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Galani I, Souli M, Katsala D, Karaiskos I, Giamarellou H, Antoniadou A. In vitro activity of apramycin (EBL-1003) in combination with colistin, meropenem, minocycline or sulbactam against XDR/PDR Acinetobacter baumannii isolates from Greece. J Antimicrob Chemother 2024; 79:1101-1108. [PMID: 38501368 PMCID: PMC11062935 DOI: 10.1093/jac/dkae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES To evaluate the in vitro activity of the combination of apramycin with colistin, meropenem, minocycline or sulbactam, against some well-characterized XDR Acinetobacter baumannii clinical isolates from Greece, to understand how apramycin can be best incorporated into clinical practice and optimize effectiveness. METHODS In vitro interactions of apramycin (0.5×, 1× and 2× the MIC value) with colistin (2 mg/L), meropenem (30 mg/L), minocycline (3.5 mg/L) or sulbactam (24 mg/L) were tested using time-kill methodology. Twenty-one clinical A. baumannii isolates were chosen, exhibiting apramycin MICs of 4-16 mg/L, which were at or below the apramycin preliminary epidemiological cut-off value of 16 mg/L. These isolates were selected for a range of colistin (4-32 mg/L), meropenem (16-256 mg/L), minocycline (8-32 mg/L) and sulbactam (8-32 mg/L) MICs across the resistant range. Synergy was defined as a ≥2 log10 cfu/mL reduction compared with the most active agent. RESULTS The combination of apramycin with colistin, meropenem, minocycline or sulbactam was synergistic, at least at one of the concentrations of apramycin (0.5×, 1× or 2× MIC), against 83.3%, 90.5%, 90.9% or 92.3% of the tested isolates, respectively. Apramycin alone was bactericidal at 24 h against 9.5% and 33.3% of the tested isolates at concentrations equal to 1× and 2× MIC, while the combination of apramycin at 2× MIC with colistin, meropenem or sulbactam was bactericidal against all isolates tested (100%). The apramycin 2× MIC/minocycline combination had bactericidal activity against 90.9% of the tested isolates. CONCLUSIONS Apramycin combinations may have potential as a treatment option for XDR/pandrug-resistant (PDR) A. baumannii infections and warrant validation in the clinical setting, when this new aminoglycoside is available for clinical use.
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Affiliation(s)
- I Galani
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ‘ATTIKON’, Rimini 1, 124 62 Chaidari, Athens, Greece
| | - M Souli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - D Katsala
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ‘ATTIKON’, Rimini 1, 124 62 Chaidari, Athens, Greece
| | - I Karaiskos
- 1st Department of Internal Medicine & Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - H Giamarellou
- 1st Department of Internal Medicine & Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - A Antoniadou
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ‘ATTIKON’, Rimini 1, 124 62 Chaidari, Athens, Greece
- University of Cyprus, Medical School, Nicosia, Cyprus
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Pavli A, Lymperi I, Minitsios T, Katerelos P, Souli M, Ouzounidou Z, Maltezou HC. Changing trends and pretravel preparation of business travelers from Greece during the financial crisis. Public Health 2019; 168:168-171. [PMID: 30739732 DOI: 10.1016/j.puhe.2018.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 12/06/2018] [Accepted: 12/19/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Unemployment in Greece has been increasing as a result of the financial crisis. The aim of this study was to assess the changing trends of business travelers and their pretravel preparation. STUDY DESIGN Prospective, questionnaire-based study. METHODS The study was conducted between 2008 and 2016 at all Regional Public Health Departments. All travelers seeking pretravel advice during the study period were invited to participate. RESULTS A total of 12,379 travelers completed the questionnaire, 58% of whom were business travelers. Between 2008 and 2016, the proportion of business travelers increased from 33% to 80.7% and those travelling for recreational purposes decreased from 47.9% to 15.5%. Business travelers sought pretravel advice at a mean of 18.5 days before departure; 89.1% were men with a mean age of 34.4 years. The Middle East was the most common destination (47.8%) followed by Sub-Saharan Africa (28.3%). Most business travelers stayed in urban areas (77.6%) and for ≥ 1 month (68.6%). Yellow fever vaccine was administered to 75% of business travelers. A total of 76.2%, 26.9%, 15.5%, and 13.9% of those visiting Sub-Saharan Africa received yellow fever, typhoid fever, hepatitis A, and meningococcal vaccines, respectively. Malaria prophylaxis vaccine was administered to 26.8% of business travelers; including 46.5% of those traveling to Sub-Saharan Africa and 53.5% to those traveling to the Indian subcontinent. CONCLUSIONS There is an increasing trend for business travel from Greece, especially to developing countries. Improving the knowledge of travel health consultants about the risks of business travel and the pretravel preparation of business travelers is crucial.
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Affiliation(s)
- A Pavli
- Travel Medicine Office, Hellenic Centre for Disease Control and Prevention, Athens, Greece; Department for Interventions in Healthcare Facilities, Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - I Lymperi
- Travel Medicine Office, Hellenic Centre for Disease Control and Prevention, Athens, Greece; Department for Interventions in Healthcare Facilities, Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - T Minitsios
- Travel Medicine Office, Hellenic Centre for Disease Control and Prevention, Athens, Greece; Department for Interventions in Healthcare Facilities, Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - P Katerelos
- Department for Interventions in Healthcare Facilities, Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - M Souli
- Regional Department of Public Health, Athens, Greece
| | - Z Ouzounidou
- Regional Department of Public Health, Athens, Greece
| | - H C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Centre for Disease Control and Prevention, Athens, Greece.
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Tacconelli E, Mazzaferri F, de Smet AM, Bragantini D, Eggimann P, Huttner BD, Kuijper EJ, Lucet JC, Mutters NT, Sanguinetti M, Schwaber MJ, Souli M, Torre-Cisneros J, Price JR, Rodríguez-Baño J. ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers. Clin Microbiol Infect 2019; 25:807-817. [PMID: 30708122 DOI: 10.1016/j.cmi.2019.01.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 12/16/2022]
Abstract
SCOPE The aim of these guidelines is to provide recommendations for decolonizing regimens targeting multidrug-resistant Gram-negative bacteria (MDR-GNB) carriers in all settings. METHODS These evidence-based guidelines were produced after a systematic review of published studies on decolonization interventions targeting the following MDR-GNB: third-generation cephalosporin-resistant Enterobacteriaceae (3GCephRE), carbapenem-resistant Enterobacteriaceae (CRE), aminoglycoside-resistant Enterobacteriaceae (AGRE), fluoroquinolone-resistant Enterobacteriaceae (FQRE), extremely drug-resistant Pseudomonas aeruginosa (XDRPA), carbapenem-resistant Acinetobacter baumannii (CRAB), cotrimoxazole-resistant Stenotrophomonas maltophilia (CRSM), colistin-resistant Gram-negative organisms (CoRGNB), and pan-drug-resistant Gram-negative organisms (PDRGNB). The recommendations are grouped by MDR-GNB species. Faecal microbiota transplantation has been discussed separately. Four types of outcomes were evaluated for each target MDR-GNB:(a) microbiological outcomes (carriage and eradication rates) at treatment end and at specific post-treatment time-points; (b) clinical outcomes (attributable and all-cause mortality and infection incidence) at the same time-points and length of hospital stay; (c) epidemiological outcomes (acquisition incidence, transmission and outbreaks); and (d) adverse events of decolonization (including resistance development). The level of evidence for and strength of each recommendation were defined according to the GRADE approach. Consensus of a multidisciplinary expert panel was reached through a nominal-group technique for the final list of recommendations. RECOMMENDATIONS The panel does not recommend routine decolonization of 3GCephRE and CRE carriers. Evidence is currently insufficient to provide recommendations for or against any intervention in patients colonized with AGRE, CoRGNB, CRAB, CRSM, FQRE, PDRGNB and XDRPA. On the basis of the limited evidence of increased risk of CRE infections in immunocompromised carriers, the panel suggests designing high-quality prospective clinical studies to assess the risk of CRE infections in immunocompromised patients. These trials should include monitoring of development of resistance to decolonizing agents during treatment using stool cultures and antimicrobial susceptibility results according to the EUCAST clinical breakpoints.
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Affiliation(s)
- E Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Germany; Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
| | - F Mazzaferri
- Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - A M de Smet
- University of Groningen, University Medical Centre Groningen, Department of Critical Care, Groningen, the Netherlands
| | - D Bragantini
- Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - P Eggimann
- Adult Critical Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B D Huttner
- Division of Infectious Diseases and Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - E J Kuijper
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J-C Lucet
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France; IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - N T Mutters
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Institute for Infection Prevention and Hospital Epidemiology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - M Sanguinetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Microbiologia, Rome, Italy
| | - M J Schwaber
- National Centre for Infection Control, Israel Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - M Souli
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - J Torre-Cisneros
- Infectious Diseases Service, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research (IMIBIC), Department of Medicine, University of Córdoba, Córdoba, Spain
| | - J R Price
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - J Rodríguez-Baño
- Division of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena / Department of Medicine, University of Seville / Biomedicine Institute of Seville (IBiS), Seville, Spain
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Russo A, Falcone M, Gutiérrez-Gutiérrez B, Calbo E, Almirante B, Viale PL, Oliver A, Ruiz-Garbajosa P, Gasch O, Gozalo M, Pitout J, Akova M, Peña C, Cisneros JM, Hernández-Torres A, Farcomeni A, Prim N, Origüen J, Bou G, Tacconelli E, Tumbarello M, Hamprecht A, Karaiskos I, de la Calle C, Pérez F, Schwaber MJ, Bermejo J, Lowman W, Hsueh PR, Mora-Rillo M, Rodriguez-Gomez J, Souli M, Bonomo RA, Paterson DL, Carmeli Y, Pascual A, Rodríguez-Baño J, Venditti M. Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae. Int J Antimicrob Agents 2018; 52:577-585. [PMID: 29969692 DOI: 10.1016/j.ijantimicag.2018.06.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE There are few data in the literature regarding sepsis or septic shock due to extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E. METHODS Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. RESULTS 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. β-lactam/β-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. CONCLUSIONS BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.
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Affiliation(s)
- A Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - M Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - B Gutiérrez-Gutiérrez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - E Calbo
- Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - B Almirante
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - P L Viale
- Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy
| | - A Oliver
- Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | | | - O Gasch
- Corporacio Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - M Gozalo
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain
| | - J Pitout
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Akova
- Hacettepe University School of Medicine, Ankara, Turkey
| | - C Peña
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J M Cisneros
- Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, CSIC, University of Seville, Seville, Spain
| | | | - A Farcomeni
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - N Prim
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Origüen
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Bou
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - E Tacconelli
- Universitätsklinikum Tübingen, Tübingen, Germany
| | - M Tumbarello
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Hamprecht
- Institut für Mikrobiologie, Immunologie und Hygiene Universitätsklinikum Köln, Cologne, Germany
| | | | | | - F Pérez
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - M J Schwaber
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Bermejo
- Hospital Español, Rosario, Argentina
| | - W Lowman
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - P-R Hsueh
- National Taiwan University Hospital, National Taiwan University Hospital College of Medicine, Taipei, Taiwan
| | - M Mora-Rillo
- Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - J Rodriguez-Gomez
- Intensive Care Unit. Biomedical Research Institute of Cordoba (IMIBIC)/ Reina Sofia University Hospital/University of Cordoba, Córdoba, Spain
| | - M Souli
- University General Hospital Attikon, Chaidari, Greece
| | - R A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA; Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland Ohio, USA
| | - D L Paterson
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia
| | - Y Carmeli
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Pascual
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - J Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - M Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
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Souli M, Kultsep AV, Al-Bahkali E, Pain CC, Moatamedi M. Arbitrary Lagrangian Eulerian Formulation for Sloshing Tank Analysis in Nuclear Engineering. NUCL SCI ENG 2017. [DOI: 10.13182/nse15-63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Souli
- Université de Lille, LML UMR CNRS 8107, Villeneuve-d’Ascq, France
| | | | - E. Al-Bahkali
- King Saud University, College of Engineering, Riyadh, Saudi Arabia
| | - C. C. Pain
- Imperial College London, London, United Kingdom
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Cyr DD, Allen AS, Du GJ, Ruffin F, Adams C, Thaden JT, Maskarinec SA, Souli M, Guo S, Dykxhoorn DM, Scott WK, Fowler VG. Evaluating genetic susceptibility to Staphylococcus aureus bacteremia in African Americans using admixture mapping. Genes Immun 2017; 18:95-99. [PMID: 28332560 PMCID: PMC5435963 DOI: 10.1038/gene.2017.6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/12/2022]
Abstract
The incidence of Staphylococcus aureus bacteremia (SAB) is significantly higher in African American (AA) than in European-descended populations. We used admixture mapping (AM) to test the hypothesis that genomic variations with different frequencies in European and African ancestral genomes influence susceptibility to SAB in AAs. A total of 565 adult AAs (390 cases with SAB; 175 age-matched controls) were genotyped for AM analysis. A case-only admixture score and a mixed χ2(1df) score (MIX) to jointly evaluate both single-nucleotide polymorphism (SNP) and admixture association (P<5.00e-08) were computed using MIXSCORE. In addition, a permutation scheme was implemented to derive multiplicity adjusted P-values (genome-wide 0.05 significance threshold: P<9.46e-05). After empirical multiplicity adjustment, one region on chromosome 6 (52 SNPs, P=4.56e-05) in the HLA class II region was found to exhibit a genome-wide statistically significant increase in European ancestry. This region encodes genes involved in HLA-mediated immune response and these results provide additional evidence for genetic variation influencing HLA-mediated immunity, modulating susceptibility to SAB.
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Affiliation(s)
- D D Cyr
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - A S Allen
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - G-J Du
- Duke Center for Genomic and Computational Biology, Durham, NC, USA
| | - F Ruffin
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - C Adams
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - J T Thaden
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - S A Maskarinec
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - M Souli
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.,School of Medicine, National and Kapodistrian University of Athens, Chaidari, Greece
| | - S Guo
- Dr John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - D M Dykxhoorn
- Dr John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - W K Scott
- Dr John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - V G Fowler
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.,Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
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Souli M, Karaiskos I, Masgala A, Galani L, Barmpouti E, Giamarellou H. Double-carbapenem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis 2017; 36:1305-1315. [DOI: 10.1007/s10096-017-2936-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
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Galani I, Anagnostoulis G, Chatzikonstantinou M, Petrikkos G, Souli M. Emergence of Klebsiella pneumoniae co-producing OXA-48, CTX-M-15, and ArmA in Greece. Clin Microbiol Infect 2016; 22:898-899. [DOI: 10.1016/j.cmi.2016.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/06/2016] [Accepted: 08/06/2016] [Indexed: 11/25/2022]
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Herwan J, Al-Bahkali E, Khalil KA, Souli M. Load bearing enhancement of pin joined composite laminates using electrospun polyacrylonitrile nanofiber mats. ARAB J CHEM 2016. [DOI: 10.1016/j.arabjc.2015.03.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Moatamedi M, Souli M, Al-Bahkali E. Fluid Structure Modelling of Blood Flow in Vessels. Mol Cell Biomech 2014; 11:221-234. [PMID: 26336693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper describes the capabilities of fluid structure interaction based multi-physics numerical modelling in solving problems related to vascular biomechanics. In this research work, the onset of a pressure pulse was simulated at the entrance of a three dimensional straight segment of the blood vessel like circular tube and the resulting dynamic response in the form of a propagating pulse wave through the wall was analysed and compared. Good agreement was found between the numerical results and the theoretical description of an idealized artery. Work has also been done on implementing the material constitutive models specific for vascular applications.
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Tzouvelekis LS, Markogiannakis A, Piperaki E, Souli M, Daikos GL. Treating infections caused by carbapenemase-producing Enterobacteriaceae. Clin Microbiol Infect 2014; 20:862-72. [PMID: 24890393 DOI: 10.1111/1469-0691.12697] [Citation(s) in RCA: 247] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) have spread worldwide, causing serious infections with increasing frequency. CPE are resistant to almost all available antibiotics, complicating therapy and limiting treatment options. Mortality rates associated with CPE infections are unacceptably high, indicating that the current therapeutic approaches are inadequate and must be revised. Here, we review 20 clinical studies (including those describing the largest cohorts of CPE-infected patients) that provided the necessary information regarding isolate and patient characteristics and treatment schemes, as well as a clear assessment of outcome. The data summarized here indicate that treatment with a single in vitro active agent resulted in mortality rates not significantly different from that observed in patients treated with no active therapy, whereas combination therapy with two or more in vitro active agents was superior to monotherapy, providing a clear survival benefit (mortality rate, 27.4% vs. 38.7%; p <0.001). The lowest mortality rate (18.8%) was observed in patients treated with carbapenem-containing combinations.
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Affiliation(s)
- L S Tzouvelekis
- Department of Microbiology, School of Medicine, University of Athens, Athens, Greece
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Fakas N, Souli M, Koratzanis G, Karageorgiou C, Giamarellou H, Kanellakopoulou K. Effects of Antimicrobial Prophylaxis on Asymptomatic Bacteriuria and Predictors of Failure in Patients with Multiple Sclerosis. J Chemother 2013; 22:36-43. [DOI: 10.1179/joc.2010.22.1.36] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Gharbi M, Zribi L, Jedidi M, Chakkhari H, Hamdi S, R'hayem S, Zribi N, Souli M, Darghouth MA. [Prevalence of Toxoplasma gondii infection in Tunisian sheep]. ACTA ACUST UNITED AC 2013; 106:184-7. [PMID: 23702585 DOI: 10.1007/s13149-013-0290-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 04/02/2013] [Indexed: 11/29/2022]
Abstract
The aim of this study is to estimate the prevalence of Toxoplasma gondii infection in 527 sheep from 4 governorates of Tunisia by Elisa (350 animals) and PCR (177 animals). The seroprevalence in sheep was estimated to be 1.8% (N = 166) in the governorate of Siliana (North Tunisia) and 19% (N = 184) in the governorate of Kasserine (Central Tunisia) with a commercial Elisa kit. T. gondii DNA was extracted from the apex of the heart in 25.5% (N = 106) of sheep from the Sidi-Bouzid governorate (Central Tunisia) and 12.7% (N = 71) from the Ben-Arous governorate (North Tunisia). There was no statistically significant difference between different age categories' prevalence within each locality. Our results indicate that T. gondii infection is frequent in Tunisian sheep. The implementation of a national control programme against toxoplasmosis should not neglect sheep as a frequently infected intermediate host.
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Affiliation(s)
- M Gharbi
- Laboratoire de parasitologie, École nationale de médecine vétérinaire de Sidi-Thabet, université de la Manouba, Manouba, Tunisie.
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Souli M, Galani I, Plachouras D, Panagea T, Armaganidis A, Petrikkos G, Giamarellou H. Antimicrobial activity of copper surfaces against carbapenemase-producing contemporary Gram-negative clinical isolates. J Antimicrob Chemother 2012; 68:852-7. [DOI: 10.1093/jac/dks473] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Lampri N, Galani I, Poulakou G, Katsarolis I, Petrikkos G, Giamarellou H, Souli M. Mecillinam/clavulanate combination: a possible option for the treatment of community-acquired uncomplicated urinary tract infections caused by extended-spectrum -lactamase-producing Escherichia coli. J Antimicrob Chemother 2012; 67:2424-8. [DOI: 10.1093/jac/dks215] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Galani I, Souli M, Panagea T, Poulakou G, Kanellakopoulou K, Giamarellou H. Prevalence of 16S rRNA methylase genes in Enterobacteriaceae isolates from a Greek university hospital. Clin Microbiol Infect 2012; 18:E52-4. [PMID: 22264302 DOI: 10.1111/j.1469-0691.2011.03738.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
16S ribosomal RNA methylase-mediated high-level resistance to 4-,6-aminoglycosides has been reported in clinical isolates of gram-negative bacilli from several countries. Three of 1534 (0.2%) isolates of Klebsiella pneumoniae and three of 734 (0.4%) Proteus mirabilis isolates from a university hospital in Athens, Greece, were positive for rmtB and highly resistant to all aminoglycosides tested (MICs ≥256 mg/L). Two of the K. pneumoniae rmtB-bearing isolates, were KPC-2 and OXA-10 producers and the third was a DHA-1 producer. One of the P. mirabilis isolates was a VIM-1 and OXA-10 producer and one was an OXA-10 producer. All rmtB-harbouring isolates were clonally unrelated. None of the E. coli (n = 1398) and Enterobacter spp. (n = 414) isolates were positive for armA, rmtA, rmtB, rmtC or rmtD.
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Affiliation(s)
- I Galani
- 4th Department of Internal Medicine, Infectious Disease Laboratory, Molecular Biology Section, Athens University School of Medicine, Chaidari, Greece.
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Affiliation(s)
- F. Erchiqui
- Université du Québe en Abitibi‐Témiscamingue, 445, boul. de l'Université, Rouyn‐Noranda, Québec, Canada J9X 5E4
| | - Z. Ozdemir
- Laboratoire de Mécanique, Université de Lille 1, Boulevard Paul Langevin, Cité Scientifique, 59655 Villeneuve d'Ascq, France
| | - M. Souli
- Laboratoire de Mécanique, Université de Lille 1, Boulevard Paul Langevin, Cité Scientifique, 59655 Villeneuve d'Ascq, France
| | - H. Ezzaidi
- Université du Québe à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, Canada G7H 2B1
| | - G. Dituba‐Ngoma
- Université du Québe en Abitibi‐Témiscamingue, 445, boul. de l'Université, Rouyn‐Noranda, Québec, Canada J9X 5E4
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Adams NG, Adekambi T, Afeltra J, Aguado J, Aires de Sousa M, Akiyoshi K, Al Hasan M, Ala-Kokko T, Albert M, Alfandari S, Allen D, Allerberger F, Almyroudis N, Alp E, Amin R, Anderson-Berry A, Andes DR, Andremont A, Andreu A, Angelakis M, Antachopoulos C, Antoniadou A, Arabatzis M, Arlet G, Arnez M, Arnold C, Asensio A, Asseray N, Ausiello C, Avni T, Ayling R, Baddour L, Baguelin M, Bányai K, Barbour A, Basco LK, Bauer D, Bayston R, Beall B, Becker K, Behr M, Bejon P, Belliot G, Benito-Fernandez J, Benjamin D, Benschop K, Berencsi G, Bergeron MG, Bernard K, Berner R, Beyersmann J, Bille J, Bizzini A, Bjarnsholt T, Blanc D, Blanco J, Blot S, Bohnert J, Boillat N, Bonomo R, Bonten M, Bordon JM, Borel N, Boschiroli ML, Bosilkovski M, Bosso JA, Botelho-Nevers E, Bou G, Bretagne S, Brouqui P, Brun-Buisson C, Brunetto M, Bucher H, Buchheidt D, Buckling A, Bulpa P, Cambau E, Canducci F, Cantón R, Capobianchi M, Carattoli A, Carcopino X, Cardona-Castro N, Carling PC, Carrat F, Castilla J, Castilletti C, Cavaco L, Cavallo R, Ceccherini-Silberstein F, Centrón D, Chappuis F, Charrel R, Chen M, Chevaliez S, Chezzi C, Chomel B, Chowers M, Chryssanthou E, Ciammaruconi A, Ciccozzi M, Cid J, Ciofu O, Cisneros D, Ciufolini MG, Clark C, Clarke SC, Clayton R, Clementi M, Clemons K, Cloeckaert A, Cloud J, Coenye T, Cohen Bacri S, Cohen R, Coia J, Colombo A, Colson P, Concerse P, Cordonnier C, Cormican M, Cornaglia G, Cornely O, Costa S, Cots F, Craxi A, Creti R, Crnich C, Cuenca Estrella M, Cusi MG, d'Ettorre G, da Cruz Lamas C, Daikos G, Dannaoui E, De Barbeyrac B, De Grazia S, de Jager C, de Lamballerie X, de Marco F, del Palacio A, Delpeyroux F, Denamur E, Denis O, Depaquit J, Deplano A, Desenclos JC, Desjeux P, Deutch S, Di Luca D, Dianzani F, Diep B, Diestra K, Dignani C, Dimopoulos G, Divizia M, Doi Y, Dornbusch HJ, Dotis J, Drancourt M, Drevinek P, Dromer F, Dryden M, Dubreuil L, Dubus JC, Dumitrescu O, Dumke R, DuPont H, Edelstein M, Eggimann P, Eis-Huebinger AM, El Atrouni WI, Entenza J, Ergonul O, Espinel-Ingroff A, Esteban J, Etienne J, Fan XG, Fenollar F, Ferrante P, Ferrieri P, Ferry T, Feuchtinger T, Finegold S, Fingerle V, Fitch M, Fitzgerald R, Flori P, Fluit A, Fontana R, Fournier PE, François M, Francois P, Freedman DO, Friedrich A, Gallego L, Gallinella G, Gangneux JP, Gannon V, Garbarg-Chenon A, Garbino J, Garnacho-Montero J, Gatermann S, Gautret P, Gentile G, Gerlich W, Ghannoum M, Ghebremedhin B, Ghigo E, Giamarellos-Bourboulis E, Girgis R, Giske C, Glupczynski Y, Gnarpe J, Gomez-Barrena E, Gorwitz RJ, Gosselin R, Goubau P, Gould E, Gradel K, Gray J, Gregson D, Greub G, Grijalva CG, Groll A, Groschup M, Gutiérrez J, Hackam DG, Hall WA, Hallett R, Hansen S, Harbarth S, Harf-Monteil C, Hasanjani RMR, Hasler P, Hatchette T, Hauser P, He Q, Hedges A, Helbig J, Hennequin C, Herrmann B, Hezode C, Higgins P, Hoesli I, Hoiby N, Hope W, Houvinen P, Hsu LY, Huard R, Humphreys H, Icardi M, Imoehl M, Ivanova K, Iwamoto T, Izopet J, Jackson Y, Jacobsen K, Jang TN, Jasir A, Jaulhac B, Jaureguy F, Jefferies JM, Jehl F, Johnstone J, Joly-Guillou ML, Jonas M, Jones M, Joukhadar C, Kahl B, Kaier K, Kaiser L, Kato H, Katragkou A, Kearns A, Kern W, Kerr K, Kessin R, Kibbler C, Kimberlin D, Kittang B, Klaassen C, Kluytmans J, Ko WC, Koh WJ, Kostrzewa M, Kourbeti I, Krause R, Krcmery V, Krizova P, Kuijper E, Kullberg BJ, Kumar G, Kunin CM, La Scola B, Lagging M, Lagrou K, Lamagni T, Landini P, Landman D, Larsen A, Lass-Floerl C, Laupland K, Lavigne JP, Leblebicioglu H, Lee B, Lee CH, Leggat P, Lehours P, Leibovici L, Leon L, Leonard N, Leone M, Lescure X, Lesprit P, Levy PY, Lew D, Lexau CA, Li SY, Li W, Lieberman D, Lina B, Lina G, Lindsay JA, Livermore D, Lorente L, Lortholary O, Lucet JC, Lund B, Lütticken R, MacLeod C, Madhi S, Maertens J, Maggi F, Maiden M, Maillard JY, Maira-Litran T, Maltezou H, Manian FA, Mantadakis E, Maragakis L, Marcelin AG, Marchaim D, Marchetti O, Marcos M, Markotic A, Martina B, Martínez J, Martinez JL, Marty F, Maurin M, McGee L, Mediannikov O, Meersseman W, Megraud F, Meletiadis J, Mellmann A, Meyer E, Meyer W, Meylan P, Michalopoulos A, Micol R, Midulla F, Mikami Y, Miller RF, Miragaia M, Miriagou V, Mitchell TJ, Miyakis S, Mokrousov I, Monecke S, Mönkemüller K, Monno L, Monod M, Morales G, Moriarty F, Morosini I, Mortensen E, Mubarak K, Mueller B, Mühlemann K, Muñoz Bellido JL, Murray P, Muscillo M, Mylotte J, Naessens A, Nagy E, Nahm MH, Nassif X, Navarro D, Navarro F, Neofytos D, Nes I, Ní Eidhin D, Nicolle L, Niederman MS, Nigro G, Nimmo G, Nordmann P, Nougairède A, Novais A, Nygard K, Oliveira D, Orth D, Ortiz JR, Osherov N, Österblad M, Ostrosky-Zeichner L, Pagano L, Palamara AT, Pallares R, Panagopoulou P, Pandey P, Panepinto J, Pappas G, Parkins M, Parola P, Pasqualotto A, Pasteran F, Paul M, Pawlotsky JM, Peeters M, Peixe L, Pepin J, Peralta G, Pereyre S, Perfect JR, Petinaki E, Petric M, Pettigrew M, Pfaller M, Philipp M, Phillips G, Pichichero M, Pierangeli A, Pierard D, Pigrau C, Pilishvili T, Pinto F, Pistello M, Pitout J, Poirel L, Poli G, Poppert S, Posfay-Barbe K, Pothier P, Poxton I, Poyart C, Pozzetto B, Pujol M, Pulcini C, Punyadeera C, Ramirez M, Ranque S, Raoult D, Rasigade JP, Re MC, Reilly JS, Reinert R, Renaud B, Rice L, Rich S, Richet H, Rigouts L, Riva E, Rizzo C, Robotham J, Rodicio MR, Rodriguez J, Rodriguez-Bano J, Rogier C, Roilides E, Rolain JM, Rooijakkers S, Rooney P, Rossi F, Rotimi V, Rottman M, Roux V, Ruhe J, Russo G, Sadowy E, Sagel U, Said SI, Saijo M, Sak B, Sa-Leao R, Sanders EAM, Sanguinetti M, Sarrazin C, Savelkoul P, Scheifele D, Schmidt WP, Schønheyder H, Schönrich G, Schrenzel J, Schubert S, Schwarz K, Schwarz S, Sefton A, Segondy M, Seifert H, Seng P, Senneville E, Sexton D, Shafer RW, Shalit I, Shankar N, Shata TM, Shields J, Sibley C, Sicinschi L, Siljander T, Simitsopoulou M, Simoons-Smit AM, Sissoko D, Sjögren J, Skiada A, Skoczynska A, Skov R, Slack M, Sogaard M, Sola C, Soriano A, Sotto A, Sougakoff W, Sougakoff W, Souli M, Spelberg B, Spelman D, Spiliopoulou I, Springer B, Stefani S, Stein A, Steinbach WJ, Steinbakk M, Strakova L, Strenger V, Sturm P, Sullivan P, Sutton D, Symmons D, Tacconelli E, Tamalet C, Tang JW, Tang YW, Tattevin P, Thibault V, Thomsen RW, Thuny F, Tong S, Torres C, Townsend R, Tristan A, Trouillet JL, Tsai HC, Tsitsopoulos P, Tuerlinckx D, Tulkens P, Tumbarello M, Tureen J, Turnidge JD, Turriziani O, Tutuian R, Uçkay I, Upton M, Vabret A, Vamvakas EC, van den Boom D, Van Eldere J, van Leeuwen W, van Strijp J, Van Veen S, Vandamme P, Vandenesch F, Vayssier M, Velin D, Venditti M, Venter M, Venuti A, Vergnaud G, Verheij T, Verhofstede C, Viscoli C, Vizza CD, Vogel U, Waller A, Wang YF, Warn P, Warris A, Wauters G, Weidmann M, Weill FX, Weinberger M, Welch D, Wellinghausen N, Wheat J, Widmer A, Wild F, Willems R, Willinger B, Winstanley C, Witte W, Wolff M, Wong F, Wootton M, Wyllie D, Xu W, Yamamoto S, Yaron S, Yildirim I, Zaoutis T, Zazzi M, Zbinden R, Zehender GG, Zemlickova H, Zerbini ML, Zhang L, Zhang Y, Zhao YD, Zhu Z, Zimmerli W. ACKNOWLEDGEMENT OF REVIEWERS. Clin Microbiol Infect 2011. [DOI: 10.1111/j.1469-0691.2010.03428.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Galani I, Souli M, Mitchell N, Chryssouli Z, Giamarellou H. Presence of plasmid-mediated quinolone resistance in Klebsiella pneumoniae and Escherichia coli isolates possessing blaVIM-1 in Greece. Int J Antimicrob Agents 2010; 36:252-4. [PMID: 20580536 DOI: 10.1016/j.ijantimicag.2010.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
Abstract
Amongst nalidixic acid-resistant, ciprofloxacin-susceptible Escherichia coli and Klebsiella pneumoniae clinical isolates recovered over a 5-month period from inpatients and outpatients of Attikon University General Hospital (Athens, Greece), only one E. coli was positive for qnrB2 and one K. pneumoniae was positive for qnrA1. Both isolates were extended-spectrum beta-lactamase-negative, metallo-beta-lactamase-positive and carried the bla(VIM-1) gene. Neither of the isolates had mutations in gyrA and parC or carried aac(6')-Ib-cr or qepA. The K. pneumoniae isolate also harboured bla(CMY-13) on the same transferable plasmid with qnrA1. This is the first report of a qnrA1-positive K. pneumoniae and qnrB2-positive E. coli harbouring a concurrent bla(VIM-1) gene.
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Affiliation(s)
- I Galani
- 4th Department of Internal Medicine, Molecular Biology Section, Athens University School of Medicine, Athens, Greece.
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Carmeli Y, Akova M, Cornaglia G, Daikos GL, Garau J, Harbarth S, Rossolini GM, Souli M, Giamarellou H. Controlling the spread of carbapenemase-producing Gram-negatives: therapeutic approach and infection control. Clin Microbiol Infect 2010; 16:102-11. [PMID: 20085604 DOI: 10.1111/j.1469-0691.2009.03115.x] [Citation(s) in RCA: 233] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although the rapid spread of carbapenemase-producing Gram-negatives (CPGNs) is providing the scientific community with a great deal of information about the molecular epidemiology of these enzymes and their genetic background, data on how to treat multidrug-resistant or extended drug-resistant carbapenemase-producing Enterobacteriaceae and how to contain their spread are still surprisingly limited, in spite of the rapidly increasing prevalence of these organisms and of their isolation from patients suffering from life-threatening infections. Limited clinical experience and several in vitro synergy studies seem to support the view that antibiotic combinations should be preferred to monotherapies. But, in light of the data available to date, it is currently impossible to quantify the real advantage of drug combinations in the treatment of these infections. Comprehensive clinical studies of the main therapeutic options, broken down by pathogen, enzyme and clinical syndrome, are definitely lacking and, as carbapenemases keep spreading, are urgently needed. This spread is unveiling the substantial unpreparedness of European public health structures to face this worrisome emergency, although experiences from different countries-chiefly Greece and Israel-have shown that CPGN transmission and cross-infection can cause a substantial threat to the healthcare system. This unpreparedness also affects the treatment of individual patients and infection control policies, with dramatic scarcities of both therapeutic options and infection control measures. Although correct implementation of such measures is presumably cumbersome and expensive, the huge clinical and public health problems related to CPGN transmission, alongside the current scarcity of therapeutic options, seem to fully justify this choice.
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Affiliation(s)
- Y Carmeli
- Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Abstract
International and local surveillance networks as well as numerous reports in the biomedical literature provide evidence that the prevalence of antibiotic resistant Gram-negative bacteria is escalating in many European countries. Furthermore, isolates characterised as multidrug-resistant (i.e. resistant to three or more classes of antimicrobials), extensively drug resistant (i.e. resistant to all but one or two classes) or pandrug-resistant (i.e. resistant to all available classes) are increasingly frequently isolated in hospitalised patients causing infections for which no adequate therapeutic options exist. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae are specifically addressed in this review as the most problematic and often extensively or pandrug-resistant pathogens. According to the available multicentre surveillance studies, the proportion of imipenem-resistant A. baumannii strains is reported to be as high as 85% in bloodstream isolates from intensive care unit patients in Greece and 48% in clinical isolates from hospitalised patients in Spain and Turkey. Among 33 European countries participating in the European Antimicrobial Resistance Surveillance System (EARSS) in 2007, six countries reported carbapenem resistance rates of more than 25% among P. aeruginosa isolates, the highest rate reported from Greece (51%). According to EARSS, Greece has also the highest resistance rates among K. pneumoniae; 46% to carbapenems, 58% to quinolones and 63% to third generation cephalosporins. This review describes the magnitude of antimicrobial resistance in Gram-negative bacteria in Europe highlighting where the efforts of the scientific communities, the academia, the industry and the government should focus in order to confront this threat.
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Affiliation(s)
- M Souli
- Fourth Department of Internal Medicine, Athens University Medical School, Athens, Greece
| | - I Galani
- Fourth Department of Internal Medicine, Athens University Medical School, Athens, Greece
| | - H Giamarellou
- Fourth Department of Internal Medicine, Athens University Medical School, Athens, Greece
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Souli M, Galani I, Giamarellou H. Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. Euro Surveill 2008; 13:19045. [PMID: 19021957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
International and local surveillance networks as well as numerous reports in the biomedical literature provide evidence that the prevalence of antibiotic resistant Gram-negative bacteria is escalating in many European countries. Furthermore, isolates characterised as multidrug-resistant (i.e. resistant to three or more classes of antimicrobials), extensively drug resistant (i.e. resistant to all but one or two classes) or pandrug-resistant (i.e. resistant to all available classes) are increasingly frequently isolated in hospitalised patients causing infections for which no adequate therapeutic options exist. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae are specifically addressed in this review as the most problematic and often extensively or pandrug-resistant pathogens. According to the available multicentre surveillance studies, the proportion of imipenem-resistant A. baumannii strains is reported to be as high as 85% in bloodstream isolates from intensive care unit patients in Greece and 48% in clinical isolates from hospitalised patients in Spain and Turkey. Among 33 European countries participating in the European Antimicrobial Resistance Surveillance System (EARSS) in 2007, six countries reported carbapenem resistance rates of more than 25% among P. aeruginosa isolates, the highest rate reported from Greece (51%). According to EARSS, Greece has also the highest resistance rates among K. pneumoniae; 46% to carbapenems, 58% to quinolones and 63% to third generation cephalosporins. This review describes the magnitude of antimicrobial resistance in Gram-negative bacteria in Europe highlighting where the efforts of the scientific communities, the academia, the industry and the government should focus in order to confront this threat.
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Affiliation(s)
- M Souli
- Fourth Department of Internal Medicine, Athens University Medical School, Athens, Greece
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Sakka V, Tsiodras S, Galani L, Antoniadou A, Souli M, Galani I, Pantelaki M, Siafakas N, Zerva L, Giamarellou H. Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci. Clin Microbiol Infect 2008; 14:14-21. [DOI: 10.1111/j.1469-0691.2007.01840.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Galani L, Sakka V, Tsiodras S, Pantelaki M, Galani I, Souli M, Antoniadou A, Athanasia S, Kontopidou F, Nikolaou H, Fytrou H, Siafakas N, Zerva L, Giamarellou H. P1697 Reduced rates of vancomycin-resistant enterococci coloni-sation after implementation of infection control measures. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Galani I, Kontopidou F, Rekatzina P, Deliolanis J, Souli M, Antoniadou A, Giamarellou H. P1644 Sensitivity to colistin: evaluation of available interpretive criteria of disc diffusion test. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Erchiqui F, Souli M, Yedder RB. Nonisothermal finite-element analysis of thermoforming of polyethylene terephthalate sheet: Incomplete effect of the forming stage. POLYM ENG SCI 2007. [DOI: 10.1002/pen.20947] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Souli M, Volonakis K, Kapaskelis A, Galani I, Grammelis V, Vorou R, Tsivra M, Chryssouli Z, Katsala D, Giamarellou H. Characterisation of macrolide-non-susceptible Streptococcus pneumoniae colonising children attending day-care centres in Athens, Greece during 2000 and 2003. Clin Microbiol Infect 2007; 13:70-7. [PMID: 17184290 DOI: 10.1111/j.1469-0691.2006.01555.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nasopharyngeal Streptococcus pneumoniae isolates colonising young children are representative of isolates causing clinical disease. This study determined the frequency of macrolide-non-susceptible pneumococci, as well as their phenotypic and genotypic characteristics, among pneumococci collected during two cross-sectional surveillance studies of the nasopharynx of 2847 children attending day-care centres in the Athens metropolitan area during 2000 and 2003. In total, 227 macrolide-non-susceptible pneumococcal isolates were studied. Increases in macrolide non-susceptibility, from 23% to 30.3% (p <0.05), and in macrolide and penicillin co-resistance, from 3.4% to 48.6% (p <0.001), were identified during the study period. The M resistance phenotype, associated with the presence of the mef(A)/(E) gene, predominated in both surveys, and isolates carrying both mef(A)/(E) and erm(AM) were identified, for the first time in Greece, among the isolates from the 2003 survey. Pulsed-field gel electrophoresis analysis of the isolates from the 2000 survey indicated the spread of a macrolide- and penicillin-resistant clone among day-care centres. The serogroups identified most commonly in the study were 19F, 6A, 6B, 14 and 23F, suggesting that the theoretical protection of the seven-valent conjugate vaccine against macrolide-non-susceptible isolates was c. 85% during both study periods.
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Affiliation(s)
- M Souli
- Fourth Department of Internal Medicine, Athens University School of Medicine, University General Hospital Attikon, Chaidari, Greece
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Souli M, Pontikis K, Chryssouli Z, Galani I, Giamarellou H. Successful treatment of right-sided prosthetic valve endocarditis due to methicillin-resistant teicoplanin-heteroresistant Staphylococcus aureus with linezolid. Eur J Clin Microbiol Infect Dis 2005; 24:760-2. [PMID: 16283218 DOI: 10.1007/s10096-005-0023-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Souli
- Fourth Department of Internal Medicine, University General Hospital, ATTIKON 1 Rimini Str 124 62, Chaidari, Greece
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Galani I, Souli M, Chryssouli Z, Katsala D, Giamarellou H. First identification of an Escherichia coli clinical isolate producing both metallo-beta-lactamase VIM-2 and extended-spectrum beta-lactamase IBC-1. Clin Microbiol Infect 2004; 10:757-60. [PMID: 15301681 DOI: 10.1111/j.1469-0691.2004.00913.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An Escherichia coli strain with decreased susceptibility to carbapenems was isolated from a hospitalised patient in Athens, Greece. The strain was resistant to all beta-lactams, including aztreonam, whereas the MIC of imipenem and meropenem was 0.5 mg/L. A positive EDTA-disk synergy test suggested the production of a metallo-beta-lactamase. PCR experiments revealed the presence of the bla(VIM-2), bla(IBC-1), and bla(TEM-1) genes. Resistance to beta-lactams was not transferable by conjugation. This is the first report of a clinical isolate of E. coli producing VIM-2, and the first report of the coexistence of bla(VIM-2) and bla(IBC-1) in a single clinical isolate.
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Affiliation(s)
- I Galani
- 4th Department of Internal Medicine, Molecular Biology Section, University of Athens Medical School, Athens, Greece
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Souli M, Kopsinis G, Kavouklis E, Gabriel L, Giamarellou H. Vancomycin levels in human aqueous humour after intravenous and subconjunctival administration. Int J Antimicrob Agents 2001; 18:239-43. [PMID: 11673036 DOI: 10.1016/s0924-8579(01)00375-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the present study was to evaluate the level of vancomycin in human aqueous humour after intravenous (i.v.) and subconjunctival administration. One hundred patients scheduled to undergo cataract extraction participated in the study. Fifty-three of them received 20 mg vancomycin subconjunctivally and 47 received two doses of vancomycin i.v. (1 g b.i.d.). Specimens of aqueous humour from the first group were collected 1, 2, 2.5, 3, 3.5, 5, 6, 7, and 8 h after the subconjunctival injection. In the second group, specimens of blood and aqueous humour were collected 1, 2, 4, 6, 8, 10, and 12 h after the end of infusion of the second dose of the antibiotic. The levels of vancomycin were determined by fluorescent polarization immunoassay. In the first group peak levels of 24.82+/-3.55 microg/ml were achieved in aqueous humour at 5 h, whereas in the second group peak levels of 1.42+/-0.47 microg/ml were detected at 6 h. The latter levels, although higher than the MICs of most of the Gram-positive pathogens causing eye infections, are inadequate for the treatment of infections in vivo. These results support the need for subconjunctival instead of i.v. administration of vancomycin in order to achieve therapeutic levels of the drug in human aqueous humour or for prophylactic use whenever indicated.
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Affiliation(s)
- M Souli
- Fourth Department of Internal Medicine, Athens University School of Medicine, Sismanoglio General Hospital, 1 Sismanogliou Str., 15126 Maroussi, Attikis, Athens, Greece
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Souli M, Thauvin-Eliopoulos C, Eliopoulos GM. In vivo activities of evernimicin (SCH 27899) against vancomycin-susceptible and vancomycin-resistant enterococci in experimental endocarditis. Antimicrob Agents Chemother 2000; 44:2733-9. [PMID: 10991853 PMCID: PMC90144 DOI: 10.1128/aac.44.10.2733-2739.2000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To assess the potential efficacy of evernimicin (SCH 27899) against serious enterococcal infections, we used a rat model of aortic valve endocarditis established with either a vancomycin-susceptible Enterococcus faecalis or a vancomycin-resistant Enterococcus faecium strain. Animals infected with either one of the test strains were assigned to receive no treatment (controls) or 5-day therapy with one of the following regimens: evernimicin 60-mg/kg of body weight intravenous (i.v.) bolus once daily, 60-mg/kg i.v. bolus twice daily (b.i.d.), 60 mg/kg/day i.v. by continuous infusion, or 120 mg/kg/day i.v. by continuous infusion. These regimens were compared with vancomycin at 150 mg/kg/day. In animals infected with E. faecalis, evernimicin at 120 mg/kg/day by continuous infusion significantly reduced bacterial counts in vegetations (final density, 5.75+/-3.38 log(10) CFU/g) compared with controls (8.51+/-1.11 log(10) CFU/g). In animals infected with 0.5 ml of an 8 x 10(7)-CFU/ml inoculum of the vancomycin-resistant E. faecium, both 60-mg/kg bolus once a day and b.i.d. dose regimens of evernimicin were very effective (viable counts, 3.45+/-1.44 and 3.81+/-1.98 log(10) CFU/g, respectively). Vancomycin was unexpectedly active against infections induced with that inoculum. In animals infected with a 10(9)-CFU/ml inoculum of the vancomycin-resistant E. faecium, the evernimicin 60-mg/kg i.v. bolus b.i.d. reduced viable counts in vegetations compared with controls (6.27+/-1.63 versus 8.34+/-0.91 log(10) CFU/g; P<0.05), whereas vancomycin was ineffective. Although resistant colonies could be selected in vitro, we were not able to identify evernimicin-resistant clones from cardiac vegetations. An unexplained observation from these experiments was the great variability in final bacterial densities within cardiac vegetations from animals in each of the evernimicin treatment groups.
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Affiliation(s)
- M Souli
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Torres-Viera C, Thauvin-Eliopoulos C, Souli M, DeGirolami P, Farris MG, Wennersten CB, Sofia RD, Eliopoulos GM. Activities of taurolidine in vitro and in experimental enterococcal endocarditis. Antimicrob Agents Chemother 2000; 44:1720-4. [PMID: 10817739 PMCID: PMC89943 DOI: 10.1128/aac.44.6.1720-1724.2000] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In vitro, the antimicrobial agent taurolidine inhibited virtually all of the bacteria tested, including vancomycin-resistant enterococci, oxacillin-resistant staphylococci, and Stenotrophomonas maltophilia, at concentrations between 250 and 2,000 microg/ml. Taurolidine was not effective in experimental endocarditis. While it appears unlikely that this antimicrobial would be useful for systemic therapy, its bactericidal activity and the resistance rates found (<10(-9)) are favorable indicators for its possible development for topical use.
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Affiliation(s)
- C Torres-Viera
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA
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Eliopoulos GM, Wennersten CB, Gold HS, Schülin T, Souli M, Farris MG, Cerwinka S, Nadler HL, Dowzicky M, Talbot GH, Moellering RC. Characterization of vancomycin-resistant Enterococcus faecium isolates from the United States and their susceptibility in vitro to dalfopristin-quinupristin. Antimicrob Agents Chemother 1998; 42:1088-92. [PMID: 9593132 PMCID: PMC105750 DOI: 10.1128/aac.42.5.1088] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In the course of clinical studies with the investigational streptogramin antimicrobial dalfopristin-quinupristin, isolates of vancomycin-resistant Enterococcus faecium were referred to our laboratory from across the United States. Seventy-two percent of the strains were of the VanA type, phenotypically and genotypically, while 28% were of the VanB type. High-level resistance to streptomycin or gentamicin was observed in 86 and 81%, respectively, of the VanA strains but in only 69 and 66%, respectively, of the VanB strains. These enterococci were resistant to ampicillin (MIC for 50% of the isolates tested [MIC50] and MIC90, 128 and 256 microg/ml, respectively) and to the other approved agents tested, with the exception of chloramphenicol (MIC90, 8 microg/ml) and novobiocin (MIC90, 1 microg/ml). Considering all of the isolates submitted, dalfopristin-quinupristin inhibited 86.4% of them at concentrations of < or = 1 microg/ml and 95.1% of them at < or = 2 microg/ml. However, for the data set comprised of only the first isolate submitted for each patient, 94.3% of the strains were inhibited at concentrations of < or = 1 microg/ml and 98.9% were inhibited at concentrations of < or = 2 microg/ml. Multiple drug resistance was very common among these isolates of vancomycin-resistant E. faecium, while dalfopristin-quinupristin inhibited the majority at concentrations that are likely to be clinically relevant.
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Affiliation(s)
- G M Eliopoulos
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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Souli M, Wennersten CB, Eliopoulos GM. In vitro activity of BAY 12-8039, a new fluoroquinolone, against species representative of respiratory tract pathogens. Int J Antimicrob Agents 1998; 10:23-30. [PMID: 9624540 DOI: 10.1016/s0924-8579(98)00020-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The in vitro antibacterial activity of BAY 12-8039, a novel 8-methoxy-quinolone, was compared with those of other quinolones, amoxicillin/clavulanate, cefuroxime and erythromycin against species commonly implicated in respiratory tract infections as well as viridans group streptococci. The new compound was highly active against methicillin-susceptible staphylococci (MIC90 0.125 microgram/ml), penicillin-susceptible and penicillin-resistant pneumococci (MIC90 0.5 and MIC50 0.25 microgram/ml, respectively), penicillin-susceptible and penicillin-resistant viridans group streptococci (MIC90 0.5 and 0.25 microgram/ml, respectively), group A streptococci (MIC90 0.25 microgram/ml), M. catarrhalis (MIC90 0.125 microgram/ml) and H. influenzae (MIC90 0.063 microgram/ml), irrespective of beta-lactamase production. It was, however, less active against methicillin-resistant staphylococci (MIC50 and MIC90, 2 and 4 micrograms/ml, respectively). The new compound demonstrated bactericidal activity at concentrations 2, 4, 8 times the MIC against representative isolates of the above collection. At a concentration of eight times the MIC, the frequency of spontaneous resistance ranged from 2.5 x 10(-7) to < 4 x 10(-8). These results suggested that BAY 12-8039 would be a promising agent for the eradication of respiratory tract pathogens and that clinical trials assessing its efficacy for the management of infections caused by these organisms are warranted.
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Affiliation(s)
- M Souli
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
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Souli M, Giamarellou H. Effects of slime produced by clinical isolates of coagulase-negative staphylococci on activities of various antimicrobial agents. Antimicrob Agents Chemother 1998; 42:939-41. [PMID: 9559814 PMCID: PMC105573 DOI: 10.1128/aac.42.4.939] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A novel in vitro semiquantitative method was developed to investigate the influence of staphylococcal slime on the activities of 22 antimicrobial agents. Pefloxacin, teicoplanin, and vancomycin demonstrated remarkable decreases in efficacy: 30, 52, and 63%, respectively. The activity of rifampin was not significantly reduced (0.99%), whereas all other agents tested were modestly affected (<15% decrease). These data could be influential in the treatment of implant-associated infections caused by slime-producing staphylococci.
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Affiliation(s)
- M Souli
- First Department of Propedeutic Medicine, Laiko General Hospital, Athens University School of Medicine, Greece
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