over the study period varied by geographic region and year; in 2014 (the most recent year analyzed), LOS ranged from 7.7 days in Ontario to 13.4 days in the Canadian Prairie for a primary diagnosis and from 18.2 days in Ontario to 25.2 days in Atlantic Canada for a secondary diagnosis. A secondary diagnosis was associated with higher rates of continuing care compared with a primary diagnosis (10.6%-24.2% vs 4.6%-12.1%). CONCLUSION This study demonstrated that the mean LOS associated with ABSSSI due to MRSA in Canada was minimally 7 days. Clinical management strategies, including medication management, which might facilitate hospital discharge, have the potential to reduce hospital LOS and related economic burden associated with ABSSSI caused by MRSA.
Collapse
Affiliation(s)
| | | | | | - Robin Lawrence
- Global Health Outcomes, Merck & Co, Inc., Kenilworth, NJ, USA
| | - Linda Harris
- Global Health Outcomes, Merck & Co, Inc., Kenilworth, NJ, USA
| |
Collapse
|
8
|
Antonanzas F, Lozano C, Torres C. Economic features of antibiotic resistance: the case of methicillin-resistant Staphylococcus aureus. Pharmacoeconomics 2015; 33:285-325. [PMID: 25447195 DOI: 10.1007/s40273-014-0242-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper analyses and updates the economic information regarding methicillin-resistant Staphylococcus aureus (MRSA), including information that has been previously reviewed by other authors, and new information, for the purpose of facilitating health management and clinical decisions. The analysed articles reveal great disparity in the economic burden on MRSA patients; this is mainly due to the diversity of the designs of the studies, as well as the variability of the patients and the differences in health care systems. Regarding prophylactic strategies, the studies do not provide conclusive results that could unambiguously orientate health management. The studies addressing treatments noted that linezolid seems to be a cost-effective treatment for MRSA, mostly because it is associated with a shorter length of stay (LOS) in hospital. However, important variables such as antimicrobial susceptibility, infection type and resistance emergence should be included in these analyses before a conclusion is reached regarding which treatment is the best (most efficient). The reviewed studies found that rapid MRSA detection, using molecular techniques, is an efficient technique to control MRSA. As a general conclusion, the management of MRSA infections implicates important economic costs for hospitals, as they result in higher direct costs and longer LOS than those related to methicillin-susceptible S. aureus (MSSA) patients or MRSA-free patients; there is wide variability in those increased costs, depending on different variables. Moreover, the research reveals a lack of studies on other related topics, such as the economic implications of changes in MRSA epidemiology (community patients and lineages associated with farm animals).
Collapse
|
9
|
Hong KL, Battistella L, Salva AD, Williams RM, Sooter LJ. In vitro selection of single-stranded DNA molecular recognition elements against S. aureus alpha toxin and sensitive detection in human serum. Int J Mol Sci 2015; 16:2794-809. [PMID: 25633102 PMCID: PMC4346865 DOI: 10.3390/ijms16022794] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/05/2014] [Accepted: 01/19/2015] [Indexed: 12/11/2022] Open
Abstract
Alpha toxin is one of the major virulence factors secreted by Staphylococcus aureus, a bacterium that is responsible for a wide variety of infections in both community and hospital settings. Due to the prevalence of S. aureus related infections and the emergence of methicillin-resistant S. aureus, rapid and accurate diagnosis of S. aureus infections is crucial in benefiting patient health outcomes. In this study, a rigorous Systematic Evolution of Ligands by Exponential Enrichment (SELEX) variant previously developed by our laboratory was utilized to select a single-stranded DNA molecular recognition element (MRE) targeting alpha toxin with high affinity and specificity. At the end of the 12-round selection, the selected MRE had an equilibrium dissociation constant (Kd) of 93.7 ± 7.0 nM. Additionally, a modified sandwich enzyme-linked immunosorbent assay (ELISA) was developed by using the selected ssDNA MRE as the toxin-capturing element and a sensitive detection of 200 nM alpha toxin in undiluted human serum samples was achieved.
Collapse
Affiliation(s)
- Ka L Hong
- Department of Pharmaceutical Sciences, West Virginia University, 1 Medical Center Drive, P.O. Box 9530, Morgantown, WV 26506, USA.
| | - Luisa Battistella
- Department of Pharmaceutical Sciences, West Virginia University, 1 Medical Center Drive, P.O. Box 9530, Morgantown, WV 26506, USA.
| | - Alysia D Salva
- Department of Pharmaceutical Sciences, West Virginia University, 1 Medical Center Drive, P.O. Box 9530, Morgantown, WV 26506, USA.
| | - Ryan M Williams
- Department of Pharmaceutical Sciences, West Virginia University, 1 Medical Center Drive, P.O. Box 9530, Morgantown, WV 26506, USA.
| | - Letha J Sooter
- Department of Pharmaceutical Sciences, West Virginia University, 1 Medical Center Drive, P.O. Box 9530, Morgantown, WV 26506, USA.
| |
Collapse
|
10
|
Athanasakis K, Petrakis I, Ollandezos M, Tsoulas C, Patel DA, Karampli E, Kyriopoulos J. Antibacterial Treatment of Meticillin-Resistant Staphylococcus Aureus Complicated Skin and Soft Tissue Infections: a Cost and Budget Impact Analysis in Greek Hospitals. Infect Dis Ther 2014; 3:257-68. [PMID: 25287947 PMCID: PMC4269618 DOI: 10.1007/s40121-014-0044-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Indexed: 11/26/2022] Open
Abstract
Introduction Meticillin-resistant staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant infections worldwide. Its prevalence remains high in the Greek hospital setting. Complicated skin and soft tissue infections (cSSTIs) due to MRSA are associated with prolonged hospitalization, additional healthcare costs and significant morbidity. The purpose of this study was to conduct a cost analysis and a budget impact analysis relative to different management scenarios for MRSA-cSSTIs from a hospital perspective. Methods Equal efficacy was assumed for the pharmacotherapies under evaluation and resource use was elicited via an expert panel of seven local infectious disease specialists. The model was based on a previously published economic model that was adapted for the Greek hospital setting and included a decision tree for the management of hospitalized patients with MRSA-cSSTIs, which simulated costs and outcomes for the duration of hospitalization according to the therapeutic scenario. Inpatient costs consisted of hospitalization, diagnostic/laboratory testing, physician visits and antibiotic treatment. Results Current economic impact of MRSA-cSSTIs for the inpatient setting in Greek hospitals was estimated at €29,196,218. Total per patient cost according to first-line agent was €2,457, €2,762, €2,850, €3,494 and €3,094 and mean length of stay was 9.2, 12.5, 10.3, 13.0 and 14.0 days for linezolid, vancomycin, daptomycin, tigecycline, and teicoplanin, respectively. An estimated 10,287 MRSA-cSSTI patients are treated annually in Greek hospitals. Thus, increasing the use of linezolid by 11% over a 3-year period (current use 19%; 3 year projection 30%), for the management of MRSA-cSSTIs, could result in 3-year savings of €896,065. Conclusion Management of MRSA-cSSTI requires intensive resource use; overall healthcare costs differ according to the chosen first-line treatment. In light of considerable budget constraints, development of hospital strategies which facilitate early discharge, such as the introduction of clinical criteria and guidelines for switching from intravenous to oral MRSA-cSSTI therapy, could result in substantial savings for the Greek hospital budget. Electronic supplementary material The online version of this article (doi:10.1007/s40121-014-0044-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kostas Athanasakis
- Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21, Athens, Greece
| | | | - Mark Ollandezos
- Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21, Athens, Greece
| | | | | | - Eleftheria Karampli
- Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21, Athens, Greece.
| | - John Kyriopoulos
- Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21, Athens, Greece
| |
Collapse
|
11
|
Wang SZ, Hu JT, Zhang C, Zhou W, Chen XF, Jiang LY, Tang ZH. The safety and efficacy of daptomycin versus other antibiotics for skin and soft-tissue infections: a meta-analysis of randomised controlled trials. BMJ Open 2014; 4:e004744. [PMID: 24961714 PMCID: PMC4078778 DOI: 10.1136/bmjopen-2013-004744] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Daptomycin, a cyclic lipopeptide that exhibits rapid, concentration-dependent bactericidal activity in vitro against a broad spectrum of Gram-positive pathogens, has now, since 2003, been approved in more than 70 countries and regions to treat skin and soft-tissue infections (SSTIs). The purpose of this meta-analysis was to compare the safety and efficacy of daptomycin with other antibiotics, especially with vancomycin which has long been considered the standard therapy for complicated SSTIs. DESIGN Meta-analysis of randomised controlled trials (RCTs). DATA SOURCES We thoroughly searched PubMed, EMBASE, Cochrane Central to identify relevant RCTs. Six RCTs with a total of 1710 patients were included in this meta-analysis. RESULTS The results demonstrated that the efficacy of daptomycin was at par with or maybe better than other first-line antibiotics for treating SSTIs as shown by the OR for clinical success (OR=1.05, 95% CI 0.84 to 1.31, p=0.65, I(2)=0%); daptomycin versus vancomycin subgroup (OR=1.19, 95% CI 0.77 to 1.83, p=0.43, I(2)=0%); overall microbiological success (OR=1.05, 95% CI 0.61 to 1.79, p=0.86, I(2)=42%); microbiological success of daptomycin versus comparators for Staphylococcus aureus (SA, OR=1.05, 95% CI 0.61 to 2.60, p=0.53, I(2)=47%), for methicillin-resistant S. aureus (OR=0.90, 95% CI 0.77 to 1.06, p=0.20, I(2)=56%). However, daptomycin tended to have a similar treatment-related adverse events (AEs) incidence in comparison with other antibiotics (OR=1.06, 95% CI 0.71 to 1.59, p=0.76, I(2)=41%). The trend showed that daptomycin might cause less discontinuation due to AEs and death compared with other first-line antibiotics (OR=0.71, 95% CI 0.46 to 1.10, p=0.12, I(2)=11%). Significantly more patients in the daptomyicn group had creatine phosphokinase elevation than those in the control group; however, it could be reversed when the therapy ended (OR=1.95, 95% CI 1.04 to 3.65, p=0.04, I(2)=0). CONCLUSIONS This meta-analysis demonstrated that the safety and efficacy of daptomycin was not inferior to that of other first-line drugs, and daptomycin tended to exhibit superior efficacy when compared with vancomycin or with comparators for SA infections; nevertheless, more high-quality RCTs are needed to draw a more credible conclusion.
Collapse
Affiliation(s)
- Shou Zhen Wang
- Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jun Tao Hu
- Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chi Zhang
- Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wei Zhou
- Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xian Feng Chen
- Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Liang Yan Jiang
- Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhan Hong Tang
- Surgical Intensive Care Unit, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| |
Collapse
|