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Alavi SE, Koohi Moftakhari Esfahani M, Raza A, Adelnia H, Ebrahimi Shahmabadi H. PEG-grafted liposomes for enhanced antibacterial and antibiotic activities: An in vivo study. NanoImpact 2022; 25:100384. [PMID: 35559890 DOI: 10.1016/j.impact.2022.100384] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
Staphylococcus aureus (S. aureus) biofilm-associated infections are a primary concern for public health worldwide. Current therapeutics cannot penetrate the biofilms efficiently, resulting in low drug concentrations at the infected sites and increasing the frequency of drug usage. To solve this issue, nanotechnology platforms seem to be a promising approach. In this study, the potential therapeutic effects of (PEG)ylated liposome (PEG-Lip) for the delivery of nafcillin (NF) antibiotic were assessed. The results demonstrated that NF-loaded liposome (Lip-NF) and NF-loaded PEG-Lip (PEG-Lip-NF) released 76.4 and 62% of the loaded NF, respectively, in a controlled manner after 50 h. Also, it was found that PEG-Lip-NF, compared to Lip-NF and NF, was more effective against a methicillin-susceptible S. aureus (MSSA; minimum inhibitory concentration (MIC): 1.0 ± 0.03, 0.5 ± 0.02, and 0.25 ± 0.01 μg/mL; and minimum biofilm inhibitory concentration (MBIC50): 4.0 ± 0.18, 1.0 ± 0.04, and 0.5 ± 0.02 μg/mL for NF, Lip-NF, and PEG-Lip-NF, respectively). PEG-Lip-NF, compared to NF and Lip-NF, could also more efficiently decrease the side effects of NF through improving human MG-63 osteoblast cell viability (cell viability at 100 μM of NF: 76, 68, and 38% for PEG-Lip-NF, Lip-NF, and NF, respectively). PEG-Lip-NF, compared to control, NF, and Lip-NF groups, was more efficacious by 45, 25, and 10%, respectively, to decrease the virulence of MSSA bacteremia through inhibiting the weight loss of the infected mice. Also, PEG-Lip-NF and Lip-NF, compared to control and NF groups, caused a considerable decrease in the mortality rate in a murine model of bacteremia (number of dead mice: 0, 0, 2, and 8 out of 15 for PEG-Lip-NF, Lip-NF, NF, and control groups, respectively). Overall, the results of this study demonstrated that the loading of NF into PEG-Lip is a promising strategy to decrease the side effects of NF with improved antibacterial effects for the treatment of MSSA biofilm-associated infections.
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Affiliation(s)
- Seyed Ebrahim Alavi
- Department of Microbiology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Aun Raza
- School of Pharmacy, The University of Queensland, Woolloongabba 4102, Australia
| | - Hossein Adelnia
- Australian Institute for Bioengineering and Nanotechnology, the University of Queensland, Brisbane, Queensland 4072, Australia
| | - Hasan Ebrahimi Shahmabadi
- Department of Microbiology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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2
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Selvaraj J, Ponnulakshmi R, Vishnupriya V, Kirubhanand C. Molecular docking analysis of Enterotoxin I from Staphylococcus aureus with Nafcillin analogues. Bioinformation 2020; 16:731-735. [PMID: 34675457 PMCID: PMC8503772 DOI: 10.6026/97320630016731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/23/2020] [Revised: 08/15/2020] [Accepted: 08/15/2020] [Indexed: 11/23/2022] Open
Abstract
Staphylococcal enterotoxins (SEs) are liked with food poisoning and other related infections. Nafcillin is an antibiotic used to treat S. aureus. Therefore, it is of interest to study the molecular interactions of 25 nafcillin analogues with enterotoxin I using molecular docking analysis. The analysis shows optimal interaction features of Nafcillin analogues with Enterotoxin I from Staphylococcus aureus for further consideration.
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Affiliation(s)
- Jayaraman Selvaraj
- Department of Biochemistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 600 077, India
| | - Rajagopal Ponnulakshmi
- Central Research Laboratory, Meenakshi Academy of Higher Education and Research (Deemed to be University), West K. K. Nagar, Chennai-600 078, India
| | - Veeraraghavan Vishnupriya
- Department of Biochemistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 600 077, India
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Campos S, Salazar R, Arancibia-Miranda N, Rubio MA, Aranda M, García A, Sepúlveda P, Espinoza LC. Nafcillin degradation by heterogeneous electro-Fenton process using Fe, Cu and Fe/Cu nanoparticles. Chemosphere 2020; 247:125813. [PMID: 31951953 DOI: 10.1016/j.chemosphere.2020.125813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 05/03/2023]
Abstract
Heterogeneous electro-Fenton (HEF) is as an alternative to the conventional electro-Fenton (EF) process. HEF uses a solid phase catalyst, whereas EF employs a solubilized one. This implies that in HEF, material can be recovered through a simple separation process such as filtration or magnetic separation in HEF. HEF also has the advantage of not requires a previous pH adjustment, which facilitates working in a higher pH range. In this work, Fe, Cu and Fe/Cu bimetallic nanoparticles (Fe/Cu NPs) were synthesized, characterized and used for the degradation of Nafcillin (NAF). The effect of the adsorption and the anodic oxidation (AO-H2O2) process was tested to assess their influence on HEF. NAF adsorption did not exceed 24% of antibiotic removal and the AO-H2O2 process eliminated the total NAF after 240 min of electrolysis. Through the HEF process, the antibiotic was completely removed using Fe/Cu NPs after 7.0 min of electrolysis, while these NPs, mineralization reached 41% after 240 min. In this case, NAF degradation occurs mainly due to the generation of hydroxyl radicals in the BDD electrode, and the Fenton reaction with Fe and Cu NPs. The main organic intermediates produced during the degradation of NAF by HEF were identified allowing the proposal of degradation pathway. Finally, the antibiotic was also completely eliminated from a wastewater from slaughterhouse after 15 min of treatment by HEF and using Fe/Cu bimetallic NPs.
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Affiliation(s)
- Sebastian Campos
- Laboratorio de Electroquímica del Medio Ambiente, LEQMA, Departamento de Química de los Materiales, Universidad de Santiago de Chile, USACH, Casilla 40, C.P. 33, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile
| | - Ricardo Salazar
- Laboratorio de Electroquímica del Medio Ambiente, LEQMA, Departamento de Química de los Materiales, Universidad de Santiago de Chile, USACH, Casilla 40, C.P. 33, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile.
| | - Nicolás Arancibia-Miranda
- Center for the Development of Nanoscience and Nanotechnology, CEDENNA, 9170124, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile; Facultad de Química and Biología, Universidad de Santiago de Chile, USACH, Casilla 40, C.P. 33, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile
| | - M A Rubio
- Center for the Development of Nanoscience and Nanotechnology, CEDENNA, 9170124, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile; Facultad de Química and Biología, Universidad de Santiago de Chile, USACH, Casilla 40, C.P. 33, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile
| | - Mario Aranda
- Laboratorio de Investigación en Fármacos y Alimentos, Departamento de Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Chile
| | - Alejandra García
- Laboratorio de síntesis y modificación de nanoestructuras y materiales bidimensionales, Centro de Investigación en Materiales, Avanzados S.C. (CIMAV), Mexico
| | - Pamela Sepúlveda
- Center for the Development of Nanoscience and Nanotechnology, CEDENNA, 9170124, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile; Facultad de Química and Biología, Universidad de Santiago de Chile, USACH, Casilla 40, C.P. 33, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile.
| | - L Carolina Espinoza
- Laboratorio de Electroquímica del Medio Ambiente, LEQMA, Departamento de Química de los Materiales, Universidad de Santiago de Chile, USACH, Casilla 40, C.P. 33, Av. Libertador Bernardo ÓHiggins, 3363, Estación Central, Santiago, Chile.
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Twilla JD, Algrim A, Adams EH, Samarin M, Cummings C, Finch CK. Comparison of Nafcillin and Cefazolin for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia. Am J Med Sci 2020; 360:35-41. [PMID: 32376001 DOI: 10.1016/j.amjms.2020.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/04/2019] [Revised: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Traditionally, the antibiotic of choice for Methicillin-susceptible Staphylococcus aureus related blood stream infections (MSSA-BSI) are the antistaphylococcal penicillins. Cefazolin is considered an alternative agent, with recent evidence showing similar clinical efficacy. This study further evaluates the utility of nafcillin versus cefazolin in MSSA bacteremia including high disease burden sources of infection and its impact on treatment failure. METHODS This retrospective study included patients admitted to Methodist LeBonheur Healthcare adult hospitals from 2011 to 2016. Patients were included if they received at least 3 days of either nafcillin or cefazolin and had a positive blood culture for MSSA. The primary objective was to evaluate rates of treatment failure between groups. Secondary outcomes included clinical and microbiological cure, MSSA-BSI associated readmissions, identification of risk factors for treatment failure including disease burden, in-hospital and 90 day mortality. RESULTS A total of 277 patients were included (nafcillin n = 126; cefazolin n = 151). Treatment failure and microbiologic cure were similar between nafcillin and cefazolin (20.6% vs. 16.6%; 91.2% vs. 87.2%, respectively). Clinical cure was significantly higher in the cefazolin treatment arm (93.4 vs. 83.3%; P = 0.012). However, the total number of patients with high disease burden was greater in the nafcillin group (54.8% vs. 39.1%; P = 0.011). Higher rates of in-hospital mortality were observed in the nafcillin group (15.1% vs. 6%; P = 0.016). CONCLUSIONS Our study observed significantly higher rates of clinical cure and reduced in-hospital mortality in patients who received cefazolin. Further analysis is warranted to evaluate the effectiveness of these agents and identifying predictors of treatment failure.
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Affiliation(s)
- Jennifer D Twilla
- Methodist University Hospital, Memphis, Tennessee; College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Amie Algrim
- Methodist University Hospital, Memphis, Tennessee
| | - Ethan H Adams
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Michael Samarin
- Methodist University Hospital, Memphis, Tennessee; College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Carolyn Cummings
- Methodist University Hospital, Memphis, Tennessee; College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Christopher K Finch
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee.
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5
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Miller MA, Fish DN, Barber GR, Barron MA, Goolsby TA, Moine P, Mueller SW. A comparison of safety and outcomes with cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bloodstream infections. J Microbiol Immunol Infect 2018; 53:321-327. [PMID: 30190234 DOI: 10.1016/j.jmii.2018.07.006] [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] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/11/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Methicillin-susceptible Staphylococcus aureus (MSSA) is a frequent cause of bloodstream infections (BSI). Treatment with nafcillin (NAF) has been preferred to cefazolin (CFZ). However, comparable outcomes have been found with CFZ with possibly lower risk for side-effects. This study compared safety and effectiveness of NAF versus CFZ for MSSA BSI. METHODS This single center retrospective study evaluated adults admitted with MSSA BSI who received NAF or CFZ. Patients receiving ≥24 h of antibiotics were included for safety analyses. Patients receiving NAF or CFZ for ≥75% of a 14 day minimum treatment course were assessed for clinical effectiveness. The primary safety outcome was incidence of renal toxicity with multiple secondary safety endpoints. Clinical success was defined as symptom resolution, repeat negative cultures, lack of additional therapy for presumed failure, and lack of recurrence within 30 days. RESULTS A total of 130 patients receiving NAF (n = 79) or CFZ (n = 51) were included for safety analysis. Of those, 90 met criteria for effectiveness assessment (NAF n = 40, CFZ n = 50). Baseline characteristics were well matched. NAF was associated with a higher incidence of nephrotoxicity compared to CFZ (25% vs. 2%, RR 1.31, 95% CI 1.15-1.5, p < 0.001), allergic reactions (p = 0.01) and a trend for hepatotoxicity (p = 0.08). Clinical success was achieved in 82% NAF and 94% CFZ treated patients (p = 0.1). CONCLUSION CFZ was associated with less nephrotoxicity and no difference in clinical success compared to NAF for MSSA BSI. A prospective study comparing NAF to CFZ for MSSA BSI should be conducted to elucidate differences in therapies.
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Affiliation(s)
- Matthew A Miller
- Department of Pharmacy Services, University of Colorado Health-Anschutz Medical Campus, 12401 East 17th Avenue, Aurora, CO, 80045, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA
| | - Douglas N Fish
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA
| | - Gerard R Barber
- Department of Pharmacy Services, University of Colorado Health-Anschutz Medical Campus, 12401 East 17th Avenue, Aurora, CO, 80045, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA
| | - Michelle A Barron
- Division of Infectious Diseases, University of Colorado Denver School of Medicine, 12401 East 17th Avenue, Aurora, CO, 80045, USA
| | - Tiffany A Goolsby
- Department of Pharmacy Services, University of Colorado Health-Anschutz Medical Campus, 12401 East 17th Avenue, Aurora, CO, 80045, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA
| | - Pierre Moine
- Department of Anesthesiology, University of Colorado Denver, School of Medicine, Aurora, CO, 80045, USA
| | - Scott W Mueller
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA.
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Vidal J, Huiliñir C, Santander R, Silva-Agredo J, Torres-Palma RA, Salazar R. Effective removal of the antibiotic Nafcillin from water by combining the Photoelectro-Fenton process and Anaerobic Biological Digestion. Sci Total Environ 2018; 624:1095-1105. [PMID: 29625524 DOI: 10.1016/j.scitotenv.2017.12.159] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 05/03/2023]
Abstract
The elimination of the antibiotic Nafcillin (NAF), which is usually used in hospitals and veterinary clinics around the world, was assessed through a combination of three advanced electrochemical oxidation processes followed by anaerobic digestion process. In the first stage different electrochemical advanced oxidation processes (EAOPs) were used: electro-oxidation with hydrogen peroxide (EO-H2O2), electro-Fenton (EF) and Photo electro-Fenton (PEF). After PEF, almost complete and highly efficient degradation and elimination of NAF was achieved, with the concomitant elimination of the associated antimicrobial activity. The fast degradation rate produced by PEF is explained by the oxidative action of hydroxyl radicals (•OH) together with the direct UV photolysis of complexes formed between Fe3+ and some organic intermediates. Total removal of NAF occurs after 90min of electrolysis by PEF, with the generation of organic intermediates that remain in solution. However, when this post PEF process solution was treated with an anaerobic biological process, the intermediates generated in the electrochemical degradation of NAF were completely eliminated after 24h. The kinetic degradation of NAF as well as the identification/quantification of products and intermediates formed during the degradation of antibiotic, such as inorganic ions, carboxylic acids and aromatic compounds, were determined by chromatographic and photometric methods. Finally, an oxidation pathway is proposed for the complete conversion to CO2.
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Affiliation(s)
- Jorge Vidal
- Laboratorio de Electroquímica del Medio Ambiente (LEQMA), Departamento de Química de los Materiales, Facultad de Química y Biología, Universidad de Santiago de Chile (USACH), Casilla 40, Correo 33, Santiago, Chile
| | - Cesar Huiliñir
- Departamento de Ingeniería Química, Laboratorio de Biotecnología Ambiental, Facultad de Ingeniería, Universidad de Santiago de Chile (USACH), Chile
| | - Rocío Santander
- Laboratorio de Electroquímica del Medio Ambiente (LEQMA), Departamento de Química de los Materiales, Facultad de Química y Biología, Universidad de Santiago de Chile (USACH), Casilla 40, Correo 33, Santiago, Chile
| | - Javier Silva-Agredo
- Grupo de Investigación en Remediación Ambiental y Biocatálisis, Instituto de Química, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Ricardo A Torres-Palma
- Grupo de Investigación en Remediación Ambiental y Biocatálisis, Instituto de Química, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia.
| | - Ricardo Salazar
- Laboratorio de Electroquímica del Medio Ambiente (LEQMA), Departamento de Química de los Materiales, Facultad de Química y Biología, Universidad de Santiago de Chile (USACH), Casilla 40, Correo 33, Santiago, Chile.
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7
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Monogue ML, Ortwine JK, Wei W, Eljaaly K, Bhavan KP. Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia. J Infect Public Health 2018. [PMID: 29526442 DOI: 10.1016/j.jiph.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Anti-staphylococcal penicillins have long been the first-line treatment option for methicillin-susceptible Staphylococcus aureus (MSSA) infections. Recent retrospective data comparing nafcillin and cefazolin report similar clinical efficacy despite concerns about high inoculum MSSA infections. METHODS This was a retrospective, non-inferiority, cohort study comparing treatment failure rates between nafcillin and cefazolin in patients with MSSA bacteremia from any source, other than meningitis. Multiple logistic regression was used to adjust for confounding variables. RESULTS A total of 142 patients were included in the study. The overall treatment failure rate among patients receiving cefazolin was non-inferior to nafcillin (11.3% versus 8.5%; 90% confidence interval -5.2% to 10.8%). Rates of adverse drug events were significantly higher in the nafcillin arm (19.7% versus 7%; p=0.046). After adjustment for confounding variables, no difference between treatment groups was found in treatment failure (adjusted odds ratio (OR)=1.2; 95% CI, 0.3-4.5), but nafcillin was associated with significantly higher nephrotoxicity (adjusted odds ratio (OR)=5.4; 95% CI, 1.1-26.8). CONCLUSION Cefazolin was associated with lower nephrotoxicity and similar treatment failure rates compared to nafcillin suggesting that cefazolin is an appealing first line agent for most MSSA bloodstream infections.
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Affiliation(s)
| | - Jessica K Ortwine
- Parkland Hlth. and Hosp. System, Dallas, TX, United States; University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Wenjing Wei
- Parkland Hlth. and Hosp. System, Dallas, TX, United States; University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Khalid Eljaaly
- Department of Clinical Pharmacy, King Abdulaziz University, Saudi Arabia; College of Pharmacy, University of Arizona, United States
| | - Kavita P Bhavan
- University of Texas Southwestern Medical School, Dallas, TX, United States; University of Texas Southwestern Med. Ctr., Department of Medicine, Infectious Disease, Dallas, TX, United States
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Oh DH, Kim JJ, Kim J, Seong H, Lee SJ, Kim YC, Kim EJ, Jung IY, Jeong WY, Jeong SJ, Ku NS, Han SH, Choi JY, Song YG, Kim JM. Comparison of the efficacy of nafcillin and glycopeptides as definitive therapy for patients with methicillin-susceptible Staphylococcus aureus bacteremia: a retrospective cohort study. BMC Infect Dis 2018; 18:60. [PMID: 29378565 PMCID: PMC5789670 DOI: 10.1186/s12879-018-2978-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/02/2017] [Accepted: 01/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background Studies have shown that the prognosis of the treatment of methicillin-susceptible S. aureus (MSSA) with glycopeptides is inferior compared to treatment with β-lactam. However, there are only few studies comparing treatment with antistaphylococcal penicillin alone to glycopeptide treatment. The aim of this study was to compare the efficacy of nafcillin, an antistaphylococcal penicillin, with that of glycopeptides as a definitive therapy for MSSA bacteremia. Methods Patients with MSSA bacteremia recruited from a tertiary referral hospital were enrolled in this retrospective cohort study. Demographic characteristics, laboratory data, and clinical outcome of the treatment were compared between a group receiving nafcillin and a group receiving glycopeptides. Results A total of 188 patients with MSSA bacteremia were included in this study. The glycopeptide group had a higher rate of malignancy (28.6 vs. 60.8%, p < 0.001) and proportion of healthcare-associated infections (47.3 vs. 72.2%, p < 0.001) compared to the nafcillin group. The ratio of skin and soft tissue infections (30.0 vs. 16.7%, p = 0.037) and bone and joint infections (17.8 vs. 6.3%, p = 0.022), as well as levels of C-reactive protein (139.60 vs. 107.61 mg/dL, p = 0.022) were higher in the nafcillin group. All-cause 28-day mortality was significantly high in the glycopeptide group (7.7 vs. 20.6%, p = 0.013). Conclusion In patients with MSSA bacteremia, all-cause 28-day mortality rate was higher in a group treated with glycopeptides than in a group treated with nafcillin. Therefore, the use of nafcillin should be considered as a definitive therapy for MSSA bacteremia. Electronic supplementary material The online version of this article (10.1186/s12879-018-2978-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dong Hyun Oh
- Department of Internal Medicine, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, 02053, Seoul, South Korea
| | - Jung Ju Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jinnam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Hye Seong
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Se Ju Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Yong Chan Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - In Young Jung
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Woo Yong Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea. .,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea.
| | - Sang Hoon Han
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - Young Goo Song
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.,AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
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Rao Q, Schuster I, Seoud T, Zarrabi K, Goolsarran N. A Patient with Nafcillin-Associated Drug-Induced Liver Failure. Case Rep Gastroenterol 2017; 11:564-568. [PMID: 29033779 PMCID: PMC5636993 DOI: 10.1159/000480071] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/01/2017] [Indexed: 12/25/2022] Open
Abstract
Nafcillin-induced acute liver injury is a rare and potentially fatal complication that has been known since the 1960s but inadequately studied. At this time, the only proven treatment is early discontinuation of the drug. Because of the high prevalence of nafcillin class antibiotic use in the United States, it is important for clinicians to have a high clinical suspicion for this diagnosis. We present a case of liver failure attributable to nafcillin use in a 68-year-old male with a history methicillin-sensitive Staphylococcus and L3/L4 osteomyelitis. After starting long-term antibiotic therapy, he presented with painless jaundice which necessitated discontinuation of the drug. At the time of presentation, the patient's lab work exhibited a bilirubin/direct bilirubin of 9.4/8.2 mg/dL, alkaline phosphatase of 311 IU/L, and aspartate transaminase/alanine transaminase of 109/127 IU/L. The patient was switched to i.v. vancomycin given the concern for drug-induced liver injury. Imaging did not show obstruction of the hepatobiliary or pancreaticobiliary trees. Serology was unremarkable for viral etiology, autoimmune processes, Wilson disease, and hemochromatosis. A liver biopsy showed findings consistent with drug-induced liver injury. The patient's liver function tests peaked at day 7 of admission and trended towards normal levels with cessation of nafcillin therapy. The patient was discharged with a diagnosis of nafcillin-induced acute liver injury. Our case highlights the importance of early recognition of the diagnosis and careful monitoring of liver function when nafcillin is employed in the clinical setting.
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Affiliation(s)
- Qin Rao
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Isaiah Schuster
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Talal Seoud
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Kevin Zarrabi
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Nirvani Goolsarran
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
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Guido MV, Jithpratuck W, Parks GE, Krishnaswamy G. Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis. Gastroenterology Res 2017; 10:202-207. [PMID: 28725311 PMCID: PMC5505289 DOI: 10.14740/gr824w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/13/2017] [Indexed: 11/11/2022] Open
Abstract
A 71-year-old female with no history of liver disease or antibiotic allergy developed jaundice with elevated liver enzymes and eosinophilia following treatment with nafcillin for septic arthritis. Further workup demonstrated hepatocellular dysfunction and liver biopsy showed expansion of portal tracts by lymphocytes and eosinophils consistent with a hypersensitivity reaction. Nafcillin and related antibiotics were withdrawn, and her symptoms resolved 3 months later. We searched PubMed using terms of "nafcillin cholestasis" and "nafcillin hepatitis", and a review of the literature showed other reports of nafcillin-induced hepatitis and cholestasis. Avoidance and on occasion the guarded use of glucocorticoids can lead to recovery from the insult. This case report shows that while rare, nafcillin can cause cholestatic hepatitis through a likely eosinophil-mediated hypersensitivity reaction. Further studies are needed to elucidate the mechanism of this reaction.
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Affiliation(s)
- Mark V Guido
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | | | - Graham E Parks
- Department of Pathology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Guha Krishnaswamy
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.,Division of Allergy and Clinical Immunology, W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC, USA
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Abstract
The widespread bacterial resistance to a broad range of antibiotics necessitates rapid antibiotic susceptibility testing before effective treatment could start in the clinic. Among resistant bacteria, Staphylococcus aureus is one of the most important, and Methicillin-resistant (MRSA) strains are a common cause of life threatening infections. However, standard susceptibility testing for S. aureus is time consuming and thus the start of effective antibiotic treatment is often delayed. To circumvent the limitations of current susceptibility testing systems, we designed an assay that enables measurements of bacterial growth with higher spatial and temporal resolution than standard techniques. The assay consists of arrays of microwells that confine small number of bacteria in small spaces, where their growth is monitored with high precision. These devices enabled us to investigate the effect of different antibiotics on S. aureus growth. We measured the Minimal Inhibitory Concentration (MIC) in less than 3 hours. In addition to being significantly faster than the 48 hours needed for traditional microbiological methods, the assay is also capable of differentiating the specific effects of different antibiotic classes on S. aureus growth. Overall, this assay has the potential to become a rapid, sensitive, and robust tool for use in hospitals and laboratories to assess antibiotic sensitivity.
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Affiliation(s)
- Fatemeh Jalali
- BioMEMS Resource Center, Department of Surgery, Massachusetts General Hospital, Shriners Burns Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Felix Ellett
- BioMEMS Resource Center, Department of Surgery, Massachusetts General Hospital, Shriners Burns Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Daniel Irimia
- BioMEMS Resource Center, Department of Surgery, Massachusetts General Hospital, Shriners Burns Hospital, Harvard Medical School, Boston, MA 02129, USA
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Tong SY, Nelson J, Paterson DL, Fowler VG Jr, Howden BP, Cheng AC, Chatfield M, Lipman J, Van Hal S, O'Sullivan M, Robinson JO, Yahav D, Lye D, Davis JS; CAMERA2 study group and the Australasian Society for Infectious Diseases Clinical Research Network. CAMERA2 - combination antibiotic therapy for methicillin-resistant Staphylococcus aureus infection: study protocol for a randomised controlled trial. Trials 2016; 17:170. [PMID: 27029920 DOI: 10.1186/s13063-016-1295-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a serious infection resulting in 20–50 % 90-day mortality. The limitations of vancomycin, the current standard therapy for MRSA, make treatment difficult. The only other approved drug for treatment of MRSA bacteraemia, daptomycin, has not been shown to be superior to vancomycin. Surprisingly, there has been consistent in-vitro and in-vivo laboratory data demonstrating synergy between vancomycin or daptomycin and an anti-staphylococcal β-lactam antibiotic. There is also growing clinical data to support such combinations, including a recent pilot randomised controlled trial (RCT) that demonstrated a trend towards a reduction in the duration of bacteraemia in patients treated with vancomycin plus flucloxacillin compared to vancomycin alone. Our aim is to determine whether the addition of an anti-staphylococcal penicillin to standard therapy results in improved clinical outcomes in MRSA bacteraemia. Methods/Design We will perform an open-label, parallel-group, randomised (1:1) controlled trial at 29 sites in Australia, New Zealand, Singapore, and Israel. Adults (aged 18 years or older) with MRSA grown from at least one blood culture and able to be randomised within 72 hours of the index blood culture collection will be eligible for inclusion. Participants will be randomised to vancomycin or daptomycin (standard therapy) given intravenously or to standard therapy plus 7 days of an anti-staphylococcal β-lactam (flucloxacillin, cloxacillin, or cefazolin). The primary endpoint will be a composite outcome at 90 days of (1) all-cause mortality, (2) persistent bacteraemia at day 5 or beyond, (3) microbiological relapse, or (4) microbiological treatment failure. The recruitment target of 440 patients is based on an expected failure rate for the primary outcome of 30 % in the control arm and the ability to detect a clinically meaningful absolute decrease of 12.5 %, with a two-sided alpha of 0.05, a power of 80 %, and assuming 10 % of patients will not be evaluable for the primary endpoint. Discussion Key potential advantages of adding anti-staphylococcal β-lactams to standard therapy for MRSA bacteraemia include their safety profile, low cost, and wide availability. Trial registration ClinicalTrials.gov Identifier: NCT02365493. Registered 24 February 2015.
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