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Nayiga S, MacPherson EE, Mankhomwa J, Nasuwa F, Pongolani R, Kabuleta R, Kesby M, Dacombe R, Hilton S, Grace D, Feasey N, Chandler CI. "Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi. Glob Health Action 2024; 17:2322839. [PMID: 38441912 PMCID: PMC10916894 DOI: 10.1080/16549716.2024.2322839] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not. OBJECTIVE We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi. METHODS Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting. RESULTS Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred. CONCLUSIONS Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.
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Affiliation(s)
- Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Eleanor E MacPherson
- Research and Innovation Services, University of Glasgow, Glasgow, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - John Mankhomwa
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | | | | | - Rita Kabuleta
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mike Kesby
- School of Geography & Sustainable Development, University of St Andrews, St Andrews, UK
| | - Russell Dacombe
- Research and Innovation Services, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Delia Grace
- Natural Resources Institute, University of Greenwich, Chatham, UK
- International Livestock Research Institute, Nairobi, Kenya
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- The School of Medicine, University of St Andrews, St Andrews, UK
| | - Clare I.R. Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Luo Q, Lu P, Chen Y, Shen P, Zheng B, Ji J, Ying C, Liu Z, Xiao Y. ESKAPE in China: epidemiology and characteristics of antibiotic resistance. Emerg Microbes Infect 2024; 13:2317915. [PMID: 38356197 PMCID: PMC10896150 DOI: 10.1080/22221751.2024.2317915] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
The escalation of antibiotic resistance and the diminishing antimicrobial pipeline have emerged as significant threats to public health. The ESKAPE pathogens - Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. - were initially identified as critical multidrug-resistant bacteria, demanding urgently effective therapies. Despite the introduction of various new antibiotics and antibiotic adjuvants, such as innovative β-lactamase inhibitors, these organisms continue to pose substantial therapeutic challenges. People's Republic of China, as a country facing a severe bacterial resistance situation, has undergone a series of changes and findings in recent years in terms of the prevalence, transmission characteristics and resistance mechanisms of antibiotic resistant bacteria. The increasing levels of population mobility have not only shaped the unique characteristics of antibiotic resistance prevalence and transmission within People's Republic of China but have also indirectly reflected global patterns of antibiotic-resistant dissemination. What's more, as a vast nation, People's Republic of China exhibits significant variations in the levels of antibiotic resistance and the prevalence characteristics of antibiotic resistant bacteria across different provinces and regions. In this review, we examine the current epidemiology and characteristics of this important group of bacterial pathogens, delving into relevant mechanisms of resistance to recently introduced antibiotics that impact their clinical utility in China.
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Affiliation(s)
- Qixia Luo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Ping Lu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Beiwen Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Jinru Ji
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Chaoqun Ying
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Zhiying Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medical School, College of medicine, Zhejiang University, Hangzhou, People’s Republic of China
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Jin Y, Zhou W, Ge Q, Shen P, Xiao Y. Epidemiology and clinical features of Skin and Soft Tissue Infections Caused by PVL-Positive and PVL-Negative Methicillin-Resistant Staphylococcus aureus Isolates in inpatients in China: a single-center retrospective 7-year study. Emerg Microbes Infect 2024; 13:2316809. [PMID: 38323591 PMCID: PMC10883109 DOI: 10.1080/22221751.2024.2316809] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/06/2024] [Indexed: 02/08/2024]
Abstract
Previous studies have mainly focused on outpatient cases of skin and soft tissue infections (SSTIs), with limited attention to inpatient occurrences. Thus, we aimed to compare the clinical parameters of inpatients with SSTIs, performed genomic characterization, and determined the subtypes of Panton-Valentine leucocidin (PVL) bacteriophages of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from these patients. We found that PVL-positive patients had shorter hospital stays (mean, 9 vs. 24 days; p < 0.001) and abscess resolution durations (mean, 8 vs. 13 days; p < 0.01). PVL-positive MRSA-induced SSTIs were more frequently associated with abscesses [36/55 (65.5%) vs. 15/124 (12.1%), p < 0.001], with 52.7% undergoing incision and drainage; over 80% of PVL-negative patients received incision, drainage, and antibiotics. In PVL-positive patients receiving empirical antibiotics, anti-staphylococcal agents such as vancomycin and linezolid were administered less frequently (32.7%, 18/55) than in PVL-negative patients (74.2%, 92/124), indicating that patients with PVL-positive SSTIs are more likely to require surgical drainage rather than antimicrobial treatment. We also found that the ST59 lineage was predominant, regardless of PVL status (41.3%, 74/179). Additionally, we investigated the linear structure of the lukSF-PV gene, revealing that major clusters were associated with specific STs, suggesting independent acquisition of PVL by different strain types and indicating that significant diversity was observed even within PVL-positive strains detected in the same facility. Overall, our study provides comprehensive insights into the clinical, genetic, and phage-related aspects of MRSA-induced SSTIs in hospitalized patients and contributes to a more profound understanding of the epidemiology and evolution of these pathogens in the Chinese population.
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Affiliation(s)
- Ye Jin
- Department of General Intensive Care Unit, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- Key Laboratory of Early Warning and Intervention of Multiple Organ Failure, China National Ministry of Education, Hangzhou, Zhejiang, People's Republic of China
| | - Wangxiao Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qi Ge
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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He P, Huang S, Wang R, Yang Y, Yang S, Wang Y, Qi M, Li J, Liu X, Zhang X, Feng M. Novel nitroxoline derivative combating resistant bacterial infections through outer membrane disruption and competitive NDM-1 inhibition. Emerg Microbes Infect 2024; 13:2294854. [PMID: 38085067 PMCID: PMC10829846 DOI: 10.1080/22221751.2023.2294854] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
ABSTRACTNew Delhi metallo-β-lactamase-1 (NDM-1) has rapidly disseminated worldwide, leading to multidrug resistance and worse clinical prognosis. Designing and developing effective NDM-1 inhibitors is a critical and urgent challenge. In this study, we constructed a library of long-lasting nitroxoline derivatives and identified ASN-1733 as a promising dual-functional antibiotic. ASN-1733 can effectively compete for Ca2+ on the bacterial surface, causing the detachment of lipopolysaccharides (LPS), thereby compromising the outer membrane integrity and permeability and exhibiting broad-spectrum bactericidal activity. Moreover, ASN-1733 demonstrated wider therapeutic applications than nitroxoline in mouse sepsis, thigh and mild abdominal infections. Furthermore, ASN-1733 can effectively inhibit the hydrolytic capability of NDM-1 and exhibits synergistic killing effects in combination with meropenem against NDM-1 positive bacteria. Mechanistic studies using enzymatic experiments and computer simulations revealed that ASN-1733 can bind to key residues on Loop10 of NDM-1, hindering substrate entry into the enzyme's active site and achieving potent inhibitory activity (Ki = 0.22 µM), even in the presence of excessive Zn2+. These findings elucidate the antibacterial mechanism of nitroxoline and its derivatives, expand their potential application in the field of antibacterial agents and provide new insights into the development of novel NDM-1 inhibitors.
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Affiliation(s)
- Peng He
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Sijing Huang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Rui Wang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Yunkai Yang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Shangye Yang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Yue Wang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Mengya Qi
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Jiyang Li
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xuyao Zhang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
| | - Meiqing Feng
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, People’s Republic of China
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Chen Y, Liu L, Liu J, Ji T, Gao Y, Yang D, Zhao M, Zhai Y, Cao Z. Serotype distribution, antimicrobial resistance, and molecular characterization of group B Streptococcus isolates from Chinese pregnant woman. J Matern Fetal Neonatal Med 2024; 37:2295805. [PMID: 38124302 DOI: 10.1080/14767058.2023.2295805] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study was aimed to investigate the serotypes, antibiotic susceptibilities, and multi-locus sequence type (MLST) profiles of group B Streptococcus (GBS) in the Beijing area. METHODS Lower vaginal and rectal swabs were obtained from pregnant women of 35-37 gestational weeks (GWs) who attended the Beijing Obstetrics and Gynecology Hospital. All GBS isolates were identified with Gram staining, catalase reaction assays, and CAMP tests, followed by antibiotic susceptibility testing, serotype identification, multilocus sequence typing and erythromycin resistance gene analysis (ermB and mefE). RESULTS From July 2020 to June 2022, 311 (5.17%) of 6012 pregnant women that were screened for GBS colonization were detected positive. Of the eight serotypes identified (III, Ia, Ib, IV, II, VIII, V, and NT), serotypes III (43.09%), Ia (34.08%) and Ib (17.04%) were the predominant species. In the antimicrobial susceptibility experiments, the resistant rates measured for erythromycin, clindamycin, levofloxacin, and tetracycline were 76.21%, 63.99%, 50.80%, and 81.03%, respectively, and 7.6% of GBS isolates showed inducible clindamycin in resistance (D-test phenotype). Meanwhile, the multilocus sequence typing analysis showed that sequence type 19 (ST19) (30.34%) and ST10 (18.62%) were the dominant sequence types. Among the 237 erythromycin-resistant isolates, 176 harbored ermB (128, 54.00%) or mefE (48, 20.30%) gene alone. CONCLUSION The infection rates, serotypes or MSLT distribution, and antimicrobial resistance of GBS in Beijing area were investigated, which may be applied in analyses of the epidemiological characteristics of GBS. This contributes to the basic knowledge required for successful GBS vaccine development suited for disease prevention and treatment in China, as well as the implementation of effective clinical antimicrobials.
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Affiliation(s)
- Yifei Chen
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Lin Liu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jing Liu
- Laboratory Department of Tsinghua University Hospital, Beijing, China
| | - Tongzhen Ji
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yang Gao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Dongmei Yang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Mohan Zhao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yanhong Zhai
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zheng Cao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
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Duncan JL, Ahmad RN, Danesi H, Slade DJ, Davalos RV, Verbridge SS. Electro-antibacterial therapy (EAT) to enhance intracellular bacteria clearance in pancreatic cancer cells. Bioelectrochemistry 2024; 157:108669. [PMID: 38377890 DOI: 10.1016/j.bioelechem.2024.108669] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
Intratumoral bacteria have been implicated in driving tumor progression, yet effective treatments to modulate the tumor microbiome remain limited. In this study, we investigate the use of electroporation in combination with metronidazole to enhance the clearance of intracellular Fusobacterium nucleatum within pancreatic cancer cells. We explore various parameters, including electric field strength, pulse width, and pulse number to assess the permeability of pancreatic cancer cells infected with F. nucleatum, compared to non-infected cells of the same type. We subsequently quantify the clearance of intracellular bacteria when these pulsing schemes are applied to a suspension of infected pancreatic cancer cells in the presence of metronidazole. Our results reveal distinct differences in cell permeability between infected and non-infected cells, identifying a unique biophysical marker for host cells infected with F. nucleatum. We demonstrate that the combinatorial use of electroporation and metronidazole significantly enhances the delivery of metronidazole into host cells, leading to more effective clearance of intracellular F. nucleatum compared to independent treatments; we term this novel approach Electro-Antibacterial Therapy (EAT). EAT holds promise as an innovative strategy for addressing intratumoral bacteria in pancreatic cancer, other malignancies, and potentially treatment-resistant infections, offering new avenues for therapeutic intervention.
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Affiliation(s)
- Josie L Duncan
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech - Emory University, Atlanta, GA, USA
| | - Raffae N Ahmad
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Blacksburg, VA, USA
| | - Hunter Danesi
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Blacksburg, VA, USA
| | - Daniel J Slade
- Department of Biochemistry, Virginia Tech, Blacksburg, VA, USA
| | - Rafael V Davalos
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech - Emory University, Atlanta, GA, USA; Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Blacksburg, VA, USA.
| | - Scott S Verbridge
- Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences, Blacksburg, VA, USA
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Liu W, Sun Y, Zhou B, Chen Y, Liu M, Wang L, Qi M, Liu B, Dong B. Near-infrared light triggered upconversion nanocomposites with multifunction of enhanced antimicrobial photodynamic therapy and gas therapy for inflammation regulation. J Colloid Interface Sci 2024; 663:834-846. [PMID: 38447398 DOI: 10.1016/j.jcis.2024.02.179] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Antibacterial photodynamic therapy (aPDT) is highly effective in killing bacteria, while the problem of hypoxia and limited light penetration in deep tissue has not been properly solved. In addition, few aPDT works take into account the regulation of inflammation, which is an important regulatory process after antimicrobial therapy and the final purpose of treatment. In this work, to address the above isssues, we have designed a multi-functional composite UCNPs-Ce6-Mn(CO)5Br@Silane (referred to as UCM@Si), which consists of several key components: Up-conversion nanoparticles (UCNPs: NaErF4:Tm3+@NaYF4:Yb3+), Chlorin e6 (Ce6) and Manganese pentacarbonyl bromide (Mn(CO)5Br). When exposed to near-infrared (NIR) light (980 nm), the UCNPs can emit strong red light at 655 nm which further trigger the aPDT of Ce6. The generated reactive oxygen (ROS) subsequently break the metal carbonyl bond of Mn(CO)5Br, leading to the production of carbon monoxide (CO) molecules as well as manganese ions (Mn2+), which further decomposes hydrogen peroxide (H2O2) in the microenvironment to oxygen (O2). Therefore, this simple nanocomposite not only provides substantial self-oxygen replenishment for enhanced aPDT, but also facilitates effective inflammation regulation via CO across a wide range of deep infections. This approach leverages the unique properties of these materials to combat bacterial infections by simultaneously killing bacteria, regulating inflammation, and enhancing the oxygen levels in the affected microenvironment. This O2 and CO gas based aPDT treatment system offers a promising approach to comprehensively address microbial-induced infectious diseases, particularly deep infections, holding the potential clinical applications.
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Affiliation(s)
- Wei Liu
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Changchun 130021, China
| | - Yue Sun
- Department of Oral Implantology, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Bingshuai Zhou
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Changchun 130021, China
| | - Yifan Chen
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Changchun 130021, China
| | - Min Liu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui 230601, China
| | - Lin Wang
- Department of Oral Implantology, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Manlin Qi
- Department of Oral Implantology, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, Changchun 130021, China.
| | - Bailong Liu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui 230601, China.
| | - Biao Dong
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Changchun 130021, China.
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Jiang H, Fang W, Xu S, Luo H, Li D, Liu Y, Zeng Z, Tong Y, Zhao L. Synergistic quorum sensing inhibition and mild-temperature photothermal therapy of integrated nanoplatform for implant-associated biofilm infections. J Colloid Interface Sci 2024; 663:143-156. [PMID: 38401436 DOI: 10.1016/j.jcis.2024.02.155] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
In current clinical practice, the presence of biofilms poses a significant challenge in the effective elimination of bacterial infections because of the physical and chemical barriers formed by biofilms, which offer persistent protection to bacteria. Here, we developed hollow mesoporous polydopamine (hMP) nanoparticles (NPs) loaded with luteolin (Lu) as a quorum sensing inhibitor, which were further coated with hyaluronic acid (HA) shells to create hMP-Lu@HA NPs. We observed that upon reaching the infection site, the HA shells underwent initial degradation by the hyaluronidase enzyme present in the bacterial infection's microenvironment to expose the hMP-Lu NPs. Subsequently, Lu was released in response to the acidic conditions characteristic of bacterial infections, which effectively hindered and dispersed the biofilm. Moreover, when subjected to near-infrared irradiation, the robust photothermal conversion effect of hMP NPs accelerated the release of Lu and disrupted the integrity of the biofilms by localized heating. This dual action enhanced the eradication of the biofilm infection. Importantly, hMP-Lu@HA NPs also promoted tissue regeneration and healing at the implantation site, concurrently addressing biofilm infection. Taken together, this nanosystem, combined with mild-temperature photothermal therapy and quorum sensing inhibition strategy, holds significant potential for applications in the treatment of implantation-associated infections.
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Affiliation(s)
- Hezhong Jiang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, China
| | - Wenlan Fang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, China
| | - Shiqi Xu
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, China
| | - Haimeng Luo
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, China
| | - Dongqiu Li
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, China
| | - Yuan Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Zhijun Zeng
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu Medical College, Chengdu 610051, China.
| | - Yan Tong
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, China.
| | - Long Zhao
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu Medical College, Chengdu 610051, China.
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He P, Wang D, Zheng R, Wang H, Fu L, Tang G, Shi Z, Wu Y, Yang G. An antibacterial biologic patch based on bacterial cellulose for repair of infected hernias. Carbohydr Polym 2024; 333:121942. [PMID: 38494213 DOI: 10.1016/j.carbpol.2024.121942] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Abstract
Infection-associated complications and repair failures and antibiotic resistance have emerged as a formidable challenge in hernia repair surgery. Consequently, the development of antibiotic-free antibacterial patches for hernia repair has become an exigent clinical necessity. Herein, a GBC/Gel/LL37 biological patch (biopatch) with exceptional antibacterial properties is fabricated by grafting 2-Methacryloyloxyethyl trimethylammonium chloride (METAC), a unique quaternary ammonium salt with vinyl, onto bacterial cellulose (GBC), followed by compounding with gelatin (Gel) and LL37. The GBC/Gel/LL37 biopatch exhibits stable swelling capacity, remarkable mechanical properties, flexibility, and favorable biocompatibility. The synergistic effect of METAC and LL37 confers upon the GBC/Gel/LL37 biopatch excellent antibacterial efficacy against Staphylococcus aureus and Escherichia coli, effectively eliminating invading bacteria without the aid of exogenous antibiotics in vivo while significantly reducing local acute inflammation caused by infection. Furthermore, the practical efficacy of the GBC/Gel/LL37 biopatch is evaluated in an infected ventral hernia model, revealing that the GBC/Gel/LL37 biopatch can prevent the formation of visceral adhesions, facilitate the repair of infected ventral hernia, and effectively mitigate chronic inflammation. The prepared antibacterial GBC/Gel/LL37 biopatch is very effective in dealing with the risk of infection in hernia repair surgery and offers potential clinical opportunities for other soft injuries, exhibiting considerable clinical application prospects.
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Affiliation(s)
- Pengyu He
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Dawei Wang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Ruizhu Zheng
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Hao Wang
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Lina Fu
- College of Medicine, Huanghuai University, Zhumadian, Henan 463000, China; Zhumadian Central Hospital, Zhumadian, Henan 463000, China
| | - Guoliang Tang
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Zhijun Shi
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
| | - Yiping Wu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China.
| | - Guang Yang
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
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Yao X, Gao J, Wang L, Hou X, Ge L, Qin X, Qiu J, Deng X, Li W, Wang J. Cananga oil inhibits Salmonella infection by mediating the homeostasis of purine metabolism and the TCA cycle. J Ethnopharmacol 2024; 325:117864. [PMID: 38325671 DOI: 10.1016/j.jep.2024.117864] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/22/2024] [Accepted: 02/03/2024] [Indexed: 02/09/2024]
Abstract
ETHNOPHARMACOLOGY RELEVANCE Cananga oil (CO) is derived from the flowers of the traditional medicinal plant, the ylang-ylang tree. As a traditional antidepressant, CO is commonly utilized in the treatment of various mental disorders including depression, anxiety, and autism. It is also recognized as an efficient antibacterial insecticide, and has been traditionally utilized to combat malaria and acute inflammatory responses resulting from bacterial infections both in vitro and in vivo. AIM OF THE STUDY The objective of this study is to comprehensively investigate the anti-Salmonella activity and mechanism of CO both in vitro and in vivo, with the expectation of providing feasible strategies for exploring new antimicrobial strategies and developing novel drugs. METHODS The in vitro antibacterial activity of CO was comprehensively analyzed by measuring MIC, MBC, growth curve, time-killing curve, surface motility, biofilm, and Live/dead bacterial staining. The analysis of the chemistry and active ingredients of CO was conducted using GC-MS. To examine the influence of CO on the membrane homeostasis of Salmonella, we conducted utilizing diverse techniques, including ANS, PI, NPN, ONPG, BCECF-AM, DiSC3(5), and scanning electron microscopy (SEM) analysis. In addition, the antibacterial mechanism of CO was analyzed and validated through metabolomics analysis. Finally, a mouse infection model of Salmonella typhimurium was established to evaluate the toxic side effects and therapeutic effects of CO. RESULTS The antibacterial effect of CO is the result of the combined action of the main chemical components within its six (palmitic acid, α-linolenic acid, stearic acid, benzyl benzoate, benzyl acetate, and myristic acid). Furthermore, CO disrupts the balance of purine metabolism and the tricarboxylic acid cycle (TCA cycle) in Salmonella, interfering with redox processes. This leads to energy metabolic disorders and oxidative stress damage within the bacteria, resulting in bacterial shock, enhanced membrane damage, and ultimately bacterial death. It is worth emphasizing that CO exerts an effective protective influence on Salmonella infection in vivo within a non-toxic concentration range. CONCLUSION The outcomes indicate that CO displays remarkable anti-Salmonella activity both in vitro and in vivo. It triggers bacterial death by disrupting the balance of purine metabolism and the TCA cycle, interfering with the redox process, making it a promising anti-Salmonella medication.
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Affiliation(s)
- Xinyu Yao
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China; State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
| | - Jinying Gao
- Department of Respiratory Medicine, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Lanqiao Wang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
| | - Xiaoning Hou
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
| | - Litao Ge
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Xinxin Qin
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Jiazhang Qiu
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China; State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
| | - Xuming Deng
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China; State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
| | - Wei Li
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Jianfeng Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China; State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
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11
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Ishioka H, Fujii N, Tajima T, Suzuki S, Tsuzuki S, Matsunaga N, Ohmagari N. Cumulative antibiogram preparation among hospitals participating in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology. J Infect Chemother 2024; 30:459-462. [PMID: 37940037 DOI: 10.1016/j.jiac.2023.11.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The cumulative antibiogram is essential to guide empirical therapy for infectious diseases and monitor the trend of antimicrobial resistance. However, the status of antibiogram generation at medical institutions in Japan is uncertain. METHODS A web-based questionnaire survey was conducted in February 2023 on the status of antibiogram preparation among facilities participating in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE), an infection control surveillance system in Japan. RESULTS The questionnaire collection rate was 19.6% (379/1931). Of all facilities, 47% (178/379) performed microbiological tests mainly in-house, while 53% (201/379) performed microbiological tests mainly outsourced. Of all facilities, 78% (296/379) prepared antibiograms. Of those without antibiograms, 33% (27/83) were considering the development in the future. Some facilities cited staff shortage as a barrier to preparing antibiograms. Of the 214 facilities with antibiograms that could use the J-SIPHE system to prepare antibiograms, 19% (41/214) were using the J-SIPHE system to prepare their antibiograms. CONCLUSIONS One-quarter of the facilities that responded to the survey had not prepared antibiograms. Technical support for surveillance and awareness activity for using cumulative antibiograms might promote antibiogram preparation in Japan, which may improve antimicrobial stewardship and antimicrobial resistance measures.
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Affiliation(s)
- Haruhiko Ishioka
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
| | - Naoki Fujii
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Taichi Tajima
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sanae Suzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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12
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Rossi CC, Ahmad F, Giambiagi-deMarval M. Staphylococcus haemolyticus: An updated review on nosocomial infections, antimicrobial resistance, virulence, genetic traits, and strategies for combating this emerging opportunistic pathogen. Microbiol Res 2024; 282:127652. [PMID: 38432015 DOI: 10.1016/j.micres.2024.127652] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
Staphylococcus haemolyticus, a key species of the Staphylococcus genus, holds significant importance in healthcare-associated infections, due to its notable resistance to antimicrobials, like methicillin, and proficient biofilms-forming capabilities. This coagulase-negative bacterium poses a substantial challenge in the battle against nosocomial infections. Recent research has shed light on Staph. haemolyticus genomic plasticity, unveiling genetic elements responsible for antibiotic resistance and their widespread dissemination within the genus. This review presents an updated and comprehensive overview of the clinical significance and prevalence of Staph. haemolyticus, underscores its zoonotic potential and relevance in the one health framework, explores crucial virulence factors, and examines genetics features contributing to its success in causing emergent and challenging infections. Additionally, we scrutinize ongoing studies aimed at controlling spread and alternative approaches for combating it.
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Affiliation(s)
- Ciro César Rossi
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Viçosa, MG, Brazil.
| | - Faizan Ahmad
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Viçosa, MG, Brazil
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13
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Magrini E, Rando E, Del Giacomo P, Matteini E, Leanza GM, Sanmartin F, Carbone A, Maiuro G, Dusina A, Cingolani A. Cerebrospinal fluid drain infection caused by pandrug-resistant Staphylococcus epidermidis successfully treated with ceftaroline in combination with fosfomycin and vancomycin. Diagn Microbiol Infect Dis 2024; 109:116205. [PMID: 38422663 DOI: 10.1016/j.diagmicrobio.2024.116205] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 03/02/2024]
Abstract
External ventricular drain-related cerebrospinal fluid infection represents a fearsome complication of neurosurgical interventions. Although vancomycin represents the standard of care for methicillin-resistant CoNS healthcare-associated ventriculitis, resistance phenomena have been described. We reported a case of a persistent external ventricular fluid drain infection after device removal by pandrug-resistant Staphylococcus epidermidis successfully treated with intravenous ceftaroline in combination with fosfomycin and vancomycin. No evidence regarding pandrug-resistant S. epidermidis therapy currently exists to our knowledge. In this case, the S. epidermidis phenotype emerged during the therapy course, possibly due to initial device retention, biofilm formation and the host immune impaired response. Despite being poorly studied in vivo, ceftaroline may be considered an option when other alternatives are unavailable, thanks to its described activity against CoNS in vitro. This case extends the experience with ceftaroline for central nervous system infections suggesting it could also be used in high antimicrobial resistance settings for immunocompromised people.
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Affiliation(s)
- Eugenia Magrini
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Emanuele Rando
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Del Giacomo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elena Matteini
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Maria Leanza
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Sanmartin
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Carbone
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Maiuro
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alex Dusina
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonella Cingolani
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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14
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Li D, Rao H, Xu Y, Zhang M, Zhang J, Luo J. Monotherapy vs combination therapy in patients with Klebsiella pneumoniae bloodstream infection: A systematic review and meta-analysis. J Infect Chemother 2024; 30:372-378. [PMID: 38369125 DOI: 10.1016/j.jiac.2024.02.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/24/2023] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To determine whether mortality is lower in patients with Klebsiella pneumoniae bloodstream infection (BSI) who receive combination antimicrobial therapy than in those who receive monotherapy. METHODS Two authors independently searched for relevant articles in the PubMed, Embase, Web of Science, and Cochrane Library databases through to August 10, 2023. Risk of bias was evaluated using the ROBINS-I tool. Possible sources of heterogeneity were evaluated by meta-regression using a mixed-effects model. RESULTS Among 8044 articles screened, there were 23 studies (3443 patients) that were eligible for meta-analysis. Meta-regression analysis identified the proportion of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI to be a potential source of heterogeneity. Subgroup analysis showed that mortality on monotherapy was significantly higher when the proportion of patients with CRKP BSI was ≥50% (OR 1.75, 95% CI 1.33-2.30) and significantly lower when this proportion was <50% (OR 0.55, 95% CI 0.24-1.24). Overall mortality was significantly higher on tigecycline monotherapy (OR 2.86, 95% CI 1.46-5.59) than on combination therapy containing both these agents. There was a trend in favor of colistin/polymyxin B-containing combination therapy (OR 1.37, 95% CI 0.83-2.28). CONCLUSIONS Combination antimicrobial therapy can lower mortality in patients with CRKP but may not show a survival advantage over monotherapy when the proportion of patients with CRKP BSI is <50%. High-quality prospective observational studies are needed because of the high risk of bias and limited data in the studies performed to date.
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Affiliation(s)
- Dan Li
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China
| | - Huayun Rao
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China
| | - Yi Xu
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China
| | - Min Zhang
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China
| | - Jie Zhang
- Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jianrong Luo
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China.
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15
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McKnite AM, Green DJ, Nelson R, Brewer SC, Watt KM. Medication patterns and dosing guidance in pediatric patients supported with intermittent hemodialysis or continuous kidney replacement therapy. Pediatr Nephrol 2024; 39:1521-1532. [PMID: 38051389 DOI: 10.1007/s00467-023-06199-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Hemodialysis is a life-saving technology used during periods of acute or chronic kidney failure to remove toxins, and maintain fluid, electrolyte and metabolic balance. While this technology plays an important role for pediatric patients with kidney dysfunction, it can alter the pharmacokinetic behavior of medications placing patients at risk for suboptimal dosing and drug toxicity. The ability to directly translate pharmacokinetic alterations into dosing recommendations has thus far been limited and dosing guidance specific to pediatric hemodialysis patients is rare. Despite differences in dialysis prescription and patient populations, intermittent (iHD) and continuous kidney replacement therapy (CKRT) patients are often pooled together. In order to develop evidence-based dosing guidelines, it is important to first prioritize drugs for study in each modality. METHODS Here we aim to identify priority drugs in two hemodialysis modalities, through: 1) Identification of hospitalized, pediatric patients who received CKRT or intermittent hemodialysis (iHD) using a machine learning-based predictive model based on medications; 2) Identification of medication administration patterns in these patient cohorts; and 3) Identification of the most commonly prescribed drugs that lack published dosing guidance. RESULTS Notable differences were found in the pattern of medications and drug dosing guidance between iHD and CKRT patients. Antibiotics, diuretics and sedatives were more common in CKRT patients. Out of the 50 most commonly administered medications in the two modalities, only 34% and 28% had dosing guidance present for iHD and CKRT, respectively. CONCLUSIONS Our results add to the understanding of the differences between iHD and CKRT patient populations by identifying commonly used medications that lack dosing guidance for each hemodialysis modality, helping to pinpoint priority medications for further study. Overall, this study provides an overview of the current limitations in medication use in this at-risk population, and provides a framework for future studies by identifying commonly used medications in pediatric CKRT and iHD patients.
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Affiliation(s)
- Autumn M McKnite
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, USA.
| | - Danielle J Green
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Raoul Nelson
- Department of Pediatrics, Division of Pediatric Nephrology, University of Utah, Salt Lake City, UT, USA
| | - Simon C Brewer
- Department of Geography, University of Utah, Salt Lake City, UT, USA
| | - Kevin M Watt
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Division of Clinical Pharmacology, University of Utah, Salt Lake City, UT, USA
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16
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Dominic C, Pye HV, Mishra EK, Adriaenssens EM. Bacteriophages for bronchiectasis: treatment of the future? Curr Opin Pulm Med 2024; 30:235-242. [PMID: 38345396 DOI: 10.1097/mcp.0000000000001050] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW Bronchiectasis is a chronic respiratory disease characterized by dilated airways, persistent sputum production and recurrent infective exacerbations. The microbiology of bronchiectasis includes various potentially pathogenic microorganisms including Pseudomonas aeruginosa which is commonly cultured from patients' sputum. P. aeruginosa is difficult to eradicate and frequently exhibits antimicrobial resistance. Bacteriophage therapy offers a novel and alternative method to treating bronchiectasis and can be used in conjunction with antibiotics to improve patient outcome. RECENT FINDINGS Thirteen case reports/series to date have successfully used phages to treat infections in bronchiectasis patients, however these studies were constrained to few patients ( n = 32) and utilized personalized phage preparations and adjunct antibiotics. In these studies, phage therapy was delivered by inhalation, intravenously or orally and was well tolerated in most patients without any unfavourable effects. Favourable clinical or microbiological outcomes were seen following phage therapy in many patients. Longitudinal patient follow-up reported regrowth of bacteria and phage neutralization in some studies. There are five randomized clinical controlled trials ongoing aiming to use phage therapy to treat P. aeruginosa associated respiratory conditions, with limited results available to date. SUMMARY More research, particularly robust clinical trials, into how phages can clear respiratory infections, interact with resident microbiota, and how bacteria might develop resistance will be important to establish to ensure the success of this promising therapeutic alternative.
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Affiliation(s)
- Catherine Dominic
- Department of Respiratory Medicine, Norfolk and Norwich University Hospitals Foundation Trust
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Hannah V Pye
- Quadram Institute Bioscience, Norwich Research Park
| | - Eleanor K Mishra
- Department of Respiratory Medicine, Norfolk and Norwich University Hospitals Foundation Trust
- Norwich Medical School, University of East Anglia, Norwich, UK
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17
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Merchant N, Liu C. Thoracic empyema: aetiology, diagnosis, treatment, and prevention. Curr Opin Pulm Med 2024; 30:204-209. [PMID: 38323933 DOI: 10.1097/mcp.0000000000001054] [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] [Indexed: 02/08/2024]
Abstract
PURPOSE OF REVIEW The aim of this study was to review current key points in the aetiology, diagnosis, treatment, and prevention of empyema thoracis. Early postpandemic trends have seen an increasing global incidence and evolution in the aetiology of empyema. Due to varied aetiology and typically lengthy treatment, empyema will be disproportionately affected by the rising tide of antimicrobial resistance (AMR), thus warranting attention and further research. RECENT FINDINGS Multiple novel biomarkers (e.g. IL-36γ) are under investigation to aid diagnosis, while oral health assessment tools are now available for prognosticating and risk-stratifying patients with thoracic empyema. There exists an ongoing lack of evidence-based guidance surrounding antibiotic treatment duration, surgical intervention indication, and prognostic scoring utility. SUMMARY Understanding aetiologies in different global regions and settings is pivotal for guiding empirical treatment. Antimicrobial resistance will make thoracic empyema increasingly challenging to treat and should prompt increased awareness of prescribing practices. Novel biomarkers are under investigation which may speed up differentiation of pleural effusion types, allowing faster cohorting of patients.Although newly identified predictors of morbidity and mortality have been suggested to be beneficial for incorporation into clinical practice, further work is required to prognosticate, risk-stratify, and standardize treatment.
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Affiliation(s)
- Na'im Merchant
- University College London Hospitals NHS Foundation Trust
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18
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Sperling S, Dahl VN, Fløe A. Lung abscess: an update on the current knowledge and call for future investigations. Curr Opin Pulm Med 2024; 30:229-234. [PMID: 38411181 DOI: 10.1097/mcp.0000000000001058] [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] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW Lung abscess is a severe and complex respiratory infection. The purpose of this review is to discuss recent publications on lung abscess, covering topics such as epidemiology, clinical presentation, diagnosis, and treatment and prevention. RECENT FINDINGS Risk factors associated with lung abscess include structural lung disease, poor dental hygiene, and ventilator-associated pneumonia, while concerns are now raised regarding the potential of electronic cigarettes use as a risk factor. The complexity of lung abscess is reflected by the relative high number of case reports describing rare and complex cases. Early transthoracic drainage could improve in-hospital outcomes, while next-generation sequencing could become an important tool in diagnostics and future clinical studies. SUMMARY High-quality evidence and guidelines to support treatment of lung abscess are lacking. Despite advancements, we call for prospective studies to evaluate the use of invasive procedures and antibiotic treatment regimens.
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Affiliation(s)
- Søren Sperling
- Department of Respiratory Diseases and Allergy
- Department of Clinical Medicine
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19
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Orszulik ST. The quality of antimicrobial susceptibility test discs and implications for clinical outcomes. Diagn Microbiol Infect Dis 2024; 109:116237. [PMID: 38428376 DOI: 10.1016/j.diagmicrobio.2024.116237] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Disc diffusion remains the main technique for evaluating antibiotic activity in clinical microbiology laboratories. However, the assay protocol endorsed by the FDA, DIN, and WHO is invalid. Despite decades of research and practice in this field, the quantitative quality of manufactured discs is largely unknown, potentially leading to adverse clinical outcomes. The usual standards expected for new medical devices in terms of quality control, QA, and evidence-based assessment of outcomes are almost completely lacking. Recent data indicate that a large proportion of discs do not meet the specifications, and that disc diffusion is a poor predictor of clinical outcomes. In addition, lack of harmonisation between EUCAST and CLSI, despite many years of effort, strongly suggests that there are serious flaws in these systems. This area lacks scientific rigour, which may have also contributed to adverse clinical outcomes and the emergence of antimicrobial resistance.
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Affiliation(s)
- Stefan T Orszulik
- De La Rue Currency, Overton, Basingstoke, Hampshire, United Kingdom.
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20
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Onishi K, Morioka H, Imaizumi T, Tsuchimoto D, Nishio M, Komiyama T. Risk factors for cefmetazole-non-susceptible bacteremia in acute cholangitis. J Infect Chemother 2024; 30:423-428. [PMID: 37981024 DOI: 10.1016/j.jiac.2023.11.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Cefmetazole (CMZ), an antibiotic with limited international distribution, is recommended by the Tokyo Guidelines 2018 (TG18) for non-severe cases of acute cholangitis (AC). However, the risk factors for CMZ-non-susceptible (CMZ-NS) bacteremia in AC remain unclear. Here, we aimed to investigate the risk factors for CMZ-NS bacteremia and evaluate mortality in patients with AC. METHODS This single-center, retrospective, observational study included all patients diagnosed with definite bacteremic AC, based on TG18, from April 2019 to March 2023. Risk factors for CMZ-NS bacteremia were analyzed by univariate, and age- and sex-adjusted, logistic regression analyses. Mortality was compared by cause of obstruction, CMZ-susceptible/CMZ-NS bacteremia, and initial treatment. RESULTS In total, 165 patients were enrolled. CMZ-NS bacteremia was diagnosed in 46 (27.9 %) patients. Histories of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy were identified as significant factors associated with the risk of CMZ-NS bacteremia. Thirteen patients died within 30 days of hospital admission. The mortality of patients with AC and malignant biliary obstruction was statistically higher than that of patients with bile duct stones. No patients with AC and bile duct stones died in the group with CMZ-NS bacteremia and inappropriate initial antibiotics. CONCLUSIONS In AC, a history of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy are associated with an increased risk of CMZ-NS bacteremia. Therefore, the choice of empiric therapy for AC should be based on the etiology and patient background, rather than on the severity.
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Affiliation(s)
- Katsuhiro Onishi
- Department of Pharmacy, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
| | - Hiroshi Morioka
- Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Daisuke Tsuchimoto
- Department of Pharmacy, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
| | - Mitsuru Nishio
- Infection Control Team, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan; Department of Clinical Laboratory, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
| | - Takuma Komiyama
- Department of Gastroenterology, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
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Wei X, Liu C, Li Z, Gu Z, Yang J, Luo K. Chitosan-based hydrogel dressings for diabetic wound healing via promoting M2 macrophage-polarization. Carbohydr Polym 2024; 331:121873. [PMID: 38388059 DOI: 10.1016/j.carbpol.2024.121873] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Abstract
A long-term inflammatory phase of diabetic wounds is the primary cause to prevent their effective healing. Bacterial infection, excess reactive oxygen species (ROS), especially failure of M2-phenotype macrophage polarization can hinder the transition of diabetic wounds from an inflammation phase to a proliferation one. Herein, a chitosan-based hydrogel dressing with the ability of regulating M2 macrophage polarization was reported. The PAAc/CFCS-Vanillin hydrogel dressing was synthesized by one step thermal polymerization of catechol-functionalized chitosan (CFCS), acrylic acid, catechol functional methacryloyl chitosan‑silver nanoparticles (CFMC-Ag NPs) and bioactive vanillin. The PAAc/CFCS-Vanillin hydrogel possessed sufficient mechanical strength and excellent adhesion properties, which helped rapidly block bleeding of wounds. Thanks to CFCS, CFMC-Ag NPs and vanillin in the hydrogel, it displayed excellent antibacterial infection in the wounds. Vanillin helped scavenge excess ROS and regulate the levels of inflammatory factors to facilitate the polarization of macrophages into the M2 phenotype. A full-thickness skin defect diabetic wound model showed that the wounds treated by the PAAc/CFCS-Vanillin hydrogel exhibited the smallest wound area, and superior granulation tissue regeneration, remarkable collagen deposition, and angiogenesis were observed in the wound tissue. Therefore, the PAAc/CFCS-Vanillin hydrogel could hold promising potential as a dressing for the treatment of diabetic chronic wounds.
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Affiliation(s)
- Xuelian Wei
- Department of Radiology, Huaxi MR Research Center (HMRRC), Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Caikun Liu
- School of Biomedical Sciences and Engineering, Guangzhou International Campus, South China University of Technology, Guangzhou 511442, China
| | - Zhiqian Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhengxiang Gu
- Department of Radiology, Huaxi MR Research Center (HMRRC), Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Junxiao Yang
- State Key Laboratory of Environmental-Friendly Energy Materials, Southwest University of Science and Technology, Mianyang 621010, China.
| | - Kui Luo
- Department of Radiology, Huaxi MR Research Center (HMRRC), Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, and Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, 610041, China.
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22
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Padaga SG, Ch S, Paul M, Wable BD, Ghosh B, Biswas S. Chitosan oligosaccharide/pluronic F127 micelles exhibiting anti-biofilm effect to treat bacterial keratitis. Carbohydr Polym 2024; 330:121818. [PMID: 38368100 DOI: 10.1016/j.carbpol.2024.121818] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/23/2023] [Accepted: 01/10/2024] [Indexed: 02/19/2024]
Abstract
Mono or dual chitosan oligosaccharide lactate (COL)-conjugated pluronic F127 polymers, FCOL1 and FCOL2 were prepared, self-assembled to form micelles, and loaded with gatifloxacin. The Gati@FCOL1/Gati@FCOL2 micelles preparation process was optimized by QbD analysis. Micelles were characterized thoroughly for size, CMC, drug compatibility, and viscosity by GPC, DLS, SEM, IR, DSC, and XRD. The micelles exhibited good cellular uptake in both monolayers and spheroids of HCEC. The antibacterial and anti-biofilm activities of the micelles were evaluated on P. aeruginosa and S. aureus. The anti-quorum sensing activity was explored in P. aeruginosa by analyzing micelles' ability to produce virulence factors, including AHLs, pyocyanin, and the motility behavior of the organism. Gati@FCOL2 Ms was mucoadhesive, cornea-penetrant, antibacterial, and inhibited the biofilm formation by P. aeruginosa and S. aureus significantly more than Gati@FCOL1. A significant reduction in bacterial load in mice cornea was observed after Gati@FCOL2 Ms-treatment to the P. aeruginosa-induced bacterial keratitis-infected mice.
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Affiliation(s)
- Sri Ganga Padaga
- Nanomedicine Research Lab, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad 500078, Telangana, India
| | - Sanjay Ch
- Nanomedicine Research Lab, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad 500078, Telangana, India
| | - Milan Paul
- Nanomedicine Research Lab, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad 500078, Telangana, India
| | - Bhavika Deepak Wable
- Nanomedicine Research Lab, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad 500078, Telangana, India
| | - Balaram Ghosh
- Nanomedicine Research Lab, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad 500078, Telangana, India
| | - Swati Biswas
- Nanomedicine Research Lab, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad 500078, Telangana, India.
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23
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Tanha N, Areskog Lejbman I, De Bus L, De Pascale G, Garnacho-Montero J, Leone M, Fujitan S, De Waele JJ, Torisson G, Sjövall F. Clinical outcomes in combination versus mono antibiotic therapy in ICU admitted patients with a suspected infection - A substudy of the DIANA study. J Crit Care 2024; 80:154501. [PMID: 38128219 DOI: 10.1016/j.jcrc.2023.154501] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE In a retrospective cohort study of intensive care unit (ICU) admitted adult patients with suspected or confirmed infection, associations between combination versus mono empirical antibiotic therapy and clinical cure at day 7 as well as mortality at day 7 and 28, were investigated. MATERIALS AND METHODS Patients from the DIANA study were grouped and analysed by combination versus mono antibiotic therapy. Clinical cure was defined as survival and resolution of all signs and symptoms related to the infection. Odds ratios (ORs) were calculated by logistic regression analyses. RESULTS Of the 1398 included patients, 568 patients (41%) received combination therapy. In total, 641(46%) patients achieved clinical cure and 135 (10%) patients had died as of day 7. There were no significant associations between combination and mono therapy relating to clinical cure and mortality. CONCLUSIONS This study found no differences in clinical cure and mortality between empirical combination versus mono therapy in a large cohort of ICU patients with a suspected infection.
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Affiliation(s)
- Nima Tanha
- Department of Perioperative Medicine and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Ilja Areskog Lejbman
- Department of Perioperative Medicine and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Gennaro De Pascale
- Department of Basic Biotechnological Sciences, Intensive Clinics and Perioperatives, Cattolica del Sacro Cuore University, Rome, Italy
| | | | - Marc Leone
- Department of Anesthesiology and Intensive care unit, Nord Hospital, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France.
| | - Shigeki Fujitan
- Department of Emergency medicine and Critical care medicine, St. Marianna University, Kanagawa, Japan
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden.
| | - Fredrik Sjövall
- Department of Perioperative Medicine and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden.
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24
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Nelson A, Baur JW, Lew A, Pettit NN, Nguyen CT. Rethinking Perioperative Antibiotic Prophylaxis for Low-Risk Head and Neck Procedures. Ann Otol Rhinol Laryngol 2024; 133:458-461. [PMID: 38183237 DOI: 10.1177/00034894231222690] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
OBJECTIVE For true clean-contaminated head and neck procedures, the literature supports ≤24 hours of perioperative antibiotics. However, there are certain otolaryngology procedures with low surgical site infection (SSI) risk for which there is negligible benefit from antibiotic prophylaxis. The objective of this evaluation was to describe antibiotic use and adherence to evidence-based institutional guidelines in low-risk head and neck procedures. METHODS This was a single-center, retrospective cohort study of patients undergoing low-risk clean-contaminated head and neck procedures wherein antibiotic prophylaxis was not indicated, based on evidence-based institutional guidelines. RESULTS Among the 291 included patients, perioperative antibiotics were unnecessarily administered in 29% of patients. Among patients who received antibiotics, 76% received preoperative antibiotics and 41% received postoperative antibiotics, for a median duration of 7 days. There were no significant differences in SSIs, mortality, and length of stay for those receiving perioperative antibiotics versus those not receiving perioperative antibiotics. CONCLUSION These data highlight the need for antibiotic stewardship interventions and partnerships between antibiotic stewardship teams and surgical services.
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Affiliation(s)
- Avery Nelson
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Jordan W Baur
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Alison Lew
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Natasha N Pettit
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Cynthia T Nguyen
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
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25
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Eikani C, Hoyt A, Cho E, Levack AE. The State of Local Antibiotic Use in Orthopedic Trauma. Orthop Clin North Am 2024; 55:207-216. [PMID: 38403367 DOI: 10.1016/j.ocl.2023.07.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Fracture-related infections are a challenging complication in orthopedic trauma that often necessitates multiple surgeries. Early administration of systemic antibiotics and surgical intervention remains the gold standard of care, but despite these measures, treatment failures can be as high as 35%. For these reasons, the introduction of local antibiotics at the site of at-risk fractures has increased over the past decade. This review looks at the various measures being used clinically including local antibiotic powder, polymethylmethacrylate, biodegradable substances, antibiotic-coated implants, and novel methods such as hydrogels and nanoparticles that have the potential for use in the future.
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Affiliation(s)
- Carlo Eikani
- Loyola University Stritch School of Medicine; Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maguire Suite 1700, Maywood, IL, USA.
| | - Aaron Hoyt
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maguire Suite 1700, Maywood, IL, USA
| | - Elizabeth Cho
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maguire Suite 1700, Maywood, IL, USA
| | - Ashley E Levack
- Loyola University Stritch School of Medicine; Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maguire Suite 1700, Maywood, IL, USA
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Moghadam MT, Mojtahedi A, Salamy S, Shahbazi R, Satarzadeh N, Delavar M, Ashoobi MT. Phage therapy as a glimmer of hope in the fight against the recurrence or emergence of surgical site bacterial infections. Infection 2024; 52:385-402. [PMID: 38308075 DOI: 10.1007/s15010-024-02178-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE Over the last decade, surgery rates have risen alarmingly, and surgical-site infections are expanding these concerns. In spite of advances in infection control practices, surgical infections continue to be a significant cause of death, prolonged hospitalization, and morbidity. As well as the presence of bacterial infections and their antibiotic resistance, biofilm formation is one of the challenges in the treatment of surgical wounds. METHODS This review article was based on published studies on inpatients and laboratory animals receiving phage therapy for surgical wounds, phage therapy for tissue and bone infections treated with surgery to prevent recurrence, antibiotic-resistant wound infections treated with phage therapy, and biofilm-involved surgical wounds treated with phage therapy which were searched without date restrictions. RESULTS It has been shown in this review article that phage therapy can be used to treat surgical-site infections in patients and animals, eliminate biofilms at the surgical site, prevent infection recurrence in wounds that have been operated on, and eradicate antibiotic-resistant infections in surgical wounds, including multi-drug resistance (MDR), extensively drug resistance (XDR), and pan-drug resistance (PDR). A cocktail of phages and antibiotics can also reduce surgical-site infections more effectively than phages alone. CONCLUSION In light of these encouraging results, clinical trials and research with phages will continue in the near future to treat surgical-site infections, biofilm removal, and antibiotic-resistant wounds, all of which could be used to prescribe phages as an alternative to antibiotics.
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Affiliation(s)
- Majid Taati Moghadam
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mojtahedi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shakiba Salamy
- Department of Microbiology, Faculty of Pharmacy, Islamic Azad University, Tehran, Iran
| | - Razieh Shahbazi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Naghmeh Satarzadeh
- Student Research Committee, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Delavar
- Vice President of Health and Executive Vice President, Rey Health Center, Tehran University of Medical Sciences, Tehran, Iran
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Dyer CEF, Kalua K, Chisambi AB, Wand H, McManus H, Liu B, Kaldor JM, Vaz Nery S. Water, Sanitation, and Hygiene (WASH) Factors Influencing the Effectiveness of Mass Drug Administration to Eliminate Trachoma as a Public Health Problem in Malawi. Ophthalmic Epidemiol 2024; 31:127-133. [PMID: 36987395 DOI: 10.1080/09286586.2023.2194409] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Following a national population-based trachoma survey in Malawi one round of azithromycin mass drug administration (MDA) was carried out, with a post-MDA impact survey showing TF prevalence below 5% and considered eliminated as a public health problem. However, active trachoma was still present in over 200 children. We assessed whether water, sanitation, and hygiene (WASH) factors were associated with ongoing presence of TF in children aged 1-9 years following MDA. METHODS A secondary analysis was performed on a sub-set of the post-MDA impact survey data for children aged 1-9 years. We used a logistic regression analysis, adjusted for clustering at the household and village level. RESULTS Among 16,142 children aged 1-9 years, 209 (1.3%) had TF after MDA. Factors associated with a significantly lower odds of TF after MDA were living in a household with a handwashing facility (aOR: 0.37) and living in a household where water for washing is located further away from the home (30 min away aOR: 0.39, p = .034, or more than 1 h away aOR: 0.31, p = .018) compared with water in the yard. CONCLUSION The inverse association between a domestic handwashing facility and TF is consistent with previous findings, but the association of increasing distance to collect water for washing with a reduced risk of TF was unexpected and may reflect the impact of drought and unmeasured behavioural factors related to water usage. A more comprehensive collection of sociodemographic and WASH factor information in population-based trachoma surveys will provide insight into achieving and maintaining low levels of trachoma.
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Affiliation(s)
- Clare E F Dyer
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Khumbo Kalua
- Department of Ophthalmology, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre Institute for Community Ophthalmology, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Alvin B Chisambi
- Blantyre Institute for Community Ophthalmology, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Hamish McManus
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Bette Liu
- School of Population Health, University of New South Wales, Sydney, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
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28
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Bruno DR, Cleale RM, Jardon G, Short T, Mills B, Pedraza JR. Outcomes after treatment of nonsevere gram-negative clinical mastitis with ceftiofur hydrochloride for 2 or 5 days compared with negative control. J Dairy Sci 2024; 107:2390-2405. [PMID: 37923203 DOI: 10.3168/jds.2023-23684] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
A study was conducted at 3 commercial dairies in California to compare outcomes of treating nonsevere (mild and moderate) gram-negative (GN) clinical mastitis (CM) with intramammary (IMM) ceftiofur HCl (125 mg of ceftiofur HCl per tube) in either 2-d (SP2) or 5-d (SP5) treatment programs compared with nontreatment (CON). In addition, we contrasted results from cases classified as mild and moderate. Four hundred fifteen cases were included in the final dataset, including 135 CON, 133 SP2, and 147 SP5. Milk from quarters with CM was sampled for on-farm culture (OFC) to differentiate gram-positive (GP) and GN bacteria, with results known within 24 h. Those with GN infections were randomly assigned to experimental groups, while those with GP, mixed infections, and contaminated samples did not continue in the study and received standard farm therapy. For cows with GN infections, a sample was submitted for MALDI-TOF assay. Only nonsevere cases were enrolled, and all quarters yielded monocultures of GN species. Clinical scores were obtained 0, 1, 2, 3, 4, 5, 14, 21, and 28 ± 3 d relative to enrollment. Milk samples were collected from quarters 14, 21, and 28 ± 3 d after enrollment, and submitted for routine culture and, when appropriate, submitted to MALDI-TOF evaluation. For many response criteria, there were significant interactions between treatments and CM severity scores at the time of enrollment, with effectiveness of ceftiofur HCl treatment being more beneficial compared with CON as mastitis clinical severity increased. While most treatment responses were significant for animals with mild or moderate GN mastitis, the largest responses were noted among cows with moderate CM cases.
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Affiliation(s)
- D R Bruno
- University of California Agriculture and Natural Resources, Cooperative Extension, Fresno, CA 93710.
| | | | - G Jardon
- Department of Animal Science, South Dakota State University, Brookings, SD 57007
| | - T Short
- Zoetis, Parsippany, NJ 07054
| | - B Mills
- Cattle Services, Mooresville, NC 28115
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Beltsios E, Zubarevich A, Ruemke S, Rubalskii E, Osswald A, Arjomandi Rad A, Heidenau F, Buer J, Hanke J, Schmitto J, Popov AF, Kuehn C, Schmack B, Ruhparwar A, Weymann A. Antibacterial copper-filled TiO 2 coating of cardiovascular implants to prevent infective endocarditis-A pilot study. Artif Organs 2024; 48:356-364. [PMID: 38010063 DOI: 10.1111/aor.14688] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Infective endocarditis (IE) poses a significant health risk, especially in patients with prosthetic heart valves. Despite advances in treatment, mortality rates remain high. This study aims to investigate the antibacterial properties of a copper titanium dioxide (4× Cu-TiO2) coating on cardiovascular implants against Staphylococcus aureus, a common causative agent of IE. METHODS Titanium oxide carriers functionalized with copper ions were employed as an antibacterial coating for heart and vascular prostheses. The coating's antibacterial efficacy was assessed using S. aureus ATCC 29213. Microscopic evaluations were conducted on both biological and artificial materials. Antibacterial activity was qualitatively assessed via a modified disc diffusion method and quantitatively measured through colony counts in NaCl suspensions. RESULTS The coating process was successfully applied to all tested cardiovascular prosthetic materials. Qualitative assessments of antibacterial effectiveness revealed an absence of bacterial growth in the area directly beneath the coated valve. Quantitative evaluations showed a significant reduction in bacterial colonization on coated mechanical valves, with 2.95 × 104 CFU per valve, compared to 1.91 × 105 CFU in control valves. CONCLUSIONS The 4× Cu-TiO2 coating demonstrated promising antibacterial properties against S. aureus, suggesting its potential as an effective strategy for reducing the risk of bacterial colonization of cardiovascular implants. Further studies are needed to assess the longevity of the coating and its efficacy against other pathogens.
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Affiliation(s)
- Eleftherios Beltsios
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Stefan Ruemke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Evgenii Rubalskii
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | | | | | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jasmin Hanke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Schmitto
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bastian Schmack
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Tabah A, De Bus L, Leone M. Antibiotic de-escalation: finally, some action and not only words. Lancet Infect Dis 2024; 24:331-333. [PMID: 38215768 DOI: 10.1016/s1473-3099(23)00749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Redcliffe 4020, QLD, Australia; Queensland University of Technology, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
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Kannan KP, Gunasekaran V, Sreenivasan P, Sathishkumar P. Recent updates and feasibility of nanodrugs in the prevention and eradication of dental biofilm and its associated pathogens-A review. J Dent 2024; 143:104888. [PMID: 38342369 DOI: 10.1016/j.jdent.2024.104888] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVES Dental biofilm is one of the most prevalent diseases in humans, which is mediated by multiple microorganisms. Globally, half of the human population suffers from dental biofilm and its associated diseases. In recent trends, nano-formulated drugs are highly attractive in the treatment of dental biofilms. However, the impact of different types of nanodrugs on the dental biofilm and its associated pathogens have not been published till date. Thus, this review focuses on the recent updates, feasibility, mechanisms, limitations, and regulations of nanodrugs applications in the prevention and eradication of dental biofilm. STUDY SELECTION, DATA AND SOURCES A systematic search was conducted in PubMed/Google Scholar/Scopus over the past five years covering the major keywords "nanodrugs, metallic nanoparticles, metal oxide nanoparticles, natural polymers, synthetic polymers, biomaterials, dental biofilm, antibiofilm mechanism, dental pathogens", are reviewed in this study. Nearly, 100 scientific articles are selected in this relevant topic published between 2019 and 2023. Data from the selected studies dealing with nanodrugs used for biofilm treatment was qualitatively analyzed. CONCLUSIONS The nanodrugs such as silver nanoparticles, gold nanoparticles, selenium nanoparticles, zinc oxide nanoparticles, copper oxide nanoparticles, titanium oxide nanoparticles, hydroxyapatite nanoparticles and these inorganic nanoparticles incorporated polymer-based nanocomposites, organic/inorganic nanoparticles mediated antimicrobial photodynamic therapy exhibits an excellent antibacterial and antibiofilm activity towards dental pathogens. Finally, this review highlights that bioinspired nanodrugs will be very useful to control the dental biofilm and its associated diseases. CLINICAL SIGNIFICANCE Microbial influence on the oral environment is unavoidable; therefore, curing such dental biofilms and pathogens is essential for the impactful reflection of applying biocompatible treatments. In this direction, the current review explains the demand for the nanodrug in inhibiting biofilms for the effective exploration of employing treatments.
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Affiliation(s)
- Kannika Parameshwari Kannan
- Green Lab, Department of Prosthodontics, Saveetha Dental College and Hospital, SIMATS, Saveetha University, Chennai 600 077, India
| | - Vinothini Gunasekaran
- Green Lab, Department of Prosthodontics, Saveetha Dental College and Hospital, SIMATS, Saveetha University, Chennai 600 077, India
| | - Pavithra Sreenivasan
- Green Lab, Department of Prosthodontics, Saveetha Dental College and Hospital, SIMATS, Saveetha University, Chennai 600 077, India
| | - Palanivel Sathishkumar
- Green Lab, Department of Prosthodontics, Saveetha Dental College and Hospital, SIMATS, Saveetha University, Chennai 600 077, India.
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Bagcchi S. New candidate to combat drug-resistant bacteria. Lancet Infect Dis 2024; 24:e227. [PMID: 38521076 DOI: 10.1016/s1473-3099(24)00166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
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Haghparast‐Kenarsari T, Abdouss M, Heidari Keshel S, Heshmatipour Z, Rahimi A, Biazar E. Improving properties of platelet-rich fibrin scaffold with tannic acid for wound healing. Int Wound J 2024; 21:e14571. [PMID: 38111169 PMCID: PMC10961897 DOI: 10.1111/iwj.14571] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
Platelet-rich fibrin (PRF), which is the rich source of growth factors, has been used as an efficient scaffold in tissue engineering and wound healing. In this study, tannic acid as a green cross-linker with different concentrations (0.5%, 1%, 5% and 10%) was used to improve the properties of PRF. The cross-linked gel scaffolds were evaluated by analyses such as scanning electron microscopy, Fourier transform infrared spectroscopy, swelling and degradation, mechanical strength, cell toxicity, cell adhesion and antibacterial test. The results showed that the scaffold structure changes by increasing cross-linker concentration. The swelling rate decreased from 49% to 5% for the samples without the cross-linker and with tannic acid (10%), respectively. The degradation percentage for the cross-linked samples was 8%, which showed a lower degradation rate than the non-cross-linked samples (63%). The mechanical strength of the scaffold with the cross-linker increased up to three times (Young's modulus for the non-cross linked and the cross-linked samples: 0.01 and 0.6 MPa, respectively). Cytotoxicity was not observed up to 10% cross-linker concentration. The cells proliferated well on the cross-linked scaffolds and also showed a good antibacterial effect. In general, tannic acid can improve the physical and mechanical properties of PRF without negatively affecting its biological properties.
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Affiliation(s)
| | - Majid Abdouss
- Department of ChemistryAmirkabir University of Technology (AUT)TehranIran
| | - Saeed Heidari Keshel
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Zoheir Heshmatipour
- Department of Microbiology, Tonekabon BranchIslamic Azad UniversityTonekabonIran
| | - Azam Rahimi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Esmaeil Biazar
- Tissue Engineering Group, Department of Biomedical Engineering, Tonekabon BranchIslamic Azad UniversityTonekabonIran
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Rainess R, Campbell P, Santamala J, Kubin CJ, Mehta M. Outcomes Associated with De-escalation of Antibiotics to Target Positive Cultures when Treating Febrile Neutropenia. J Pharm Pract 2024; 37:301-306. [PMID: 36201023 DOI: 10.1177/08971900221132120] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Patients with hematologic malignancies frequently develop febrile neutropenia (FN) and subsequently receive long courses of broad-spectrum antibiotics. Limited data is available on de-escalation strategies. Methods: This was a retrospective observational cohort study of adult patients with a hematologic malignancy, FN, and positive culture results from June 2017 to June 2020. A conventional group (patients who remained on empiric, broad-spectrum agents) was compared to a de-escalation group (patients whose antibiotic therapy was de-escalated based on culture results). The primary outcome was the incidence of recurrent fever or antibiotic escalation due to infection while neutropenic. Results: Of the 123 patients included, the composite primary outcome occurred in 35.3% in the de-escalation group and 39.3% in the conventional group (P = .83). For secondary outcomes, median time to recurrent fever was 7 days in the de-escalation group and 7 days in the conventional group (P = .73). Incidence of Clostridioides difficile was 5.9% in the de-escalation group and 6.7% in the conventional group (P = 1.00). Development of multidrug resistant pathogens during hospital admission was 20.6% in the de-escalation group and 14.6% in the conventional group (P = .59). Median length of broad-spectrum antibiotics was 3 days in the de-escalation group and 8 days in the conventional group (P < .001). All-cause mortality within 30 days was 0 in the de-escalation group and 5.6% in the conventional group (P = .32). Conclusion: In a small sample of patients with a hematologic malignancy and FN, de-escalating antibiotics based on positive cultures decreased the duration of antibiotic therapy without increasing the rate of antibiotic failure.
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Affiliation(s)
- Rebecca Rainess
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Peter Campbell
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer Santamala
- Department of Pharmacy, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Christine J Kubin
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Monica Mehta
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
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Caveness CF, Orvin AI, Ingram CW, Bouchard JL. Impact of restrictive urinalysis reflex to culture criteria at a large community hospital. Diagn Microbiol Infect Dis 2024; 108:116183. [PMID: 38309086 DOI: 10.1016/j.diagmicrobio.2024.116183] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/30/2023] [Accepted: 01/09/2024] [Indexed: 02/05/2024]
Abstract
Treatment of asymptomatic bacteriuria (ASB) is a common, but often unnecessary, practice. Our objective was to determine the impact of restrictive urinalysis reflex to culture (UARC) criteria on rate of urine cultures (UC) ordered and ASB treatment. Criteria were modified from positive leukocyte esterase, positive nitrites, or white blood cells (WBC) >10 cells to only WBC >10 cells. This pre-post study evaluated UARCs ordered in the emergency department or inpatient units. The primary outcome was the proportion of reflex UCs prevented. Secondary outcomes included the frequency of repeat UARCs and stand-alone UCs, gram-negative rod (GNR) bacteremia, and ASB treatment. In the pre-intervention, there were 4761 UARCs compared to 5420 in the post-intervention; 37.9 % and 21.4 % reflexed to UCs, a 43.5 % reduction in UCs. The rate of repeat UARCs, stand-alone UCs, and GNR bacteremia in the pre- and post-interventions were similar. ASB treatment rate was numerically lower in the post-intervention.
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Affiliation(s)
| | - Alison I Orvin
- Department of Pharmacy, WakeMed Health and Hospitals, Raleigh, North Carolina; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Christopher W Ingram
- Infection Control and Occupational Health, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Jeannette L Bouchard
- Department of Pharmacy, WakeMed Health and Hospitals, Raleigh, North Carolina; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
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Ward SA, Habibi AA, Ashkenazi I, Arshi A, Meftah M, Schwarzkopf R. Innovations in the Isolation and Treatment of Biofilms in Periprosthetic Joint Infection: A Comprehensive Review of Current and Emerging Therapies in Bone and Joint Infection Management. Orthop Clin North Am 2024; 55:171-180. [PMID: 38403364 DOI: 10.1016/j.ocl.2023.10.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Periprosthetic joint infections (PJIs) are a devastating complication of joint arthroplasty surgeries that are often complicated by biofilm formation. The development of biofilms makes PJI treatment challenging as they create a barrier against antibiotics and host immune responses. This review article provides an overview of the current understanding of biofilm formation, factors that contribute to their production, and the most common organisms involved in this process. This article focuses on the identification of biofilms, as well as current methodologies and emerging therapies in the management of biofilms in PJI.
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Affiliation(s)
- Spencer A Ward
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Akram A Habibi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Itay Ashkenazi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Armin Arshi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Morteza Meftah
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Ran Schwarzkopf
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA.
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Zornitzki L, Anuk L, Frydman S, Morag-Koren N, Zahler D, Freund O, Biran R, Liron Y, Tau L, Tchebiner JZ, Katash H, Bornstein G. Rate and predictors of blood culture positivity after antibiotic administration: a prospective single-center study. Infection 2024; 52:483-490. [PMID: 37884696 DOI: 10.1007/s15010-023-02105-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Blood culture obtainment prior to antibiotic administration, in patients with suspected infection, is considered the best practice in international guidelines. However, there is little data regarding the effect of a single dose of antibiotics on blood culture sterilization. METHODS We conducted a prospective study, enrolling consecutive patients with suspected infection, hospitalized in an internal medicine ward between December 2019 and January 2023. Included patients had a positive blood culture prior to antibiotic administration and a set of blood cultures taken within 24 h after a single dose of antibiotics. The rate of patients with pathogen isolation after antibiotic administration was assessed. Logistic regression was performed to examine factors associated with blood culture positivity. RESULTS A total of 155 patients were recruited for the study of which 131 (50.8% female 77.5 ± 13.4 years) met the inclusion criteria. The overall rate of patients with a positive blood culture after a single dose of antibiotics was 42.0% (55/131 patients). Increasing time between antibiotic administration and post-antibiotic culture was an independent predictor for blood culture sterilization (odds ratio 0.89 [95% confidence interval, 0.83-0.97; p = 0.006] for every 60 min). Blood culture volume was an independent predictor for blood culture positivity in a sensitivity analysis which included 82 patients (OR = 1.26 [95% CI 1.03-1.57] for every 1 ml increase; p = 0.024). CONCLUSION Blood culture positivity is reduced by antimicrobial therapy but remains high after a single dose of antibiotics. If cultures are not obtained prior to antibiotic administration, they should be obtained as soon as possible afterwards.
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Affiliation(s)
- Lior Zornitzki
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel.
| | - Lana Anuk
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Nira Morag-Koren
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zahler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Freund
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Roni Biran
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Yael Liron
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Luba Tau
- The Unit for Infectious Diseases, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Zvi Tchebiner
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Haitam Katash
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
| | - Gil Bornstein
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with the School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, Israel
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Robbins RC, Singer RS, Innes GK, Plummer PJ, Apley MD, Gaunt PS, Papich MG, Granick J, Marshall ES, Smith DR, Frey E, Cervantes HM, Beaudoin AL, Canon AJ, Brookshire C, Buckley M, Whaley J, Schnabel L, Costin M. Animal drug shortages limit veterinary therapeutic options and introduce artifacts in antimicrobial sales reporting. J Am Vet Med Assoc 2024; 262:576-579. [PMID: 38171090 DOI: 10.2460/javma.23.10.0603] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
Supply chain issues disrupt veterinary care and cause downstream consequences that alter the practice of veterinary medicine. Antimicrobials are just 1 class of pharmaceuticals that have been impacted by supply chain issues over the last couple of years. Since February 2021, 2 sponsors/manufacturers of penicillin products have reported shortages in the active pharmaceutical ingredient. With the release of the 2021 Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals by the FDA, a key finding was a 19% decrease in penicillin sales and distribution from 2020 to 2021. Herein, we provide our clinicians' professional perspective regarding how drug shortages, specifically that of penicillin, might contribute to misconstrued patterns in antimicrobial use and what can be done by veterinarians and the FDA to minimize the impact of an antimicrobial drug shortage on animal health and well-being.
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Lin A, Ahmad S, Amescua G, Cheung AY, Choi DS, Jhanji V, Mian SI, Rhee MK, Viriya ET, Mah FS, Varu DM. Blepharitis Preferred Practice Pattern®. Ophthalmology 2024; 131:P50-P86. [PMID: 38349296 DOI: 10.1016/j.ophtha.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024] Open
Affiliation(s)
- Amy Lin
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Sumayya Ahmad
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Albert Y Cheung
- Virginia Eye Consultants, Norfolk, Virginia, Assistant Professor, Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Daniel S Choi
- Cataract and Vision Center of Hawaii, Honolulu, Hawaii
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Michelle K Rhee
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, Mount Sinai Services, Elmhurst, New York
| | - Elizabeth T Viriya
- Department of Ophthalmology, Lincoln Hospital/NYC Health+ Hospitals, Bronx, New York
| | - Francis S Mah
- Departments of Cornea and External Diseases, Scripps Clinic Torrey Pines, La Jolla, California
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Chen PK, Lee YT, Liu CY, Thuy TTD, Anh K, Wu JJ, Liao CH, Huang YT, Chen YC, Kao CY. A 19-year longitudinal study to characterize carbapenem-nonsusceptible Acinetobacter isolated from patients with bloodstream infections and the contribution of conjugative plasmids to carbapenem resistance and virulence. J Microbiol Immunol Infect 2024; 57:288-299. [PMID: 38350841 DOI: 10.1016/j.jmii.2024.01.008] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND This study aimed to characterize carbapenem-nonsusceptible Acinetobacter (CNSA) isolated from patients with bacteremia from 1997 to 2015. METHODS A total of 173 CNSA (12.3%) was recovered from 1403 Acinetobacter isolates. The presence of selected β-lactamase genes in CNSA was determined by PCR amplification. The conjugation test was used to determine the transferability of metallo-β-lactamase (MBL)-carrying plasmids. Whole genome sequencing in combination with phenotypic assays was carried out to characterize MBL-plasmids. RESULTS In general, a trend of increasing numbers of CNSA was observed. Among the 173 CNSA, A. baumannii (54.9%) was the most common species, followed by A. nosocomialis (23.1%) and A. soli (12.1%). A total of 49 (28.3%) CNSA were extensively drug-resistant, and all were A. baumannii. The most common class D carbapenemase gene in 173 CNSA was blaOXA-24-like (32.4%), followed by ISAba1-blaOXA-51-like (20.8%), ISAba1-blaOXA-23 (20.2%), and IS1006/IS1008-blaOXA-58 (11.6%). MBL genes, blaVIM-11,blaIMP-1, and blaIMP-19 were detected in 9 (5.2%), 20 (11.6%), and 1 (0.6%) CNSA isolates, respectively. Transfer of MBL genes to AB218 and AN254 recipient cells was successful for 7 and 6 of the 30 MBL-plasmids, respectively. The seven AB218-derived transconjugants carrying MBL-plasmids produced less biofilm but showed higher virulence to larvae than recipient AB218. CONCLUSIONS Our 19-year longitudinal study revealed a stable increase in CNSA during 2005-2015. blaOXA-24-like, ISAba1-blaOXA-51-like, and ISAba1-blaOXA-23 were the major determinants of Acinetobacter carbapenem resistance. MBL-carrying plasmids contribute not only to the carbapenem resistance but also to A. baumannii virulence.
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Affiliation(s)
- Pek Kee Chen
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veteran General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Ying Liu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tran Thi Dieu Thuy
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kieu Anh
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiunn-Jong Wu
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
| | - Chun-Hsing Liao
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Tsung Huang
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Cheng-Yen Kao
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Health Innovation Center, National Yang Ming Chiao Tung University, Taiwan; Microbiota Research Center, National Yang Ming Chiao Tung University, Taiwan.
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Diab H, Rahy K, Jisr T, El Chaar M, Abboud E, Tokajian S. Phenotypic and molecular characterization of multi-drug resistant Klebsiella spp. isolates recovered from clinical settings. Infect Genet Evol 2024; 119:105583. [PMID: 38484958 DOI: 10.1016/j.meegid.2024.105583] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
Klebsiella pneumoniae is a Gram-negative bacterium that colonizes the gastrointestinal tract and nasopharynx with many being linked to nosocomial infections. Extended-spectrum β-lactamases (ESBL)-producing and carbapenem-resistant K. pneumoniae is recognized by the World Health Organization (WHO) as a critical public health concern. In this study, whole-genome sequencing (WGS) - based analysis was performed to understand the molecular epidemiology of multi-drug resistant Klebsiella spp. clinical isolates. Genome comparison, multi-locus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), and whole-genome-SNP-based phylogenetic analysis (wg-SNP) were used for in-depth molecular characterization. in silico typing was used to determine the resistance genes, virulence factors, Inc. groups, and capsular types. All except one isolate were non-susceptible to meropenem and 89% were non-susceptible to ertapenem and imipenem. blaNDM, blaOXA-48, and blaKPC were the detected carbapenemases with blaNDM-1 found in half of the sequenced genomes. Resistance to colistin was detected in one isolate and was linked to several genetic alterations in crrB, pmrB, and pmrC genes. The most common plasmid type was IncFIB followed by IncR, and the Type 3 fimbriae, encoded by the mrkABCDF operon, was conserved among all isolates. The most common sequence- (ST) and K-type detected were ST147 and K64. The prevelance and the genomic relatedness of ST147 isolates, as shown by the data from SNP-based phylogenetic analysis, PFGE, and genomic clustering, may be an outbreak marker. However, this can only be validated through a more comprehensive study encompassing a wider sampling scheme and over an extended timeframe.
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Affiliation(s)
- Hassan Diab
- Department of Natural Sciences, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Kelven Rahy
- Department of Computer Science and Mathematics, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Tamima Jisr
- Clinical Laboratory Department, Makassed General Hospital, P.O.Box 11-6301, Beirut, Lebanon
| | - Mira El Chaar
- Faculty of Health Sciences, University of Balamand, P.O.Box: 55251, Beirut, Lebanon
| | - Edmond Abboud
- Middle East Institute of Health Hospital, Clinical Laboratory Department, P.O.Box 60-387, Bsalim, Lebanon
| | - Sima Tokajian
- Department of Natural Sciences, Lebanese American University, P.O. Box 36, Byblos, Lebanon.
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Adhikari EH. Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem. Curr Opin Obstet Gynecol 2024; 36:67-74. [PMID: 38205786 DOI: 10.1097/gco.0000000000000939] [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] [Indexed: 01/12/2024]
Abstract
PURPOSE OF REVIEW While the clinical disease of syphilis, its consequences in pregnancy, and its sensitivity to penicillin treatment have remained relatively unchanged for a century or more, new technologies and basic discoveries in syphilis research have translated into tangible advances in clinical diagnosis, treatment, and prevention. The purpose of this review is to help the reader understand some of the recent relevant scientific publications on syphilis and its causative organism in a clinical obstetric context. RECENT FINDINGS Rates of adult and congenital syphilis have risen dramatically in the last decade despite public health efforts. Penicillin shortages and lack of screening or adequate treatment have all contributed to global disease burden. Advances in genomic and microbiological characterization of this spirochete have led to new developments in serologic and molecular diagnosis as well as evaluation of potential vaccine candidates. Until a syphilis vaccine is available, substance use disorders and lack of screening in pregnancy are associated with increased congenital syphilis, and these challenges will require novel solutions to fully address this public health crisis. SUMMARY Addressing the burden of congenital syphilis demands that obstetricians stay well informed of new tools and resources for diagnosis, treatment, and prevention of syphilis now and in the future.
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Affiliation(s)
- Emily H Adhikari
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Lyon E, Olarte L. Community-acquired bacterial pneumonia in children: an update on antibiotic duration and immunization strategies. Curr Opin Pediatr 2024; 36:144-149. [PMID: 38169463 DOI: 10.1097/mop.0000000000001325] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review is structured to update clinicians on the epidemiology, antibiotic treatment, and prevention of pediatric bacterial pneumonia. The review provides information regarding the current research on antibiotic management for bacterial pneumonia and the newest immunization recommendations to prevent pneumococcal pneumonia and other respiratory infections. RECENT FINDINGS The recommended length of antibiotic therapy for bacterial pneumonia has been discrepant between low-income and high-income countries. Recently, randomized controlled trials conducted in high-income countries provided evidence to support a short antibiotic course (3-5 days) for uncomplicated bacterial pneumonia in otherwise healthy children. The negative impact of inaccurate penicillin allergy labels in children with pneumonia has emphasized the importance of prompt allergy de-labeling. Newer pneumococcal vaccines are recommended for children and are expected to have a significant impact on bacterial pneumonia rates. SUMMARY Pediatric bacterial pneumonia is an important contributor to childhood morbidity and mortality. A short antibiotic course seems to be sufficient for the outpatient management of uncomplicated bacterial pneumonia; however, more studies are required in the inpatient setting. Future studies will inform the impact of recently introduced pneumococcal and respiratory syncytial virus vaccines on the epidemiology of bacterial pneumonia.
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Affiliation(s)
- Edward Lyon
- Department of Pediatrics, Division of Infectious Diseases, Children's Mercy Kansas City
| | - Liset Olarte
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Van Veldhuisen CL, Sissingh NJ, Boxhoorn L, van Dijk SM, van Grinsven J, Verdonk RC, Boermeester MA, Bouwense SA, Bruno MJ, Cappendijk VC, van Duijvendijk P, van Eijck CHJ, Fockens P, van Goor H, Hadithi M, Haveman JW, Jacobs MA, Jansen JM, Kop MP, Manusama ER, Mieog JSD, Molenaar IQ, Nieuwenhuijs VB, Poen AC, Poley JW, Quispel R, Römkens TE, Schwartz MP, Seerden TC, Dijkgraaf MG, Stommel MW, Straathof JWA, Venneman NG, Voermans RP, van Hooft JE, van Santvoort HC, Besselink MG. Long-Term Outcome of Immediate Versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER): Multicenter Randomized Trial. Ann Surg 2024; 279:671-678. [PMID: 37450701 PMCID: PMC10922655 DOI: 10.1097/sla.0000000000006001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To compare the long-term outcomes of immediate drainage versus the postponed-drainage approach in patients with infected necrotizing pancreatitis. BACKGROUND In the randomized POINTER trial, patients assigned to the postponed-drainage approach using antibiotic treatment required fewer interventions, as compared with immediate drainage, and over a third were treated without any intervention. METHODS Clinical data of those patients alive after the initial 6-month follow-up were re-evaluated. The primary outcome was a composite of death and major complications. RESULTS Out of 104 patients, 88 were re-evaluated with a median follow-up of 51 months. After the initial 6-month follow-up, the primary outcome occurred in 7 of 47 patients (15%) in the immediate-drainage group and 7 of 41 patients (17%) in the postponed-drainage group (RR 0.87, 95% CI 0.33-2.28; P =0.78). Additional drainage procedures were performed in 7 patients (15%) versus 3 patients (7%) (RR 2.03; 95% CI 0.56-7.37; P =0.34). The median number of additional interventions was 0 (IQR 0-0) in both groups ( P =0.028). In the total follow-up, the median number of interventions was higher in the immediate-drainage group than in the postponed-drainage group (4 vs. 1, P =0.001). Eventually, 14 of 15 patients (93%) in the postponed-drainage group who were successfully treated in the initial 6-month follow-up with antibiotics and without any intervention remained without intervention. At the end of follow-up, pancreatic function and quality of life were similar. CONCLUSIONS Also, during long-term follow-up, a postponed-drainage approach using antibiotics in patients with infected necrotizing pancreatitis results in fewer interventions as compared with immediate drainage and should therefore be the preferred approach. TRIAL REGISTRATION ISRCTN33682933.
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Affiliation(s)
- Charlotte L. Van Veldhuisen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Noor J. Sissingh
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lotte Boxhoorn
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Sven M. van Dijk
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
| | - Janneke van Grinsven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
| | - Robert C. Verdonk
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
| | - Stefan A.W. Bouwense
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | | | - Paul Fockens
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Muhammed Hadithi
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten A.J.M. Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeroen M. Jansen
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, The Netherlands
| | - Marnix P.M. Kop
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
- Department of Radiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Eric R. Manusama
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - J. Sven D. Mieog
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - I. Quintus Molenaar
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Alexander C. Poen
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Group, Delft, The Netherlands
| | - Tessa E.H. Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Matthijs P. Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Tom C. Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, location University of Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martijn W.J. Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan Willem A. Straathof
- Department of Gastroenterology and Hepatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Niels G. Venneman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rogier P. Voermans
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hjalmar C. van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | - Marc G. Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, The Netherlands
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MacConnell AE, Levack AE, Brown NM. Biofilm and How It Relates to Prosthetic Joint Infection. Orthop Clin North Am 2024; 55:161-169. [PMID: 38403363 DOI: 10.1016/j.ocl.2023.10.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Prosthetic joint infection following total joint arthroplasty is a devastating complication, resulting in increased morbidity and mortality for the patient. The formation of a biofilm on implanted hardware contributes to the difficulty in successful identification and eradication of the infection. Antibiotic therapy and surgical intervention are necessary for addressing this condition; we present a discussion on different treatment options, including those that are not yet routinely utilized in the clinical setting or are under investigation, to highlight the present and future of PJI management.
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Affiliation(s)
- Ashley E MacConnell
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA.
| | - Ashley E Levack
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA
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Allaw F, Wehbe S, Kanj SS. Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment. Curr Opin Infect Dis 2024; 37:105-111. [PMID: 38037890 DOI: 10.1097/qco.0000000000000988] [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] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to discuss the latest evidence of epidemiology, diagnostic methods, and treatment of necrotizing soft tissue infections (NSTIs) with a particular focus on necrotizing fasciitis (NF). RECENT FINDINGS NSTIs have been historically referred to as NF but encompass a broader range of infections, with variable rates ranging from 0.86 to 32.64 per 100 000 person-years, influenced by factors such as climate and seasonal variations. They have diverse microbiological profiles categorized into different types based on the involved pathogens, including polymicrobial or monomicrobial infections caused by organisms such as group A streptococcus (GAS), Staphylococcus aureus , some Gram-negative pathogens, and filamentous fungi following trauma and natural disasters. Diagnosis relies on clinical symptoms and signs, laboratory markers, and imaging. However, the gold standard for diagnosis remains intraoperative tissue culture. Treatment involves repeated surgical debridement of necrotic tissues in addition to intravenous antibiotics. Adjuvant therapies with intravenous immunoglobulin (IVIG) and hyperbaric oxygen therapy (HBOT) might have a role. Soft tissue reconstruction may be necessary following surgery. SUMMARY Prompt diagnosis and proper medical and surgical management of NSTI will improve outcomes.
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Affiliation(s)
- Fatima Allaw
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center
| | - Saliba Wehbe
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center
- Center for Infectious Disease Research, American University of Beirut, Beirut, Lebanon
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Iresjö BM, Blomström S, Engström C, Johnsson E, Lundholm K. Acute appendicitis: A block-randomized study on active observation with or without antibiotic treatment. Surgery 2024; 175:929-935. [PMID: 38218686 DOI: 10.1016/j.surg.2023.11.030] [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: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Antibiotic treatment of unselected patients with acute appendicitis is safe and effective. However, it is unknown to what extent early provision of antibiotic treatment may represent overtreatment due to spontaneous healing of appendix inflammation. The aim of the present study was to evaluate the role of antibiotic treatment versus active in-hospital observation on spontaneous regression of acute appendicitis. METHOD Patients who sought acute medical care at Sahlgrenska University Hospital were block-randomized according to age (18-60 years) and systemic inflammation (C-reactive protein <60 mg/L, white blood cell <13,000/μL), in combination with clinical and abdominal characteristics of acute appendicitis. Study patients received antibiotic treatment and active observation, while control patients were allocated to classic active "wait and see observation" for either disease regression or the need for surgical exploration. According to our standard surgical care, certified surgeons in charge decided whether and when appendectomy was necessary. In total, 1,019 patients were screened for eligibility; 203 patients met inclusion criteria, 126 were accepted to participate, 29 declined, and 48 were missed for inclusion. RESULTS The antibiotic group (n = 69) and the control group (n = 57) were comparable at inclusion. Appendectomy at first hospital stay was 28% and 53% for study and control patients (χ2, P < .004). Life table analysis indicated a time-dependent difference in the need for appendectomy during follow-up (P < .03). Antibiotics prevented surgical exploration and appendectomy by 72% to 50% compared to 47% to 37% in the control group across the time course follow-ups between 5 and 1,200 days. CONCLUSION Early antibiotic treatment is superior to traditional "wait and see observation" to avoid surgical exploration and appendectomy.
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Affiliation(s)
- Britt-Marie Iresjö
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Sara Blomström
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Cecilia Engström
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Erik Johnsson
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Kent Lundholm
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Drobniewski F, Ashmi M, He C, Cheong J, Shah A. Aminoglycosides, deafness, and non-tuberculous mycobacteria. Lancet Glob Health 2024; 12:e561. [PMID: 38485424 DOI: 10.1016/s2214-109x(24)00082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Francis Drobniewski
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London W12 0NN, UK.
| | - Marcia Ashmi
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London W12 0NN, UK
| | - Changchunzi He
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London W12 0NN, UK
| | - Jamie Cheong
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London W12 0NN, UK; Royal Brompton Hospital, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Anand Shah
- Royal Brompton Hospital, Guy's and St Thomas NHS Foundation Trust, London, UK
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Ruiz Ramos J, Suárez-Lledó Grande A, Santolaya Perrín MR, Caballero Requejo C, Hijazi Vega M, López Vinardell M, García Martín A, Campos Baeta Y, Marcos González AJ, Alonso Díez M, Conde Giner S, Herrera Carranza S, Such Diáz A, Prats Riera M, Menendez Liendo L, Toro Blanch C, Revuelta Amallo A, Calzón Blanco C. [Antibiotic stewardship programs in the Spanish emergency services: PROA-URG Study]. Rev Esp Quimioter 2024; 37:163-169. [PMID: 38372121 PMCID: PMC10945102 DOI: 10.37201/req/138.2023] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/07/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Antimicrobial stewardship programs (ASP) have become a key tool in the adaptation of these drugs to the health system. The information available on the application and indicators used in these programs in emergency departments is scarce. The objective of this study is to know the extent of ASP implementation in the emergency departments, as well as the use of antimicrobials in these units. METHODS Multicenter retrospective study. An invitation was sent to all participants of the REDFASTER-SEFH emergency pharmacist working group. A questionnaire was used consisting of 21 items, answered by a team made up of a pharmacist, emergency room specialist, infectious disease specialist and microbiologist. RESULTS Eighteen hospitals completed the survey. Fourteen (77.8%) had an ASP manager. The DDD value per 1000 admissions ranged between 36.5 and 400.5 (median: 100.4 [IQR:57.2-157.3]). Both carbapenem and macrolide group presented wide variability in use. Six (33.3%) hospitals had an annual report on the specific resistance profile for urine and blood cultures. The percentage of multi-drug resistant strains in urine cultures was 12.5% and in blood cultures 12.2%. The percentage of adequacy in the bacteremia treatment was 81.0% (IQR:74.6-85.0%), while in urinary tract infections was 78.0% (IQR:71.5-88.0). CONCLUSIONS Despite the existence of ASP members in emergency services, as well as the training activity and local guidelines is common. knowledge of the use of antimicrobials and resistances is limited. Future activities must be aimed at improving information about the ASP results in these units.
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Affiliation(s)
- J Ruiz Ramos
- Jesús Ruiz Ramos, Servicio de Farmacia. Hospital Santa Creu y San Pau, Barcelona. C/San Quintín 89, 08025 Barcelona, Spain.
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50
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Elghannam MT, Hassanien MH, Ameen YA, Turky EA, ELattar GM, ELRay AA, ELTalkawy MD. Helicobacter pylori and oral-gut microbiome: clinical implications. Infection 2024; 52:289-300. [PMID: 37917397 PMCID: PMC10954935 DOI: 10.1007/s15010-023-02115-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023]
Abstract
More than half of the world's population are colonized with H. pylori; however, the prevalence varies geographically with the highest incidence in Africa. H. pylori is probably a commensal organism that has been associated with the development of gastritis, ulcers, and gastric cancer. H. pylori alone is most probably not enough for the development of gastric carcinoma, but evidence for its association with the disease is high and has, therefore, been classified by the International Agency for Research on Cancer as a Class 1 carcinogen. Bacteroidetes and Fusobacteria positively coexisted during H. pylori infection along the oral-gut axis. The eradication therapy required to treat H. pylori infection can also have detrimental consequences for the gut microbiota, leading to a decreased alpha diversity. Therefore, therapy regimens integrated with probiotics may abolish the negative effects of antibiotic therapy on the gut microbiota. These eradication therapies combined with probiotics have also higher rates of eradication, when compared to standard treatments, and are associated with reduced side effects, improving the patient's compliance. The eradication therapy not only affects gut microbiome but also affects the oral microbiome with robust predominance of harmful bacteria. However, there have been reports of a protective role of H. pylori in Barrett's esophagus, esophageal adenocarcinoma, eosinophilic esophagitis, IBD, asthma, and even multiple sclerosis. Therefore, eradication therapy should be carefully considered, and test to treat policy should be tailored to specific communities especially in highly endemic areas. Supplementation of probiotics, prebiotics, herbals, and microbial metabolites to reduce the negative effects of eradication therapy should be considered. After failure of many eradication attempts, the benefits of H. pylori eradication should be carefully balanced against the risk of adverse effects especially in the elderly, persons with frailty, and intolerance to antibiotics.
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Affiliation(s)
- Maged T Elghannam
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt.
| | - Moataz H Hassanien
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Yosry A Ameen
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Emad A Turky
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Gamal M ELattar
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed A ELRay
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Mohammed D ELTalkawy
- Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
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