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Cao X, Huang L, Tang M, Liang Y, Liu X, Hou H, Liang S. Antibiotics daptomycin interacts with S protein of SARS-CoV-2 to promote cell invasion of Omicron (B1.1.529) pseudovirus. Virulence 2024; 15:2339703. [PMID: 38576396 PMCID: PMC11057663 DOI: 10.1080/21505594.2024.2339703] [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: 10/30/2023] [Accepted: 04/03/2024] [Indexed: 04/06/2024] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has posed enormous challenges to global public health. The use of antibiotics has greatly increased during the SARS-CoV-2 epidemic owing to the presence of bacterial co-infection and secondary bacterial infections. The antibiotics daptomycin (DAP) is widely used in the treatment of infectious diseases caused by gram-positive bacteria owing to its highly efficient antibacterial activity. It is pivotal to study the antibiotics usage options for patients of coronavirus infectious disease (COVID-19) with pneumonia those need admission to receive antibiotics treatment for bacterial co-infection in managing COVID-19 disease. Herein, we have revealed the interactions of DAP with the S protein of SARS-CoV-2 and the variant Omicron (B1.1.529) using the molecular docking approach and Omicron (B1.1.529) pseudovirus (PsV) mimic invasion. Molecular docking analysis shows that DAP has a certain degree of binding ability to the S protein of SARS-CoV-2 and several derived virus variants, and co-incubation of 1-100 μM DAP with cells promotes the entry of the PsV into human angiotensin-converting enzyme 2 (hACE2)-expressing HEK-293T cells (HEK-293T-hACE2), and this effect is related to the concentration of extracellular calcium ions (Ca2+). The PsV invasion rate in the HEK-293T-hACE2 cells concurrently with DAP incubation was 1.7 times of PsV infection alone. In general, our findings demonstrate that DAP promotes the infection of PsV into cells, which provides certain reference of antibiotics selection and usage optimization for clinicians to treat bacterial coinfection or secondary infection during SARS-CoV-2 infection.
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Affiliation(s)
- Xu Cao
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Huang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Min Tang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Liang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xinpeng Liu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Huijin Hou
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Shufang Liang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Donnelly J, McDermott H, Gash S, O'Connor C, O'Connell K, O'Donnell S, Dinesh B, Burns K, Fitzpatrick F. Getting to the heart of the matter-are two agents really better than one for the treatment of staphylococcal infective endocarditis? Int J Infect Dis 2024; 142:106975. [PMID: 38395218 DOI: 10.1016/j.ijid.2024.02.018] [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: 11/09/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024] Open
Abstract
The recently published European Society of Cardiology guidelines for infective endocarditis management recommends daptomycin combination therapy for the treatment of staphylococcal endocarditis in severe penicillin allergy, rather than daptomycin monotherapy. We discuss the evidence base behind this recommendation, highlighting concerns regarding the lack of robust clinical studies, increased cost and logistical considerations, and adverse effects of combination therapy. Although further studies are required to elucidate the role of combination vs monotherapy in these patients, we propose a pragmatic management approach to reduce the risk of adverse antimicrobial side effects and limit costs, while aiming to maintain treatment efficacy.
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Affiliation(s)
- James Donnelly
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
| | - Helene McDermott
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Sadhbh Gash
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - Ciara O'Connor
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Karina O'Connell
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sinead O'Donnell
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Binu Dinesh
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Karen Burns
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
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Omori K, Kitagawa H, Takada M, Maeda R, Nomura T, Kubo Y, Shigemoto N, Ohge H. Fosfomycin as salvage therapy for persistent methicillin-resistant Staphylococcus aureus bacteremia: A case series and review of the literature. J Infect Chemother 2024; 30:352-356. [PMID: 37922987 DOI: 10.1016/j.jiac.2023.10.024] [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: 06/24/2023] [Revised: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia can be persistent and refractory; however, the optimal approach for its treatment has not been determined. Although fosfomycin (FOM) has been shown to have synergistic effects with anti-MRSA agents in vitro, clinical experience with FOM combination therapy is limited. Thus, we present cases of persistent MRSA bacteremia that improved with the addition of FOM. In case 1, a 48-year-old man with prosthetic vascular graft infection developed persistent MRSA bacteremia despite vancomycin (VCM) and daptomycin (DAP) administration. On day 46, after the first positive blood culture, we added FOM to DAP. The blood culture became negative on day 53. In case 2, an 85-year-old woman presented with pacemaker-related MRSA bacteremia. She was treated with VCM, followed by DAP and DAP plus rifampicin. However, the bacteremia persisted for 32 days because of difficulties in immediate pacemaker removal. After adding FOM to DAP, the blood culture became negative on day 38. In case 3, a 57-year-old woman developed persistent MRSA bacteremia due to pulmonary valve endocarditis and pulmonary artery thrombosis after total esophagectomy for esophageal cancer. The bacteremia continued for 50 days despite treatment with DAP, followed by VCM, VCM plus minocycline, DAP plus linezolid (LZD), and VCM plus LZD. She was managed conservatively because of surgical complications. After adding FOM to VCM on day 51, the blood culture became negative on day 58. FOM combination therapy may be effective in eliminating bacteria and can serve as salvage therapy for refractory MRSA bacteremia.
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Affiliation(s)
- Keitaro Omori
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Division of Infection Control, Hiroshima University Hospital, Hiroshima, Japan.
| | - Hiroki Kitagawa
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Division of Infection Control, Hiroshima University Hospital, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Takada
- Division of Pharmacy, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Ryuto Maeda
- Division of Pharmacy, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Toshihito Nomura
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Division of Infection Control, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Kubo
- Division of Infection Control, Hiroshima University Hospital, Hiroshima, Japan
| | - Norifumi Shigemoto
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Division of Infection Control, Hiroshima University Hospital, Hiroshima, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Translational Research Center, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Division of Infection Control, Hiroshima University Hospital, Hiroshima, Japan
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Axell-House DB, Simar SR, Panesso D, Rincon S, Miller WR, Khan A, Pemberton OA, Valdez L, Nguyen AH, Hood KS, Rydell K, DeTranaltes AM, Jones MN, Atterstrom R, Reyes J, Sahasrabhojane PV, Suleyman G, Zervos M, Shelburne SA, Singh KV, Shamoo Y, Hanson BM, Tran TT, Arias CA. LiaX is a surrogate marker for cell envelope stress and daptomycin non-susceptibility in Enterococcus faecium. Antimicrob Agents Chemother 2024; 68:e0106923. [PMID: 38289081 PMCID: PMC10916372 DOI: 10.1128/aac.01069-23] [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] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024] Open
Abstract
Daptomycin (DAP) is often used as a first-line therapy to treat vancomycin-resistant Enterococcus faecium infections, but emergence of DAP non-susceptibility threatens the effectiveness of this antibiotic. Moreover, current methods to determine DAP minimum inhibitory concentrations (MICs) have poor reproducibility and accuracy. In enterococci, DAP resistance is mediated by the LiaFSR cell membrane stress response system, and deletion of liaR encoding the response regulator results in hypersusceptibility to DAP and antimicrobial peptides. The main genes regulated by LiaR are a cluster of three genes, designated liaXYZ. In Enterococcus faecalis, LiaX is surface-exposed with a C-terminus that functions as a negative regulator of cell membrane remodeling and an N-terminal domain that is released to the extracellular medium where it binds DAP. Thus, in E. faecalis, LiaX functions as a sentinel molecule recognizing DAP and controlling the cell membrane response, but less is known about LiaX in E. faecium. Here, we found that liaX is essential in E. faecium with an activated LiaFSR system. Unlike E. faecalis, E. faecium LiaX is not detected in the extracellular milieu and does not appear to alter phospholipid architecture. We further postulated that LiaX could be used as a surrogate marker for cell envelope activation and non-susceptibility to DAP. For this purpose, we developed and optimized a LiaX enzyme-linked immunosorbent assay (ELISA). We then assessed 86 clinical E. faecium bloodstream isolates for DAP MICs and used whole genome sequencing to assess for substitutions in LiaX. All DAP-resistant clinical strains of E. faecium exhibited elevated LiaX levels. Strikingly, 73% of DAP-susceptible isolates by standard MIC determination also had elevated LiaX ELISAs compared to a well-characterized DAP-susceptible strain. Phylogenetic analyses of predicted amino acid substitutions showed 12 different variants of LiaX without a specific association with DAP MIC or LiaX ELISA values. Our findings also suggest that many E. faecium isolates that test DAP susceptible by standard MIC determination are likely to have an activated cell stress response that may predispose to DAP failure. As LiaX appears to be essential for the cell envelope response to DAP, its detection could prove useful to improve the accuracy of susceptibility testing by anticipating therapeutic failure.
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Affiliation(s)
- Dierdre B. Axell-House
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Shelby R. Simar
- Center for Infectious Diseases, University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Diana Panesso
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - Sandra Rincon
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - William R. Miller
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ayesha Khan
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Lizbet Valdez
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - April H. Nguyen
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kara S. Hood
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Kirsten Rydell
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Andrea M. DeTranaltes
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Mary N. Jones
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Rachel Atterstrom
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - Pranoti V. Sahasrabhojane
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Geehan Suleyman
- Department of Internal Medicine, Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Marcus Zervos
- Department of Internal Medicine, Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Samuel A. Shelburne
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kavindra V. Singh
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Yousif Shamoo
- Department of Biosciences, Rice University, Houston, Texas, USA
| | - Blake M. Hanson
- Center for Infectious Diseases, University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Truc T. Tran
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Cesar A. Arias
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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Hudson JQ, Hilgers MN, Gosmanova EO. Removal of common antimicrobial agents by sustained low-efficiency dialysis. Antimicrob Agents Chemother 2024; 68:e0157923. [PMID: 38349160 PMCID: PMC10916387 DOI: 10.1128/aac.01579-23] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 03/07/2024] Open
Abstract
Adequate dosing of antimicrobials is paramount for treating infections in critically ill patients undergoing kidney replacement therapy; however, little is known about antimicrobial removal by sustained low-efficiency dialysis (SLED). The objective was to quantify the removal of cefepime, daptomycin, meropenem, piperacillin-tazobactam, and vancomycin in patients undergoing SLED. Adult patients ≥18 years with acute kidney injury (AKI) or end-stage kidney disease receiving one of the select antimicrobials and requiring SLED were included. Blood and dialysate flow rates were maintained at 250 and 100 mL/min, respectively. Simultaneous arterial and venous blood samples for the analysis of antibiotic concentrations were collected hourly for 8 hours during SLED (on-SLED). Arterial samples were collected every 2 hours for up to 6 hours while not receiving SLED (off-SLED) for the calculation of SLED clearance, half-life (t1/2) on-SLED and off-SLED, and the fraction of removal by SLED (fD). Twenty-one patients completed the study: 52% male, mean age (±SD) 53 ± 13 years, and mean weight of 98 ± 30 kg. Eighty-six percent had AKI, and 4 patients were receiving cefepime, 3 daptomycin, 10 meropenem, 6 piperacillin-tazobactam, and 13 vancomycin. The average SLED time was 7.3 ± 1.1 hours, and the mean ultrafiltration rate was 95 ± 52 mL/hour (range 10-211). The t1/2 on-SLED was substantially lower than the off-SLED t1/2 for all antimicrobials, and the SLED fD varied between 44% and 77%. An 8-hour SLED session led to significant elimination of most antimicrobials evaluated. If SLED is performed, modification of the dosing regimen is warranted to avoid subtherapeutic concentrations.
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Affiliation(s)
- Joanna Q. Hudson
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Medicine (Nephrology), The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Madelyn N. Hilgers
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Elvira O. Gosmanova
- Department of Medicine (Nephrology), The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Conquet G, Martel N, Bonzon L. Disseminated invasive Corynebacterium simulans infection complicated by high-level daptomycin resistance acquisition under treatment: a case report. J Antimicrob Chemother 2024; 79:687-689. [PMID: 38198578 DOI: 10.1093/jac/dkad409] [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] [Indexed: 01/12/2024] Open
Affiliation(s)
- Guilhem Conquet
- Laboratoire de Bactériologie, CHU Montpellier, Hôpital Arnaud de Villeneuve, Univ Montpellier, 371 avenue du Doyen Gaston Giraud, Montpellier, France
| | - Nicolas Martel
- Laboratoire de Bactériologie, CHU Montpellier, Hôpital Arnaud de Villeneuve, Univ Montpellier, 371 avenue du Doyen Gaston Giraud, Montpellier, France
| | - Lucas Bonzon
- Laboratoire de Bactériologie, CHU Montpellier, Hôpital Arnaud de Villeneuve, Univ Montpellier, 371 avenue du Doyen Gaston Giraud, Montpellier, France
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Adamu Y, Puig-Asensio M, Dabo B, Schweizer ML. Comparative effectiveness of daptomycin versus vancomycin among patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: A systematic literature review and meta-analysis. PLoS One 2024; 19:e0293423. [PMID: 38381737 PMCID: PMC10881006 DOI: 10.1371/journal.pone.0293423] [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: 05/08/2023] [Accepted: 10/12/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND In the treatment of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs), vancomycin stands as the prevalent therapeutic agent. Daptomycin remains an alternative antibiotic to treat MRSA BSIs in cases where vancomycin proves ineffective. However, studies have conflicted on whether daptomycin is more effective than vancomycin among patients with MRSA BSI. OBJECTIVE To compare the effectiveness of daptomycin and vancomycin for the prevention of mortality among adult patients with MRSA BSI. METHODS Systematic searches of databases were performed, including Embase, PubMed, Web of Science, and Cochrane Library. The Newcastle Ottawa Scale (NOS) and Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) were used to assess the quality of individual observational and randomized control studies, respectively. Pooled odd ratios were calculated using random effects models. RESULTS Twenty studies were included based on a priori set inclusion and exclusion criteria. Daptomycin treatment was associated with non-significant lower mortality odds, compared to vancomycin treatment (OR = 0.81; 95% CI, 0.62, 1.06). Sub-analyses based on the time patients were switched from another anti-MRSA treatment to daptomycin demonstrated that switching to daptomycin within 3 or 5 days was significantly associated with 55% and 45% decreased odds of all-cause mortality, respectively. However, switching to daptomycin any time after five days of treatment was not significantly associated with lower odds of mortality. Stratified analysis based on vancomycin minimum inhibitory concentration (MIC) revealed that daptomycin treatment among patients infected with MRSA strains with MIC≥1 mg/L was significantly associated with 40% lower odds of mortality compared to vancomycin treatment. CONCLUSION Compared with vancomycin, an early switch from vancomycin to daptomycin was significantly associated with lower odds of mortality. In contrast, switching to daptomycin at any time only showed a trend towards reduced mortality, with a non-significant association. Therefore, the efficacy of early daptomycin use over vancomycin against mortality among MRSA BSIs patients may add evidence to the existing literature in support of switching to daptomycin early over remaining on vancomycin. More randomized and prospective studies are needed to assess this association.
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Affiliation(s)
- Yau Adamu
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University, Kano, Nigeria
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Bashir Dabo
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Marin L. Schweizer
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States of America
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Mak JT, Ha S, Perloff S, Knorr JP. Perioperative daptomycin for prophylaxis of vancomycin-resistant Enterococcus infection in colonized liver transplant recipients. Transpl Infect Dis 2024; 26:e14186. [PMID: 37910593 DOI: 10.1111/tid.14186] [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: 06/06/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Infection with vancomycin-resistant Enterococcus (VRE) in liver transplant recipients (LTR) has been associated with extended hospital stays, increased readmission rates, graft failure, and death. A tailored perioperative surgical prophylaxis regimen targeting VRE may reduce postoperative infections in VRE-colonized patients. This study investigated the outcomes of perioperative daptomycin in this patient population. METHODS This retrospective, single-center cohort study included LTR ≥ 18 years old who were VRE-colonized from June 2018 to November 2022. VRE colonization was identified by a VRE rectal swab screen or a positive VRE culture prior to transplant. Two groups were analyzed: daptomycin versus no daptomycin. All LTR received perioperative piperacillin-tazobactam for 24 h. If VRE-colonized, one dose of daptomycin (6 mg/kg) was given pre- and postoperatively. Demographics, clinical characteristics, risk factors for VRE infection, and daptomycin dose were collected. The primary outcome was VRE infection at 14 days and 90 days post-transplant. RESULTS There were 36 VRE-colonized LTR; 19 received daptomycin and 17 did not. Baseline characteristics and risk factors for VRE infection were similar between groups. More VRE infections occurred in the no daptomycin group within 14 days post-transplant (24% vs. 0%, p = .04), but at 90 days posttransplant there was no significant difference (29% vs. 16%, p = .43). The average daptomycin dose was 7.1 mg/kg. CONCLUSION Perioperative daptomycin reduced the rate of VRE infections in VRE-colonized LTR within 14 days posttransplant but not at 90 days. Future studies should evaluate if higher doses and/or longer duration of perioperative daptomycin can reduce VRE infections beyond 14 days post-transplant.
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Affiliation(s)
- Jordan T Mak
- Department of Pharmacy, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA
| | - Seung Ha
- Department of Pharmacy, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA
| | - Sarah Perloff
- Department of Internal Medicine, Division of Infectious Diseases, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA
| | - John P Knorr
- Department of Pharmacy, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA
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Garreau R, Pham TT, Bourguignon L, Millet A, Parant F, Bussy D, Desevre M, Franchi V, Ferry T, Goutelle S. Daptomycin Exposure as a Risk Factor for Daptomycin-Induced Eosinophilic Pneumonia and Muscular Toxicity. Clin Infect Dis 2023; 77:1372-1380. [PMID: 37467019 DOI: 10.1093/cid/ciad386] [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: 02/15/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND High-dose daptomycin is increasingly used in patients with bone and joint infection (BJI). This raises concerns about a higher risk of adverse events (AEs), including daptomycin-induced eosinophilic pneumonia (DIEP) and myotoxicity. We aimed to examine pharmacokinetic and other potential determinants of DIEP and myotoxicity in patients with BJI receiving daptomycin. METHODS All patients receiving daptomycin for BJI were identified in a prospective cohort study. Cases were matched at a 1:3 ratio, with controls randomly selected from the same cohort. Bayesian estimation of the daptomycin daily area under the concentration-time curve over 24 hours (AUC24h) was performed with the Monolix software based on therapeutic drug monitoring (TDM) data. Demographic and biological data were also collected. Risk factors of AEs were analyzed using Cox proportional hazards model. RESULTS From 1130 patients followed over 7 years, 9 with DIEP, 26 with myotoxicity, and 106 controls were included in the final analysis. Daptomycin AUC24h, C-reactive protein, and serum protein levels were associated with the risk of AEs. The adjusted hazard ratio of DIEP or myotoxicity was 3.1 (95% confidence interval [CI], 1.48-6.5; P < .001) for daptomycin AUC24h > 939 mg/h/L, 9.8 (95% CI, 3.94-24.5; P < .001) for C-reactive protein > 21.6 mg/L, and 2.4 (95% CI, 1.02-5.65; P = .04) for serum protein <72 g/L. CONCLUSIONS We identified common determinants of DIEP and myotoxicity in patients with BJI. Because the risk of AEs was associated with daptomycin exposure, daptomycin TDM and model-informed precision dosing may help optimize the efficacy and safety of daptomycin treatment in this setting. A target AUC24h range of 666 to 939 mg/h/L is suggested.
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Affiliation(s)
- Romain Garreau
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Service de Pharmacie, Lyon, France
- LBBE-Laboratoire de Biométrie et Biologie Evolutive, CNRS, UMR 5558, Université Lyon 1, Villeurbanne, France
| | - Truong-Thanh Pham
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Service des Maladies Infectieuses et Tropicales, Centre de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Lyon, France
| | - Laurent Bourguignon
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Service de Pharmacie, Lyon, France
- LBBE-Laboratoire de Biométrie et Biologie Evolutive, CNRS, UMR 5558, Université Lyon 1, Villeurbanne, France
- Facultés de Médecine et de Pharmacie de Lyon, Univ Lyon, Université Lyon 1, ISPB, Lyon, France
| | - Aurélien Millet
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biochimie et Biologie Moléculaire, UM Pharmacologie -Toxicologie, Lyon, France
| | - François Parant
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biochimie et Biologie Moléculaire, UM Pharmacologie -Toxicologie, Lyon, France
| | - David Bussy
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Service des Maladies Infectieuses et Tropicales, Centre de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Lyon, France
| | - Marine Desevre
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Service des Maladies Infectieuses et Tropicales, Centre de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Lyon, France
| | - Victor Franchi
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Service des Maladies Infectieuses et Tropicales, Centre de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Lyon, France
| | - Tristan Ferry
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Service des Maladies Infectieuses et Tropicales, Centre de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Lyon, France
- Facultés de Médecine et de Pharmacie de Lyon, Univ Lyon, Université Lyon 1, ISPB, Lyon, France
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Sylvain Goutelle
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Service de Pharmacie, Lyon, France
- LBBE-Laboratoire de Biométrie et Biologie Evolutive, CNRS, UMR 5558, Université Lyon 1, Villeurbanne, France
- Facultés de Médecine et de Pharmacie de Lyon, Univ Lyon, Université Lyon 1, ISPB, Lyon, France
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10
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Jiang S, Chen M, Zhang J, Ba X, Zhang H, Hong Y, Sun L, Wang Z, Zhuang H, Zhu F, Chen Y, Wang H, Zhao F, Chen Y, Yu Y, Ji S. Profiling daptomycin resistance among diverse methicillin-resistant Staphylococcus aureus lineages in China. Antimicrob Agents Chemother 2023; 67:e0056323. [PMID: 37902403 PMCID: PMC10649010 DOI: 10.1128/aac.00563-23] [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] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
Daptomycin (DAP) is effective against methicillin-resistant Staphylococcus aureus (MRSA). However, reduced susceptibility to DAP in MRSA may lead to treatment failures. We aim to determine the distribution of DAP minimum inhibitory concentrations (MICs) and DAP heteroresistance (hDAP) among MRSA lineages in China. A total of 472 clinical MRSA isolates collected from 2015 to 2017 in China were examined for DAP susceptibility. All isolates (n = 472) were found to be DAP susceptible, but 35.17% (166/472) of them exhibited a high DAP MIC (MIC >0.5 µg/mL). The high DAP MIC group contained a larger proportion of isolates with a higher vancomycin or teicoplanin MIC (>1.5 µg/mL) than the low DAP MIC group (19.3% vs 7.8%, P < 0.001; 22.3% vs 8.2%, P < 0.001). We compared the clonal complex (CC) distributions and clinical characteristics in MRSA isolates stratified by DAP MIC. CC5 isolates were less susceptible to DAP (MIC50 = 1 µg/mL) than CC59 isolates (MIC50 = 0.5 µg/mL, P < 0.001). Population analysis profiling revealed that 5 of 10 ST5 and ST59 DAP-susceptible MRSA isolates investigated exhibited hDAP. The results also showed that CC5 MRSA with an agrA mutation (I238K) had a higher DAP MIC than those with a wild-type agrA (P < 0.001). The agrA-I238K mutation was found to be associated with agr dysfunction as indicated by the loss of δ-hemolysin production. In addition, agr/psmα defectiveness was associated with hDAP in MRSA. Whole-genome sequencing analysis revealed mutations in mprF and walR/walK in DAP-resistant subpopulations, and most DAP-resistant subpopulations (6/8, 75%) were stable. Our study suggests that the increased DAP resistance and hDAP in MRSA may threaten the effectiveness against MRSA infections.
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Affiliation(s)
- Shengnan Jiang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengzhen Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junxiong Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Xihu District Center for Disease Control and Prevention of Hangzhou, Hangzhou, China
| | - Xiaoliang Ba
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hao Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yueqin Hong
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Sun
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengan Wang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hemu Zhuang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feiteng Zhu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiyi Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiping Wang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Zhao
- Department of Clinical laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shujuan Ji
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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11
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Holland TL, Cosgrove SE, Doernberg SB, Jenkins TC, Turner NA, Boucher HW, Pavlov O, Titov I, Kosulnykov S, Atanasov B, Poromanski I, Makhviladze M, Anderzhanova A, Stryjewski ME, Assadi Gehr M, Engelhardt M, Hamed K, Ionescu D, Jones M, Saulay M, Smart J, Seifert H, Fowler VG. Ceftobiprole for Treatment of Complicated Staphylococcus aureus Bacteremia. N Engl J Med 2023; 389:1390-1401. [PMID: 37754204 DOI: 10.1056/nejmoa2300220] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Ceftobiprole is a cephalosporin that may be effective for treating complicated Staphylococcus aureus bacteremia, including methicillin-resistant S. aureus. METHODS In this phase 3, double-blind, double-dummy, noninferiority trial, adults with complicated S. aureus bacteremia were randomly assigned in a 1:1 ratio to receive ceftobiprole at a dose of 500 mg intravenously every 6 hours for 8 days and every 8 hours thereafter, or daptomycin at a dose of 6 to 10 mg per kilogram of body weight intravenously every 24 hours plus optional aztreonam (at the discretion of the trial-site investigators). The primary outcome, overall treatment success 70 days after randomization (defined as survival, bacteremia clearance, symptom improvement, no new S. aureus bacteremia-related complications, and no receipt of other potentially effective antibiotics), with a noninferiority margin of 15%, was adjudicated by a data review committee whose members were unaware of the trial-group assignments. Safety was also assessed. RESULTS Of 390 patients who underwent randomization, 387 (189 in the ceftobiprole group and 198 in the daptomycin group) had confirmed S. aureus bacteremia and received ceftobiprole or daptomycin (modified intention-to-treat population). A total of 132 of 189 patients (69.8%) in the ceftobiprole group and 136 of 198 patients (68.7%) in the daptomycin group had overall treatment success (adjusted difference, 2.0 percentage points; 95% confidence interval [CI], -7.1 to 11.1). Findings appeared to be consistent between the ceftobiprole and daptomycin groups in key subgroups and with respect to secondary outcomes, including mortality (9.0% and 9.1%, respectively; 95% CI, -6.2 to 5.2) and the percentage of patients with microbiologic eradication (82.0% and 77.3%; 95% CI, -2.9 to 13.0). Adverse events were reported in 121 of 191 patients (63.4%) who received ceftobiprole and 117 of 198 patients (59.1%) who received daptomycin; serious adverse events were reported in 36 patients (18.8%) and 45 patients (22.7%), respectively. Gastrointestinal adverse events (primarily mild nausea) were more frequent with ceftobiprole. CONCLUSIONS Ceftobiprole was noninferior to daptomycin with respect to overall treatment success in patients with complicated S. aureus bacteremia. (Funded by Basilea Pharmaceutica International and the U.S. Department of Health and Human Services; ERADICATE ClinicalTrials.gov number, NCT03138733.).
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Affiliation(s)
- Thomas L Holland
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Sara E Cosgrove
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Sarah B Doernberg
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Timothy C Jenkins
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Nicholas A Turner
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Helen W Boucher
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Oleksander Pavlov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Ivan Titov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Serhii Kosulnykov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Boyko Atanasov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Ivan Poromanski
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Manana Makhviladze
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Anastasia Anderzhanova
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Martin E Stryjewski
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Maziar Assadi Gehr
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Marc Engelhardt
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Kamal Hamed
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Daniel Ionescu
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Mark Jones
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Mikael Saulay
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Jennifer Smart
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Harald Seifert
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Vance G Fowler
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
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Wendel AF, Otchwemah R, Layer-Nicolaou F, Mattner F, Tellez-Castillo CJ, Skov R, Oberländer H, Werner G, Strommenger B. Investigating a possible link between antiseptic treatment and the increased occurrence of daptomycin-resistant Staphylococcus aureus. Clin Microbiol Infect 2023; 29:1334.e1-1334.e6. [PMID: 37321393 DOI: 10.1016/j.cmi.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/07/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Because of a steady increase in the detection of daptomycin-resistant (DAP-R) Staphylococcus aureus at three medical centres in Cologne, Germany, molecular surveillance was established from June 2016 to June 2018 to investigate the causes of the emergence and spread of respective isolates. Seventy-five S. aureus isolates, both DAP-R and DAP-susceptible, were collected from 42 patients for further analysis. METHODS Broth microdilution was used to determine the MICs for DAP and polyhexamethylene biguanide/polyhexanide (PHMB). To investigate the effect of PHMB on the development of DAP resistance, we performed selection experiments with PHMB. All isolates studied were subjected to whole-genome sequencing. Epidemiological, clinical, microbiological and molecular data were analysed comparatively. RESULTS Acquisition of DAP resistance was mainly observed in patients with acute and chronic wounds (40/42, 96.2%) treated with antiseptic (32/42, 76.2%) rather than systemic antibiotic therapy using DAP or vancomycin (7/42, 16.7%). DAP-R S. aureus had a diverse genetic background; however, within individual patients, isolates were closely related. At least three potential transmission events were detected. Most DAP-R isolates had concomitant elevated MICs for PHMB (50/54, 92.6%), and in vitro selection experiments confirmed that PHMB treatment is capable of generating DAP resistance. DAP resistance could be linked to 12 different polymorphisms in the mprF gene in the majority of clinical isolates (52/54, 96.3%) as well as in all in vitro selected strains. DISCUSSION DAP resistance in S. aureus can occur independently of prior antibiotic therapy and can be selected by PHMB. Therefore, wound treatment with PHMB may trigger individual resistance development associated with gain-of-function mutations in the mprF gene.
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Affiliation(s)
- Andreas F Wendel
- Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Cologne, Germany; Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Robin Otchwemah
- Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Cologne, Germany; Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Franziska Layer-Nicolaou
- Robert Koch Institute, Department of Infectious Diseases, Division 'Nosocomial Pathogens and Antibiotic Resistances', National Reference Centre for Staphylococci and Enterococci, Wernigerode, Germany
| | - Frauke Mattner
- Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Cologne, Germany; Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Robert Skov
- Department of Clinical Microbiology, MVZ Synlab Leverkusen GmbH, Köln-Merheim, Germany
| | - Henrik Oberländer
- Department of Plastic Surgery, Hand Surgery, Burn Centre, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Cologne, Germany
| | - Guido Werner
- Robert Koch Institute, Department of Infectious Diseases, Division 'Nosocomial Pathogens and Antibiotic Resistances', National Reference Centre for Staphylococci and Enterococci, Wernigerode, Germany
| | - Birgit Strommenger
- Robert Koch Institute, Department of Infectious Diseases, Division 'Nosocomial Pathogens and Antibiotic Resistances', National Reference Centre for Staphylococci and Enterococci, Wernigerode, Germany.
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13
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Tzalis S, Ioannou P, Billiari E, Kofteridis DP, Karakonstantis S. Daptomycin as an option for lock therapy: a systematic literature review. Future Microbiol 2023; 18:917-928. [PMID: 37622290 DOI: 10.2217/fmb-2023-0059] [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: 08/26/2023] Open
Abstract
Aim: To review preclinical and clinical data relevant to daptomycin lock therapy in catheter-related bloodstream infection (CRBSI). Methods: Systematic review in PubMed, Scopus and clinical trial registries. Results: Preclinical data demonstrate daptomycin lock solution stability and compatibility with heparin, good biofilm penetration, bactericidal activity against biofilm-embedded bacteria, and high efficacy in vitro and in animal catheter infection models. Clinical data remain limited (two case reports and five case series totaling n = 65 CRBSI episodes), albeit promising (successful catheter salvage in about 80% of cases). Conclusion: Despite theoretical advantages of daptomycin, clinical data remain scarce. Comparative studies versus alternative lock solutions are needed, as well as studies to define optimal daptomycin lock regimen (including optimal concentration, dwell time and lock duration).
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Affiliation(s)
- Sotirios Tzalis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, 71500,Greece
| | - Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, 71500,Greece
- School of Medicine, University of Crete, Heraklion, Crete, 71500, Greece
- Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, 71500, Greece
| | - Eleni Billiari
- School of Medicine, University of Crete, Heraklion, Crete, 71500, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, 71500,Greece
- School of Medicine, University of Crete, Heraklion, Crete, 71500, Greece
- Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, 71500, Greece
| | - Stamatis Karakonstantis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, 71500,Greece
- Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, 71500, Greece
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14
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Chang J, Tasellari A, Wagner JL, Scheetz MH. Contemporary pharmacologic treatments of MRSA for hospitalized adults: rationale for vancomycin versus non-vancomycin therapies as first line agents. Expert Rev Anti Infect Ther 2023; 21:1309-1325. [PMID: 37876291 DOI: 10.1080/14787210.2023.2275663] [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: 05/25/2023] [Accepted: 10/23/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) remains an important pathogen in the hospital setting and causes significant morbidity and mortality each year. Since the initial discovery over 60 years ago, vancomycin has remained a first-line treatment for many different types of MRSA infections. However, significant concerns related to target attainment and nephrotoxicity have spurred efforts to develop more effective agents in the last two decades. AREAS COVERED Newer anti-MRSA antibiotics that have been approved since 2000 include linezolid, daptomycin, and ceftaroline. As clinical evidence has accumulated, these newer agents have become more frequently used, and some are now recommended as co-first-line options (along with vancomycin) in clinical practice guidelines. For this review, a scoping review of the literature was conducted to support our findings and recommendations. EXPERT OPINION Vancomycin remains an important standard of care for MRSA infections but is limited with respect to nephrotoxicity and rapid target attainment. Newer agents such as linezolid, daptomycin, and ceftaroline have specific indications for treating different types of MRSA infections; however, newer agents also have unique attributes which require consideration during therapy.
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Affiliation(s)
- Jack Chang
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove, IL, USA
- Pharmacometrics Center of Excellence, Midwestern University College of Pharmacy, Downers Grove, IL, USA
- Northwestern Memorial Hospital, Department of Pharmacy, Chicago, IL, USA
| | - Ardita Tasellari
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove, IL, USA
| | - Jamie L Wagner
- School of Pharmacy, University of Mississippi, Jackson, MS, USA
| | - Marc H Scheetz
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove, IL, USA
- Pharmacometrics Center of Excellence, Midwestern University College of Pharmacy, Downers Grove, IL, USA
- Northwestern Memorial Hospital, Department of Pharmacy, Chicago, IL, USA
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15
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Wu X, Wu L, Shu L, Xie C, Wan Q. Characteristics of Gram-positive cocci infection and the therapeutic effect after liver transplantation. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:707-715. [PMID: 37539573 PMCID: PMC10930403 DOI: 10.11817/j.issn.1672-7347.2023.220631] [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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Gram-positive cocci is the main pathogen responsible for early infection after liver transplantation (LT), posing a huge threat to the prognosis of liver transplant recipients. This study aims to analyze the distribution and drug resistance of Gram-positive cocci, the risk factors for infections and efficacy of antibiotics within 2 months after LT, and to guide the prevention and treatment of these infections. METHODS In this study, data of pathogenic bacteria distribution, drug resistance and therapeutic efficacy were collected from 39 Gram-positive cocci infections among 256 patients who received liver transplantation from donation after citizens' death in the Third Xiangya Hospital of Central South University from January 2019 to July 2022, and risk factors for Gram-positive cocci infection were analyzed. RESULTS Enterococcus faecium was the dominant pathogenic bacteria (33/51, 64.7%), followed by Enterococcus faecalis (11/51, 21.6%). The most common sites of infection were abdominal cavity/biliary tract (13/256, 5.1%) and urinary tract (10/256, 3.9%). Fifty (98%) of the 51 Gram-positive cocci infections occurred within 1 month after LT. The most sensitive drugs to Gram-positive cocci were teicoplanin, tigecycline, linezolid and vancomycin. Vancomycin was not used in all patients, considering its nephrotoxicity. Vancomycin was not administered to all patients in view of its nephrotoxicity.There was no significant difference between the efficacy of daptomycin and teicoplanin in the prevention of cocci infection (P>0.05). Univariate analysis indicated that preoperative Model for End-Stage Liver Disease (MELD) score >25 (P=0.005), intraoperative red blood cell infusion ≥12 U (P=0.013) and exposure to more than 2 intravenous antibiotics post-LT (P=0.003) were related to Gram-positive cocci infections. Multivariate logistic regression analysis revealed that preoperative MELD score >25 (OR=2.378, 95% CI 1.124 to 5.032, P=0.024) and intraoperative red blood cell transfusion ≥ 12 U (OR=2.757, 95% CI 1.227 to 6.195, P=0.014) were independent risk factors for Gram-positive cocci infections after LT. Postoperative Gram-positive cocci infections were reduced in LT recipients exposing to more than two intravenous antibiotics post-LT (OR=0.269, 95% CI 0.121 to 0.598, P=0.001). CONCLUSIONS Gram-positive cocci infections occurring early after liver transplantation were dominated by Enterococcus faecalis infections at the abdominal/biliary tract and urinary tract. Teicoplanin, tigecycline and linezolid were anti-cocci sensitive drugs. Daptomycin and teicoplanin were equally effective in preventing cocci infections due to Gram-positive cocci. Patients with high preoperative MELD score and massive intraoperative red blood cell transfusion were more likely to suffer Gram-positive cocci infection after surgery. Postoperative Gram-positive cocci infections were reduced in recipients exposing to more than two intravenous antibiotics post-LT.
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Affiliation(s)
- Xiaoxia Wu
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013.
- Xiangya School of Nursing, Central South University, Changsha 410013.
| | - Lingli Wu
- Xiangya School of Nursing, Central South University, Changsha 410013
| | - Lin Shu
- Xiangya School of Nursing, Central South University, Changsha 410013
| | - Chenpeng Xie
- Xiangya School of Nursing, Central South University, Changsha 410013
| | - Qiquan Wan
- Transplantation Center, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Mishra NN, Abdelhady W, Elsayed AM, Lapitan C, Proctor RA, Rybak MJ, Miro JM, Bayer AS. Combinations of Daptomycin plus Ceftriaxone, but Not Ascending Daptomycin Dose-Regimens, Are Effective in Experimental Endocarditis Caused by Streptococcus mitis -oralis Strains: Target Tissue Clearances and Prevention of Emergence of Daptomycin-Resistance. Antimicrob Agents Chemother 2023; 67:e0147222. [PMID: 36877026 PMCID: PMC10112159 DOI: 10.1128/aac.01472-22] [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] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/02/2023] [Indexed: 03/07/2023] Open
Abstract
The Streptococcus mitis-oralis subgroup of the viridans group streptococci (VGS) are the most common cause of infective endocarditis (IE) in many parts of the world. These organisms are frequently resistant in vitro to standard β-lactams (e.g., penicillin; ceftriaxone [CRO]), and have the notable capacity for rapidly developing high-level and durable daptomycin resistance (DAP-R) during exposures in vitro, ex vivo, and in vivo. In this study, we used 2 prototypic DAP-susceptible (DAP-S) S. mitis-oralis strains (351; and SF100), which both evolved stable, high-level DAP-R in vitro within 1 to 3 days of DAP passage (5 to 20 μg/mL DAP). Of note, the combination of DAP + CRO prevented this rapid emergence of DAP-R in both strains during in vitro passage. The experimental rabbit IE model was then employed to quantify both the clearance of these strains from multiple target tissues, as well as the emergence of DAP-R in vivo under the following treatment conditions: (i) ascending DAP-alone dose-strategies encompassing human standard-dose and high-dose-regimens; and (ii) combinations of DAP + CRO on these same metrics. Ascending DAP-alone dose-regimens (4 to 18 mg/kg/d) were relatively ineffective at either reducing target organ bioburdens or preventing emergence of DAP-R in vivo. In contrast, the combination of DAP (4 or 8 mg/kg/d) + CRO was effective at clearing both strains from multiple target tissues (often with sterilization of bio-burdens in such organs), as well as preventing the emergence of DAP-R. In patients with serious S. mitis-oralis infections such as IE, especially caused by strains exhibiting intrinsic β-lactam resistance, initial therapy with combinations of DAP + CRO may be warranted.
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Affiliation(s)
- Nagendra N. Mishra
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
- The David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Wessam Abdelhady
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Ahmed M. Elsayed
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Christian Lapitan
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Richard A. Proctor
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Microbiology & Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jose M. Miro
- Hospital Clinic, Institut d' Investigacions Biomèdiques August Pi, iSunyer, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Arnold S. Bayer
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
- The David Geffen School of Medicine, University of California, Los Angeles, California, USA
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17
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Huang ST, Yang JL, Lin CY, Huang SH, Wang JT, Chuang YC, Chen YC, Chang SC. Risk factors for mortality after linezolid treatment of vancomycin-resistant Enterococcus bloodstream infection. Int J Infect Dis 2023; 129:96-102. [PMID: 36736576 DOI: 10.1016/j.ijid.2023.01.035] [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: 08/09/2022] [Revised: 12/14/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES We analyzed the risk factors affecting linezolid treatment outcome in vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI). METHODS We conducted a multicenter observational study of patients who received linezolid 600 mg every 12 hours for VRE BSI. The primary outcome was 28-day mortality. The estimated area under the concentration-time curve and trough concentration were calculated. Multivariable logistic regression was used for the outcome analysis. RESULTS A total of 170 patients were included: 114 (67.1%) survived and 56 (32.9%) did not. A total of 26 (18.2%) isolates showed a linezolid minimum inhibitory concentration (MIC) of ≤1 mg/l, 113 (79.0%) of 2 mg/l, and 4 (2.8%) of 4 mg/l. The univariable analysis showed that the linezolid MIC and concentration-time curve/MIC were not associated with mortality (P = 0.95 and P = 0.42, respectively). After adjusting for underlying comorbidity and disease severity, the linezolid dose per body weight (LDBW), body height, and interaction between them were independent risks for mortality. Marginal analysis showed that increasing the LDBW was protective in patients with a body height <160 cm. A trough concentration of >12.2 mg/l was a risk factor for thrombocytopenia. CONCLUSION The LDBW and body height were interactively associated with clinical outcomes of linezolid treatment for VRE BSI.
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Affiliation(s)
- Szu-Ting Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Ling Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Ying Lin
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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18
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Patel D, Brown ML, Edwards S, Oster RA, Stripling J. Outcomes of Daptomycin Plus Ceftaroline Versus Alternative Therapy for Persistent Methicillin-resistant Staphylococcus aureus (MRSA) Bacteraemia. Int J Antimicrob Agents 2023; 61:106735. [PMID: 36690124 PMCID: PMC10023467 DOI: 10.1016/j.ijantimicag.2023.106735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study aimed to evaluate both efficacy and safety of combination therapy with daptomycin plus ceftaroline (DAP/CPT) versus alternative therapy in the treatment of persistent methicillin-resistant Staphylococcus aureus bacteraemia (MRSAB). METHODS This retrospective, single-centre study investigated adult patients who underwent a change in antibiotic therapy for persistent MRSAB. Daptomycin plus ceftaroline was compared with alternative therapy after initial treatment with vancomycin or DAP monotherapy was modified. The primary outcome was in-hospital mortality, and several secondary efficacy and safety outcomes were evaluated. RESULTS A total of 68 patients with persistent MRSAB had initial therapy switched to DAP/CPT (n = 43) or alternative therapy (n = 25). In-hospital mortality was similar with DAP/CPT versus alternative therapy (16.3% vs. 16%; P = 1.0). On average, the total duration of bacteraemia was numerically 1 day less in patients switched to DAP/CPT (11.4 days vs. 12.5 days; P = 0.5). Daptomycin plus ceftaroline was de-escalated in 81% of patients after receiving combination therapy for an average of 12.5 days. Secondary outcomes, including rates of adverse events and emergence of antimicrobial resistance, were similar between the two groups. CONCLUSIONS Switching to DAP/CPT after approximately 1 week of persistent MRSA bacteraemia may result in similar clinical outcomes when compared with alternative therapy. Rates of adverse events and emergence of antimicrobial resistance were low without a statistically significant difference observed between DAP/CPT and alternative therapy. These findings, as well as the impact of earlier switch or prolonged treatment with the combination, require further investigation.
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Affiliation(s)
- Darshan Patel
- Department of Pharmacy, UAB Hospital, Birmingham, Alabama, USA; Present affiliation: Emory Johns Creek Hospital, Johns Creek, Georgia, USA.
| | - Matthew L Brown
- Department of Pharmacy, UAB Hospital, Birmingham, Alabama, USA
| | - Seth Edwards
- Department of Pharmacy, UAB Hospital, Birmingham, Alabama, USA
| | - Robert A Oster
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Joshua Stripling
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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19
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Szemraj M, Lisiecki P, Glajzner P, Szewczyk EM. Vancomycin heteroresistance among methicillin-resistant clinical isolates S. haemolyticus, S. hominis, S. simulans, and S. warneri. Braz J Microbiol 2023; 54:159-167. [PMID: 36374479 PMCID: PMC9944261 DOI: 10.1007/s42770-022-00870-7] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/01/2022] [Indexed: 11/15/2022] Open
Abstract
Besides being an essential part of the skin microbiome, coagulase-negative staphylococci are the etiological factors of serious infections. The aim of the study was to evaluate the heteroresistance to vancomycin and the potential antimicrobial efficacy of teicoplanin and daptomycin against the multiresistant strains of S. haemolyticus, S. hominis, S. warneri, and S. simulans. The study covered 80 clinical coagulase-negative staphylococci. Teicoplanin, vancomycin, and daptomycin MICs for the tested strains were determined according to EUCAST recommendation. The vanA and vanB genes were searched. The brain heart infusion screen agar method detected vancomycin heteroresistance. The population analysis profile method and analysis of autolytic activity were applied for the strains growing on BHI containing 4 mg/L vancomycin. Seven S. haemolyticus, two S. hominis, and two S. warneri strains presented a heterogeneous resistance to vancomycin. Their subpopulations were able to grow on a medium containing 4-12 mg/L of vancomycin. Monitoring heteroresistance to peptide antibiotics, which are often the last resort in staphylococcal infections, is essential due to the severe crisis in antibiotic therapy and the lack of alternatives to treat infections with multiresistant strains. Our work highlights the selection of resistant strains and the need for more careful use of peptide antibiotics.
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Affiliation(s)
- Magdalena Szemraj
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Muszyńskiego 1, 90-235, Łódź, Poland.
| | - Paweł Lisiecki
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Muszyńskiego 1, 90-235, Łódź, Poland
| | - Paulina Glajzner
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Muszyńskiego 1, 90-235, Łódź, Poland
| | - Eligia M Szewczyk
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Muszyńskiego 1, 90-235, Łódź, Poland
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Abstract
OBJECTIVE To assess the success rates of off-label uses of ceftaroline for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and evaluate emerging ceftaroline resistance. DATA SOURCES We queried PubMed/MEDLINE, with the search term "Ceftaroline." Articles were restricted to the English language and year of publication (January 1, 2009-January 31, 2022). STUDY SELECTION AND DATA EXTRACTION Clinical trials, observational studies, and case reports that reported efficacy, safety, pharmacokinetics, use in MRSA infections other than acute bacterial skin infection and community-acquired pneumonia, and ceftaroline resistance were selected. DATA SYNTHESIS The search pooled 103 publications and all abstracts were reviewed. Forty-six articles that reported efficacy, safety, pharmacokinetics, or off-label use in multiple patients and 7 articles on ceftaroline resistance are used in this review. Ceftaroline has been approved for treatment of acute skin/soft tissue infection and community-acquired pneumonia. Ceftaroline's efficacy in off-label infections ranged from 66.7% to 87.3% depending on the types of infection. There were 14 documented cases of ceftaroline resistance associated with PBP2a changes. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Case series and observational studies have documented success with ceftaroline alone or in combination with vancomycin or daptomycin for treatment of MRSA bone and joint, endovascular, diabetic foot infections, and bacteremia from other causes. CONCLUSION Despite the lack of randomized controlled trials, ceftaroline is used as salvage therapy for different MRSA infections. The data from case series and observational studies are promising but ceftaroline should be used judiciously as ceftaroline-resistant MRSA begin to emerge.
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Affiliation(s)
- Getahun Abate
- Division of Infectious Diseases, Saint Louis University, Saint Louis, MO, USA
| | - Grace Wang
- Division of Infectious Diseases, Saint Louis University, Saint Louis, MO, USA
| | - Jared Frisby
- Division of Infectious Diseases, Saint Louis University, Saint Louis, MO, USA
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21
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Zhang R, Polenakovik H, Barreras Beltran IA, Waalkes A, Salipante SJ, Xu L, Werth BJ. Emergence of Dalbavancin, Vancomycin, and Daptomycin Nonsusceptible Staphylococcus aureus in a Patient Treated With Dalbavancin: Case Report and Isolate Characterization. Clin Infect Dis 2022; 75:1641-1644. [PMID: 35510938 PMCID: PMC10200325 DOI: 10.1093/cid/ciac341] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
A patient with end-stage renal disease received 2 doses of dalbavancin for methicillin-resistant Staphylococcus aureus (MRSA) arteriovenous fistula infection and presented 5 weeks later with infective endocarditis secondary to vancomycin, daptomycin, and dalbavancin nonsusceptible MRSA. Resistance was associated with walK and scrA mutations, reduced long-chain lipid content, and reduced membrane fluidity.
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Affiliation(s)
- Rutan Zhang
- Department of Medicinal Chemistry, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Hari Polenakovik
- Veterans Affairs Medical Center, Dayton, Ohio, USA
- Department of Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | | | - Adam Waalkes
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen J Salipante
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Libin Xu
- Department of Medicinal Chemistry, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Brian J Werth
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington, USA
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22
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Wang JT, Yang CJ, Yang JL, Lin SW, Chuang YC, Sheng WH, Chen YC, Chang SC. A High Daptomycin Dose Is Associated with Better Bacterial Clearance in Infections Caused by Vancomycin-Resistant Enterococcus faecium Regardless of Daptomycin Minimum Inhibitory Concentration in a Rat Infective Endocarditis Model. Microbiol Spectr 2022; 10:e0255122. [PMID: 36190402 PMCID: PMC9603373 DOI: 10.1128/spectrum.02551-22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/18/2022] [Indexed: 01/04/2023] Open
Abstract
A high daptomycin dose has been suggested for treating vancomycin-resistant Enterococcus faecium (VREf) infections. However, even a 12 mg/kg daptomycin dose might be insufficient for treating VREf with high daptomycin minimum inhibitory concentrations (MICs). Additionally, animal pharmacodynamic and infection models to confirm the efficacy of 12 mg/kg daptomycin are lacking. Male Wistar rats were used for pharmacokinetic profiling and for the development of an infective endocarditis (IE) model. Daptomycin-susceptible dose-dependent VREf (DSE) (MIC of 0.5 mg/L) and daptomycin nonsusceptible VREf (DNSE) (MIC of 8 mg/L) were used for the IE models. The bacterial load of vegetation was the primary outcome and was evaluated after 3 days of daptomycin treatment. Daptomycin administered subcutaneously (s.c.) at 45 and 90 mg/kg, which corresponded to maximum serum concentrations (Cmax) of 122.6 mg/L and 178.5 mg/L, respectively, was equivalent to doses of 8 mg/kg and 12 mg/kg, respectively, in humans. The Cmax/MIC value was correlated with the bacterial load of vegetation after treatment (r = -0.88, P < 0.001). The 90 mg/kg s.c. group showed a significantly lower bacterial load of vegetation (log10 CFU/g) than the 45 mg/kg s.c. group against DSE (0 versus 4.75, P < 0.001) and DNSE (5.12 versus 6.98, P = 0.002). The 90 mg/kg s.c. group did not sterilize the vegetation against DNSE. Although the human equivalent dose of 12 mg/kg daptomycin was more effective than the smaller dose in reducing the bacterial load in DSE and DNSE IE, the dose could not sterilize the vegetation during a DNSE treatment. Further treatment strategies by which to manage severe VREf infections, especially at high daptomycin MICs, are urgently needed. IMPORTANCE Using a rat IE model with pharmacokinetic analysis, the treatment response of VREf IE was found to be daptomycin dose-dependent, presented as Cmax/MIC or as the 24 h area under the concentration-time curve (AUC0-24)/MIC. Daptomycin 90 mg/kg s.c. significantly reduced the bacterial load against DSE and DNSE. It also showed significant activity against DSE and DNSE, compared to 45 mg/kg s.c. Although daptomycin 90 mg/kg can eradicate the bacterial load after 3 days of treatment against DSE, eradication cannot be achieved with 90 mg/kg daptomycin against DNSE.
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Affiliation(s)
- Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jia-Ling Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Wen Lin
- School of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Cancer Center, Taipei, Taiwan
- Graduate Institute of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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23
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Yeh SL, Narasimhalu N, Vom Steeg LG, Muthami J, LeConey S, He Z, Pitcher M, Cassady H, Morley VJ, Cho SH, Bator C, Koshani R, Woods RJ, Hickner M, Read AF, Sheikhi A. Ion Exchange Biomaterials to Capture Daptomycin and Prevent Resistance Evolution in Off-Target Bacterial Populations. ACS Appl Mater Interfaces 2022; 14:42864-42875. [PMID: 36103577 DOI: 10.1021/acsami.2c14894] [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] [Indexed: 06/15/2023]
Abstract
Daptomycin (DAP), a cyclic anionic lipopeptide antibiotic, is among the last resorts to treat multidrug-resistant Gram-positive bacterial infections, caused by vancomycin-resistant Enterococcus faecium or methicillin-resistant Staphylococcus aureus. DAP is administered intravenously, and via biliary excretion, ∼5-10% of the intravenous DAP dose arrives in the gastrointestinal (GI) tract where it drives resistance evolution in the off-target populations of E. faecium bacteria. Previously, we have shown in vivo that the oral administration of cholestyramine, an ion exchange biomaterial (IXB) sorbent, prevents DAP treatment from enriching DAP resistance in the populations of E. faecium shed from mice. Here, we investigate the biomaterial-DAP interfacial interactions to uncover the antibiotic removal mechanisms. The IXB-mediated DAP capture from aqueous media was measured in controlled pH/electrolyte solutions and in the simulated intestinal fluid (SIF) to uncover the molecular and colloidal mechanisms of DAP removal from the GI tract. Our findings show that the IXB electrostatically adsorbs the anionic antibiotic via a time-dependent diffusion-controlled process. Unsteady-state diffusion-adsorption mass balance describes the dynamics of adsorption well, and the maximum removal capacity is beyond the electric charge stoichiometric ratio because of DAP self-assembly. This study may open new opportunities for optimizing cholestyramine adjuvant therapy to prevent DAP resistance, as well as designing novel biomaterials to remove off-target antibiotics from the GI tract.
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Affiliation(s)
- Shang-Lin Yeh
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Naveen Narasimhalu
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Landon G Vom Steeg
- Department of Biology, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Joy Muthami
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Sean LeConey
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Zeming He
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Mica Pitcher
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
- Department of Chemistry, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Harrison Cassady
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Valerie J Morley
- Department of Biology, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Sung Hyun Cho
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Carol Bator
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Roya Koshani
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Robert J Woods
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Michael Hickner
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Andrew F Read
- Department of Biology, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Amir Sheikhi
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
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24
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Oyama T, Kageyama K, Araoka H, Mitsuki T, Yamaguchi K, Kaji D, Taya Y, Nishida A, Ishiwata K, Takagi S, Yamamoto H, Yamamoto G, Asano-Mori Y, Uchida N, Wake A, Makino S, Taniguchi S. Clinical and microbiological characteristics of bacterial meningitis in umbilical cord blood transplantation recipients. Int J Hematol 2022; 116:966-972. [PMID: 35932398 DOI: 10.1007/s12185-022-03425-6] [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: 03/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
Bacterial meningitis is a rare but severe infectious complication after hematopoietic stem cell transplantation. However, its clinical features were previously not clear. We reviewed the cases of 7 patients diagnosed with bacterial meningitis with a positive cerebrospinal fluid culture among 1147 patients who underwent cord blood transplantation (CBT) at our institution between September 2007 and September 2020. The diagnosis was made on day + 5- + 45, and 5 patients developed bacterial meningitis before neutrophil engraftment. The causative organisms were all Gram-positive cocci: Enterococcus faecium and Enterococcus gallinarum (2 patients each), and Staphylococcus haemolyticus, Streptococcus mitis/oralis, and Rothia mucilaginosa (1 patient each). Six patients developed bacterial meningitis secondary to prior or concomitant bacteremia caused by the same bacterium. Five patients had received anti-MRSA agents at onset: vancomycin in 3, teicoplanin in 1, and daptomycin in 1. After diagnosis of bacterial meningitis, linezolid was eventually used for 6 patients. Two patients with E. gallinarum were alive at day + 1380 and + 157 after CBT, respectively, whereas 5 patients died 17-53 (median 43) days after the onset of bacterial meningitis. Breakthrough meningitis in CBT can occur even during the use of anti-MRSA drugs, and intensive antibiotic treatment is necessary.
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Affiliation(s)
- Takashi Oyama
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Kosei Kageyama
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan.
| | - Hideki Araoka
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | - Takashi Mitsuki
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Kyosuke Yamaguchi
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Daisuke Kaji
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Yuki Taya
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Aya Nishida
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Kazuya Ishiwata
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Shinsuke Takagi
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Hisashi Yamamoto
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Go Yamamoto
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Yuki Asano-Mori
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Shigeyoshi Makino
- Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan
| | - Shuichi Taniguchi
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
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25
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Pascale R, Maccaro A, Mikus E, Baldassarre M, Tazza B, Esposito F, Rinaldi M, Tenti E, Ambretti S, Albertini A, Viale P, Giannella M, Bartoletti M. A Retrospective multicenter Study on Dalbavancin Effectiveness and cost-evaluation In Sternotomic Wound Infection Treatment. DALBA SWIT-Study. J Glob Antimicrob Resist 2022; 30:390-394. [PMID: 35878780 DOI: 10.1016/j.jgar.2022.07.018] [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: 05/19/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of dalbavancin compared with standard of care (SoC) treatment as daptomycin or teicoplanin in patients with sternal wound infections (SWI). METHODS Multicentre retrospective study of patients diagnosed with SWI from January 2016 to December 2019 at two cardiac surgery facilities treated with dalbavancin, teicoplanin or daptomycin. Patients with SWI treated with dalbavancin were compared with SoC to evaluate resolution of infection at 90 and 180 days from infection diagnosis, length of stay (LoS) and management costs. RESULTS 48 patients with SWI were enrolled, 25 (50%) male, median age 67 (60-73) years, Charlson index score 5 (4-7). Fiftheen patients were treated with dalbavancin (31%), and 33 with SoC (69%): teicoplanin in 21 (63%), and daptomycin in 12 (37%). Staphylococcus species were the most frequent isolates (44, 92%), mostly (84%) resistant to methicillin. All patients were treated with surgical debridement followed by negative pressure wound therapy. Wound healing at day 90 and 180 was achieved in 46 (95.8%) and 34 (82.9%) of patients, respectively. A shorter length of hospitalization in patients treated with dalbavancin compared with SoC [12 (7-18) days vs 22 (12-36) days, p:0.009] was found. Treatment with dalbavancin resulted in total cost savings of 16026 € (95%CI 5976 - 26076, p<0.001). Savings were mainly related to the LoS that was significantly shorter in the dalbavancin group generating significantly lower cost as compared to SoC group. CONCLUSIONS Dalbavancin treatment of sternal wound infections is effective and seems to reduce hospitalization length, leading to significantly lower costs.
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Affiliation(s)
- Renato Pascale
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Angelo Maccaro
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisa Mikus
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Maurizio Baldassarre
- U.O. Medical Semiotics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Beatrice Tazza
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Fabio Esposito
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Rinaldi
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Tenti
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Simone Ambretti
- Operative Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Albertini
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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26
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Obed MN, Toresani I, Mykietuk A, Nannini EC. Ceftaroline as salvage therapy for methicillin susceptible Staphylococcus aureus complicated bacteremia. Medicina (B Aires) 2022; 82:794-797. [PMID: 36220043] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with complicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.
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Affiliation(s)
- Mora N Obed
- Instituto Médico Platense, La Plata, Buenos Aires, Argentina
| | - Inés Toresani
- Facultad de Ciencias Bioquímicas, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Analía Mykietuk
- Instituto Médico Platense, La Plata, Buenos Aires, Argentina
| | - Esteban C Nannini
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Santa Fe, Argentina. E-mail:
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET, Rosario, Santa Fe, Argentina
- Sanatorio Británico, Rosario, Santa Fe, Argentina
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27
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de Carvalho CCCR, Taglialegna A, Rosato AE. Impact of PrsA on membrane lipid composition during daptomycin-resistance-mediated β-lactam sensitization in clinical MRSA strains. J Antimicrob Chemother 2021; 77:135-147. [PMID: 34618036 PMCID: PMC8730685 DOI: 10.1093/jac/dkab356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 04/24/2021] [Accepted: 08/28/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The cyclic anionic lipopeptide daptomycin is used in the treatment of severe infections caused by Gram-positive pathogens, including MRSA. Daptomycin resistance, although rare, often results in treatment failure. Paradoxically, in MRSA, daptomycin resistance is usually accompanied by a concomitant decrease in β-lactam resistance in what is known as the 'see-saw effect'. This resensitization is extensively used for the treatment of MRSA infections, by combining daptomycin and a β-lactam antibiotic, such as oxacillin. OBJECTIVES We aimed: (i) to investigate the combined effects of daptomycin and oxacillin on the lipid composition of the cellular membrane of both daptomycin-resistant and -susceptible MRSA strains; and (ii) to assess the involvement of the post-translocational protein PrsA, which plays an important role in oxacillin resistance in MRSA, in membrane lipid composition and remodelling during daptomycin resistance/β-lactam sensitization. RESULTS The combination of microbiological and biochemical studies, with fluorescence microscopy using lipid probes, showed that the lipid composition and surface charge of the daptomycin-resistant cells exposed to daptomycin/oxacillin were dependent on antibiotic concentration and directly associated with PrsA, which influenced cardiolipin remodelling/relocation. CONCLUSIONS Our findings show that PrsA, in addition to its post-transcriptional role in the maturation of PBP 2a, is a key mediator of cell membrane remodelling connected to the see-saw effect and may have a key role in the resensitization of daptomycin-resistant strains to β-lactams, such as oxacillin.
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Affiliation(s)
- Carla C C R de Carvalho
- iBB-Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Agustina Taglialegna
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, USA
| | - Adriana E Rosato
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, USA
- Department of Pathology and Molecular Microbiology Diagnostics-Research, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA
- University of California, Riverside, CA, USA
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28
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Gascón A, Castresana M, Alzueta N, Marin M, Pío M, Echeverria A. Combination of ceftaroline and daptomycin as treatment for complicated osteomyelitis. Eur J Hosp Pharm 2021; 28:289-292. [PMID: 32414746 PMCID: PMC8403780 DOI: 10.1136/ejhpharm-2019-002183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 11/04/2022] Open
Abstract
Osteomyelitis is an infection involving bone. Staphylococcus aureus is the pathogen most frequently implicated; less frequently involved are other gram-positive organisms, such as Staphylococcus epidermidis, and also gram-negative organisms. The antibiotic of choice for treatment of osteomyelitis caused by methicillin-resistant staphylococci (MRS) is vancomycin, although other alternatives such as daptomycin or teicoplanin are also considered. Osteomyelitis caused by MRS can be difficult to treat safely and effectively. This case report describes the successful use of daptomycin combined with ceftaroline for the treatment of osteomyelitis caused by methicillin-resistant S. epidermidis (MRSE) in a 54-year-old woman, emphasising the clinical pharmacist's role in antimicrobial stewardship programmes. This alternative combination has been studied in the treatment of methicillin-resistant S. aureus (MRSA), but it may also be useful in MRSE.
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Affiliation(s)
- Ana Gascón
- Pharmacy, Hospital Reina Sofia Navarre Health Service, Tudela, Spain
| | - Marta Castresana
- Pharmacy, Hospital Reina Sofia Navarre Health Service, Tudela, Spain
| | - Natalia Alzueta
- Pharmacy Management Service, Navarre Health Service, Pamplona, Spain
| | - Marta Marin
- Pharmacy, Hospital Reina Sofia Navarre Health Service, Tudela, Spain
| | - María Pío
- Pharmacy, Hospital Reina Sofia Navarre Health Service, Tudela, Spain
| | - Aitziber Echeverria
- Internal Medicine, Hospital Reina Sofia, Navarre Health Service, Tudela, Spain
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29
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Pujol M, Miró JM, Shaw E, Aguado JM, San-Juan R, Puig-Asensio M, Pigrau C, Calbo E, Montejo M, Rodriguez-Álvarez R, Garcia-Pais MJ, Pintado V, Escudero-Sánchez R, Lopez-Contreras J, Morata L, Montero M, Andrés M, Pasquau J, Arenas MDM, Padilla B, Murillas J, Jover-Sáenz A, López-Cortes LE, García-Pardo G, Gasch O, Videla S, Hereu P, Tebé C, Pallarès N, Sanllorente M, Domínguez MÁ, Càmara J, Ferrer A, Padullés A, Cuervo G, Carratalà J. Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial. Clin Infect Dis 2021; 72:1517-1525. [PMID: 32725216 PMCID: PMC8096235 DOI: 10.1093/cid/ciaa1081] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis. METHODS A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy. RESULTS Of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval, .93-1.8]; P = .135). At 6 weeks, daptomycin plus fosfomycin was associated with lower microbiologic failure (0 vs 9 patients; P = .003) and lower complicated bacteremia (16.2% vs 32.1%; P = .022). Adverse events leading to treatment discontinuation occurred in 13 of 74 patients (17.6%) receiving daptomycin plus fosfomycin, and in 4 of 81 patients (4.9%) receiving daptomycin alone (P = .018). CONCLUSIONS Daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance. This antibiotic combination prevented microbiological failure and complicated bacteremia, but it was more often associated with adverse events. CLINICAL TRIALS REGISTRATION NCT01898338.
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Affiliation(s)
- Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - José-María Miró
- Department of Infectious Diseases, Hospital Clinic, Institut d’Investigacions Biomèdiques Agust Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Jose-María Aguado
- Department of Infectious Diseases, Hospital Universitario 12 Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Rafael San-Juan
- Department of Infectious Diseases, Hospital Universitario 12 Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Mireia Puig-Asensio
- Department of Infectious Diseases, Hospital Vall d’Hebron, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Carles Pigrau
- Department of Infectious Diseases, Hospital Vall d’Hebron, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Esther Calbo
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Fundació Docència i Recerca Mútua de Terrassa, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Miguel Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Biocruces Bizkaia, Bilbao, Spain
| | - Regino Rodriguez-Álvarez
- Department of Infectious Diseases, Hospital Universitario Cruces, Biocruces Bizkaia, Bilbao, Spain
| | - María-Jose Garcia-Pais
- Infectious Diseases Unit, Hospital Lucus Augusti, Instituto de Investigación Sanitaria de Santiago de Compostela, Lugo, Spain
| | - Vicente Pintado
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Instituto Ramon y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Rosa Escudero-Sánchez
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Instituto Ramon y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Joaquín Lopez-Contreras
- Department of Infectious Diseases, Hospital Universitari de Sant Pau, Institut d’Investigació Biomèdica de Sant Pau, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic, Institut d’Investigacions Biomèdiques Agust Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Milagros Montero
- Department of Infectious Diseases, Hospital del Mar, Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Marta Andrés
- Infectious Disease Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Juan Pasquau
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Sanitaria Granada, Granada, Spain
| | - María-del-Mar Arenas
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Sanitaria Granada, Granada, Spain
| | - Belén Padilla
- Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Javier Murillas
- Department of Internal Medicine, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears, Mallorca, Spain
| | - Alfredo Jover-Sáenz
- Territorial Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Luis-Eduardo López-Cortes
- Department of Infectious Diseases, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Graciano García-Pardo
- Department of Internal Medicine, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Oriol Gasch
- Department of Infectious Diseases, Consorci Sanitari Hospital Parc Taulí, Fundació Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
| | - Sebastian Videla
- Department of Clinical Pharmacology, Institut Investigacions Biomèdiques de Bellvitge, Clinical Research and Clinical Trials Unit, Plataforma Spanish Clinical Research Network, Barcelona, Spain
| | - Pilar Hereu
- Department of Clinical Pharmacology, Institut Investigacions Biomèdiques de Bellvitge, Clinical Research and Clinical Trials Unit, Plataforma Spanish Clinical Research Network, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit, Institut Investigacions Biomèdiques de Bellvitge, L’Hospitalet Llobregat, L’Hospitalet del Llobregat, Spain
| | - Natalia Pallarès
- Biostatistics Unit, Institut Investigacions Biomèdiques de Bellvitge, L’Hospitalet Llobregat, L’Hospitalet del Llobregat, Spain
| | - Mireia Sanllorente
- Department of Clinical Pharmacology, Institut Investigacions Biomèdiques de Bellvitge, Clinical Research and Clinical Trials Unit, Plataforma Spanish Clinical Research Network, Barcelona, Spain
| | - María-Ángeles Domínguez
- Department of Microbiology and Parasitology, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Jordi Càmara
- Department of Microbiology and Parasitology, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Anna Ferrer
- Department of Pharmacy, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Ariadna Padullés
- Department of Pharmacy, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
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Cristinacce A, Wright JG, Macpherson M, Iaconis J, Das S. Comparing probability of target attainment against Staphylococcus aureus for ceftaroline fosamil, vancomycin, daptomycin, linezolid, and ceftriaxone in complicated skin and soft tissue infection using pharmacokinetic/pharmacodynamic models. Diagn Microbiol Infect Dis 2021; 99:115292. [PMID: 33360809 DOI: 10.1016/j.diagmicrobio.2020.115292] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/19/2018] [Revised: 10/31/2019] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Abstract
For recently licensed antibiotics, such as the cephalosporin ceftaroline fosamil, probability of target attainment (PTA) curves, showing the percentage of patients reaching a predefined pharmacokinetic (PK)/pharmacodynamic (PD) target at different bacterial minimum inhibitory concentrations (MICs), have been used to support and justify dose recommendations across patient populations. However, information on PTA for older antibiotics is limited. A retrospective analysis was conducted to construct PTA curves for 4 antibiotics against Staphylococcus aureus in patients with complicated skin and soft tissue infections (cSSTIs). PK models for vancomycin, linezolid, daptomycin, and ceftriaxone were selected from the literature based on large numbers of subjects with covariates representative of patients in Europe and/or the United States. An existing model was available for ceftaroline fosamil. Standard and high-dosage regimens were used to compare the PTA of each antibiotic at MIC values 0.03 to 64 mg/L for a simulated set of patients with cSSTI caused by S. aureus. These were compared to proportions of S. aureus isolates at each MIC from global surveillance data. Ceftaroline achieved PTAs >99.9% for bacteriostatic and bactericidal targets at the MIC90 (1 mg/L), whereas the comparators failed to achieve PTAs >90%, at bacteriostatic or bactericidal targets, even when clinical doses were increased beyond those recommended. PTA analysis can be used to compare different drugs with the same simulated patient dataset, subject to availability of an appropriate PK model and robust exposure targets. This analysis shows that some antibiotics commonly used to treat cSSTIs may fail to reach high PTAs relative to contemporary MIC90 estimates.
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Affiliation(s)
| | | | | | | | - Shampa Das
- Clinical Pharmacology, AstraZeneca, Macclesfield, UK.
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31
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Johnson TM, Molina KC, Miller MA, Kiser TH, Huang M, Mueller SW. Combination ceftaroline and daptomycin salvage therapy for complicated methicillin-resistant Staphylococcus aureus bacteraemia compared with standard of care. Int J Antimicrob Agents 2021; 57:106310. [PMID: 33609718 DOI: 10.1016/j.ijantimicag.2021.106310] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 09/20/2020] [Revised: 01/20/2021] [Accepted: 02/14/2021] [Indexed: 01/03/2023]
Abstract
Complicated methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs), particularly those with delayed culture clearance, are associated with high mortality. Combination therapy with daptomycin and ceftaroline (DAP+CPT) represents a novel therapeutic approach to MRSA-BSI owing to synergistic bactericidal activity. This study aimed to compare DAP+CPT with historical standard of care (SoC) for treatment of complicated MRSA-BSI. This single-centre retrospective cohort study included patients with complicated MRSA-BSI at University of Colorado Hospital. Patients receiving DAP+CPT for ≥48 h between November 2013 and March 2020 or SoC with vancomycin or DAP ± gentamicin and/or rifampicin from November 2011 to December 2013 were compared. The primary outcome was clinical failure defined as a composite of MRSA-related mortality and recurrent infection at 60 days. A total of 60 patients received DAP+CPT (n = 30) or SoC (n = 30). Median age was 56 years and median Pitt bacteremia score was 3. Common infectious sites were endovascular (63%) and musculoskeletal (40%). DAP+CPT was associated with a numerically lower incidence of clinical failure compared with SoC (20% vs. 43%; P = 0.052). Multivariable analysis controlling for immunocompromised status (OR, 6.90, 95% CI 1.08-44.15), Charlson comorbidity index (OR, 1.12, 95% CI 0.90-1.39) and source control (OR, 0.35, 95% CI 0.08-1.46) associated DAP+CPT with 77% lower odds of clinical failure (OR, 0.23, 95% CI 0.06-0.89). In patients with complicated MRSA-BSI with delayed clearance, DAP+CPT trended towards lower rates of clinical failure than SoC and was significantly associated with decreased clinical failure after adjustment for baseline differences.
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Affiliation(s)
- Tanner M Johnson
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Kyle C Molina
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Matthew A Miller
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Tyree H Kiser
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Misha Huang
- Department of Medicine-Infectious Diseases, University of Colorado Hospital, Aurora, CO, USA; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott W Mueller
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
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32
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Yeager SD, Oliver JE, Shorman MA, Wright LR, Veve MP. Comparison of linezolid step-down therapy to standard parenteral therapy in methicillin-resistant Staphylococcus aureus bloodstream infections. Int J Antimicrob Agents 2021; 57:106329. [PMID: 33785363 DOI: 10.1016/j.ijantimicag.2021.106329] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/23/2020] [Revised: 02/19/2021] [Accepted: 03/20/2021] [Indexed: 11/18/2022]
Abstract
Data supporting oral step-down therapy in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) are sparse; linezolid offers potential in this setting. This study aimed to determine the effectiveness and safety of oral step-down linezolid compared with standard parenteral therapy (SPT) in MRSA-BSI. This was a retrospective cohort performed in adults receiving step-down/outpatient linezolid or SPT (vancomycin, daptomycin) for MRSA-BSI from 2011-2019. Primary outcome was 90-day infection-related re-admission (IRR) from clinical worsening/relapse or infection recurrence. 215 patients included (54 linezolid, 161 SPT). Infection sources were skin (34%), bone/joint (15%), endocarditis (13%), other (32%), multiple (6%). Patients receiving SPT more commonly had complicated bacteraemia (72% vs. 41%; P < 0.0001) and metastatic foci (45% vs. 20%; P = 0.001). 90-day IRR occurred in 17% and 26% of linezolid and SPT groups, respectively (P = 0.159). When accounting for disease severity, linezolid use was not independently associated with 90-day IRR (adjOR, 1.0, 95% CI 0.24-4.3; P = 0.986). There were no differences in all-cause 90-day mortality (4% vs. 6%, P = 0.487) or overall incidence of drug-related adverse events (AEs) (17% vs. 16%; P = 0.843) between the groups. More patients in the SPT group developed an AE requiring re-hospitalisation (12% vs. 2%; P = 0.024), most commonly line-related complications. Oral step-down linezolid demonstrated similar clinical and safety outcomes compared with SPT for MRSA-BSI, except linezolid was associated with fewer AEs requiring re-hospitalisation. Additional research is needed exploring step-down linezolid in MRSA-BSI, particularly in patients requiring shorter durations of outpatient therapy.
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Affiliation(s)
- Samantha D Yeager
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN 37920, USA
| | - Justin E Oliver
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Knoxville, TN 37920, USA
| | - Mahmoud A Shorman
- Division of Infectious Diseases, University of Tennessee Medical Center, Knoxville, TN 37920 USA; Graduate School of Medicine, University of Tennessee Health Science Center, Knoxville, TN 37920, USA
| | - Laurence R Wright
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN 37920, USA
| | - Michael P Veve
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN 37920, USA; Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Knoxville, TN 37920, USA.
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Zuttion F, Colom A, Matile S, Farago D, Pompeo F, Kokavecz J, Galinier A, Sturgis J, Casuso I. High-speed atomic force microscopy highlights new molecular mechanism of daptomycin action. Nat Commun 2020; 11:6312. [PMID: 33298927 PMCID: PMC7725780 DOI: 10.1038/s41467-020-19710-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023] Open
Abstract
The increase in speed of the high-speed atomic force microscopy (HS-AFM) compared to that of the conventional AFM made possible the first-ever visualisation at the molecular-level of the activity of an antimicrobial peptide on a membrane. We investigated the medically prescribed but poorly understood lipopeptide Daptomycin under infection-like conditions (37 °C, bacterial lipid composition and antibiotic concentrations). We confirmed so far hypothetical models: Dap oligomerization and the existence of half pores. Moreover, we detected unknown molecular mechanisms: new mechanisms to form toroidal pores or to resist Dap action, and to unprecedently quantify the energy profile of interacting oligomers. Finally, the biological and medical relevance of the findings was ensured by a multi-scale multi-nativeness-from the molecule to the cell-correlation of molecular-level information from living bacteria (Bacillus subtilis strains) to liquid-suspended vesicles and supported-membranes using electron and optical microscopies and the lipid tension probe FliptR, where we found that the cells with a healthier state of their cell wall show smaller membrane deformations.
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Affiliation(s)
| | - Adai Colom
- Biochemistry Department, University of Geneva, Geneva, Switzerland
| | - Stefan Matile
- Organic Chemistry Department, University of Geneva, Geneva, Switzerland
| | - Denes Farago
- Department of Technical Informatics University of Szeged, Szeged, Hungary
| | - Frédérique Pompeo
- Laboratoire de Chimie Bactérienne (LCB), Institut de Microbiologie de la Méditerranée (IMM), CNRS, UMR 7283, Aix Marseille Université, Marseille, France
| | - Janos Kokavecz
- Institute of Environmental Science and Engineering, University of Szeged, Szeged, Hungary
| | - Anne Galinier
- Laboratoire de Chimie Bactérienne (LCB), Institut de Microbiologie de la Méditerranée (IMM), CNRS, UMR 7283, Aix Marseille Université, Marseille, France
| | - James Sturgis
- LISM, UMR 7255, CNRS, Aix Marseille Université, Marseille, France
| | - Ignacio Casuso
- U1067 INSERM, Aix-Marseille Université, Marseille, France.
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Morley VJ, Kinnear CL, Sim DG, Olson SN, Jackson LM, Hansen E, Usher GA, Showalter SA, Pai MP, Woods RJ, Read AF. An adjunctive therapy administered with an antibiotic prevents enrichment of antibiotic-resistant clones of a colonizing opportunistic pathogen. eLife 2020; 9:e58147. [PMID: 33258450 PMCID: PMC7707840 DOI: 10.7554/elife.58147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
A key challenge in antibiotic stewardship is figuring out how to use antibiotics therapeutically without promoting the evolution of antibiotic resistance. Here, we demonstrate proof of concept for an adjunctive therapy that allows intravenous antibiotic treatment without driving the evolution and onward transmission of resistance. We repurposed the FDA-approved bile acid sequestrant cholestyramine, which we show binds the antibiotic daptomycin, as an 'anti-antibiotic' to disable systemically-administered daptomycin reaching the gut. We hypothesized that adjunctive cholestyramine could enable therapeutic daptomycin treatment in the bloodstream, while preventing transmissible resistance emergence in opportunistic pathogens colonizing the gastrointestinal tract. We tested this idea in a mouse model of Enterococcus faecium gastrointestinal tract colonization. In mice treated with daptomycin, adjunctive cholestyramine therapy reduced the fecal shedding of daptomycin-resistant E. faecium by up to 80-fold. These results provide proof of concept for an approach that could reduce the spread of antibiotic resistance for important hospital pathogens.
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Affiliation(s)
- Valerie J Morley
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State UniversityUniversity ParkUnited States
| | - Clare L Kinnear
- Division of Infectious Diseases, Department of Internal Medicine, University of MichiganAnn ArborUnited States
| | - Derek G Sim
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State UniversityUniversity ParkUnited States
| | - Samantha N Olson
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State UniversityUniversity ParkUnited States
| | - Lindsey M Jackson
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State UniversityUniversity ParkUnited States
| | - Elsa Hansen
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State UniversityUniversity ParkUnited States
| | - Grace A Usher
- Department of Biochemistry and Molecular Biology, The Pennsylvania State UniversityUniversity ParkUnited States
| | - Scott A Showalter
- Department of Biochemistry and Molecular Biology, The Pennsylvania State UniversityUniversity ParkUnited States
- Department of Chemistry, The Pennsylvania State UniversityUniversity ParkUnited States
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of MichiganAnn ArborUnited States
| | - Robert J Woods
- Division of Infectious Diseases, Department of Internal Medicine, University of MichiganAnn ArborUnited States
| | - Andrew F Read
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State UniversityUniversity ParkUnited States
- Huck Institutes for the Life Sciences, The Pennsylvania State UniversityUniversity ParkUnited States
- Department of Entomology, The Pennsylvania State UniversityUniversity ParkUnited States
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35
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Holubar M, Meng L, Alegria W, Deresinski S. Bacteremia due to Methicillin-Resistant Staphylococcus aureus: An Update on New Therapeutic Approaches. Infect Dis Clin North Am 2020; 34:849-861. [PMID: 33011050 DOI: 10.1016/j.idc.2020.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Vancomycin and daptomycin are options for the initial treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Treatment options for persistent MRSA bacteremia or bacteremia due to vancomycin-intermediate or vancomycin-resistant strains include daptomycin, ceftaroline, and combination therapies. There is a critical need for high-level evidence from clinical trials to allow optimally informed decisions in the treatment of MRSA bacteremia.
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Affiliation(s)
- Marisa Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room L-134, Stanford, CA 94305-5105, USA.
| | - Lina Meng
- Department of Quality, Patient Safety and Effectiveness, Stanford Health Care, 300 Pasteur Drive Lane 134, Stanford, CA 94305, USA
| | - William Alegria
- Department of Quality, Patient Safety and Effectiveness, Stanford Health Care, 300 Pasteur Drive Lane 134, Stanford, CA 94305, USA
| | - Stan Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room L-134, Stanford, CA 94305-5105, USA
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36
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Morrisette T, Lagnf AM, Alosaimy S, Rybak MJ. A comparison of daptomycin alone and in combination with ceftaroline fosamil for methicillin-resistant Staphylococcus aureus bacteremia complicated by septic pulmonary emboli. Eur J Clin Microbiol Infect Dis 2020; 39:2199-2203. [PMID: 32535805 DOI: 10.1007/s10096-020-03941-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/02/2020] [Indexed: 10/23/2022]
Abstract
The use of daptomycin (DAP) in septic pulmonary emboli (SPE) remains controversial. We analyzed 29 cases of MRSA bacteremia complicated by SPE treated with DAP (n = 14) or DAP-ceftaroline fosamil (CPT; n = 15). Initial treatment with DAP monotherapy was found to have a success rate comparable with DAP-CPT (71% vs. 80%; p = 0.68).
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
- Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI, USA.
- Department of Pharmacy, Detroit Medical Center, Detroit, MI, USA.
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37
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Tong SYC, Lye DC, Yahav D, Sud A, Robinson JO, Nelson J, Archuleta S, Roberts MA, Cass A, Paterson DL, Foo H, Paul M, Guy SD, Tramontana AR, Walls GB, McBride S, Bak N, Ghosh N, Rogers BA, Ralph AP, Davies J, Ferguson PE, Dotel R, McKew GL, Gray TJ, Holmes NE, Smith S, Warner MS, Kalimuddin S, Young BE, Runnegar N, Andresen DN, Anagnostou NA, Johnson SA, Chatfield MD, Cheng AC, Fowler VG, Howden BP, Meagher N, Price DJ, van Hal SJ, O’Sullivan MVN, Davis JS. Effect of Vancomycin or Daptomycin With vs Without an Antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA Bacteremia: A Randomized Clinical Trial. JAMA 2020; 323:527-537. [PMID: 32044943 PMCID: PMC7042887 DOI: 10.1001/jama.2020.0103] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [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: 12/15/2022]
Abstract
IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with mortality of more than 20%. Combining standard therapy with a β-lactam antibiotic has been associated with reduced mortality, although adequately powered randomized clinical trials of this intervention have not been conducted. OBJECTIVE To determine whether combining an antistaphylococcal β-lactam with standard therapy is more effective than standard therapy alone in patients with MRSA bacteremia. DESIGN, SETTING, AND PARTICIPANTS Open-label, randomized clinical trial conducted at 27 hospital sites in 4 countries from August 2015 to July 2018 among 352 hospitalized adults with MRSA bacteremia. Follow-up was complete on October 23, 2018. INTERVENTIONS Participants were randomized to standard therapy (intravenous vancomycin or daptomycin) plus an antistaphylococcal β-lactam (intravenous flucloxacillin, cloxacillin, or cefazolin) (n = 174) or standard therapy alone (n = 178). Total duration of therapy was determined by treating clinicians and the β-lactam was administered for 7 days. MAIN OUTCOMES AND MEASURES The primary end point was a 90-day composite of mortality, persistent bacteremia at day 5, microbiological relapse, and microbiological treatment failure. Secondary outcomes included mortality at days 14, 42, and 90; persistent bacteremia at days 2 and 5; acute kidney injury (AKI); microbiological relapse; microbiological treatment failure; and duration of intravenous antibiotics. RESULTS The data and safety monitoring board recommended early termination of the study prior to enrollment of 440 patients because of safety. Among 352 patients randomized (mean age, 62.2 [SD, 17.7] years; 121 women [34.4%]), 345 (98%) completed the trial. The primary end point was met by 59 (35%) with combination therapy and 68 (39%) with standard therapy (absolute difference, -4.2%; 95% CI, -14.3% to 6.0%). Seven of 9 prespecified secondary end points showed no significant difference. For the combination therapy vs standard therapy groups, all-cause 90-day mortality occurred in 35 (21%) vs 28 (16%) (difference, 4.5%; 95% CI, -3.7% to 12.7%); persistent bacteremia at day 5 was observed in 19 of 166 (11%) vs 35 of 172 (20%) (difference, -8.9%; 95% CI, -16.6% to -1.2%); and, excluding patients receiving dialysis at baseline, AKI occurred in 34 of 145 (23%) vs 9 of 145 (6%) (difference, 17.2%; 95% CI, 9.3%-25.2%). CONCLUSIONS AND RELEVANCE Among patients with MRSA bacteremia, addition of an antistaphylococcal β-lactam to standard antibiotic therapy with vancomycin or daptomycin did not result in significant improvement in the primary composite end point of mortality, persistent bacteremia, relapse, or treatment failure. Early trial termination for safety concerns and the possibility that the study was underpowered to detect clinically important differences in favor of the intervention should be considered when interpreting the findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02365493.
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Affiliation(s)
- Steven Y. C. Tong
- Victorian Infectious Disease Service, Royal Melbourne Hospital, and University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - David C. Lye
- National Centre for Infectious Diseases, Singapore
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Dafna Yahav
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Archana Sud
- Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Nepean Hospital, Kingswood, New South Wales, Australia
| | - J. Owen Robinson
- Royal Perth Hospital, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Pathwest Laboratory Medicine WA, Murdoch, Western Australia, Australia
- Antimicrobial Resistance and Infectious Diseases Research Laboratory, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Jane Nelson
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Sophia Archuleta
- Division of Infectious Diseases, National University Hospital, Singapore
- Department of Medicine, National University of Singapore, Singapore
| | - Matthew A. Roberts
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - David L. Paterson
- Centre for Clinical Research, University of Queensland, Herston, Australia
| | - Hong Foo
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool, New South Wales, Australia
| | - Mical Paul
- Rambam Health Care Campus, Haifa, Israel
- Technion–Israel Institute of Technology, Haifa, Israel
| | - Stephen D. Guy
- Footscray Hospital, Western Health, Footscray, Victoria, Australia
| | | | - Genevieve B. Walls
- Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand
| | - Stephen McBride
- Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand
| | - Narin Bak
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niladri Ghosh
- Wollongong Public Hospital, Wollongong, New South Wales, Australia
| | - Benjamin A. Rogers
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Monash Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Jane Davies
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Patricia E. Ferguson
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Genevieve L. McKew
- Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Timothy J. Gray
- Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha E. Holmes
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, Heidelberg, Victoria, Australia
| | - Simon Smith
- Cairns Hospital, Cairns, Queensland, Australia
| | - Morgyn S. Warner
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Barnaby E. Young
- National Centre for Infectious Diseases, Singapore
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Southern Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David N. Andresen
- St Vincent’s Public Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Medicine, University of Notre Dame, Darlinghurst, New South Wales, Australia
| | | | - Sandra A. Johnson
- Victorian Infectious Disease Service, Royal Melbourne Hospital, and University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Mark D. Chatfield
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Centre for Clinical Research, University of Queensland, Herston, Australia
| | - Allen C. Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Vance G. Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Benjamin P. Howden
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, Heidelberg, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Niamh Meagher
- Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, Royal Melbourne Hospital, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - David J. Price
- Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, Royal Melbourne Hospital, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastiaan J. van Hal
- Department of Microbiology and Infectious Disease, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Matthew V. N. O’Sullivan
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- New South Wales Health Pathology, Westmead Hospital, Westmead, Australia
| | - Joshua S. Davis
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia
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Mootz ML, Britt RS, Mootz AA, Lee GC, Reveles KR, Evoy KE, Teng C, Frei CR. Comparative-effectiveness of ceftaroline and daptomycin as first-line MRSA therapy for patients with sepsis admitted to hospitals in the United States Veterans Health Care System. Hosp Pract (1995) 2019; 47:186-191. [PMID: 31578888 PMCID: PMC6883169 DOI: 10.1080/21548331.2019.1676540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
Objectives: This study compared hospital readmission and mortality for patients with sepsis who received ceftaroline or daptomycin as first-line MRSA therapy.Methods: This retrospective comparative-effectiveness study included adults ≥18 years old hospitalized in the United States Veterans Health Care System with sepsis between 10/1/2010-9/30/2014, who received ceftaroline or daptomycin within 14 days of hospital admission as the first antibiotic effective against methicillin resistant Staphylococcus aureus (MRSA). Patients with pneumonia, and those who received both study drugs, were excluded. Baseline characteristics were compared using Chi-square, Fischer's exact, Student's t, and Wilcoxon Rank Sum tests. Patient outcomes were compared with multivariable logistic regression models.Results: 409 patients were included (ceftaroline = 67, daptomycin = 342). Ceftaroline patients were older, less likely to be Black, more likely to have diabetes with complications, and had higher Charlson comorbidity scores. Median (interquartile range) time from admission to drug initiation was 1 (0-1) day for ceftaroline and 1 (1-3) day for daptomycin (p = 0.01). Unadjusted hospital readmission rates for ceftaroline and daptomycin, respectively, were: 30-day (25%/37%, p = 0.06), 60-day (27%/44%, p = 0.008), and 90-day (28%/46%, p = 0.01). Unadjusted mortality rates were: in-hospital (7%/12%, p = 0.4), 30-day (3%/9%, p = 0.1), 60-day (6%/12%, p = 0.2), and 90-day (7%/15%, p = 0.1). In multivariable models with all divergent baseline characteristics included as covariates, patients treated with ceftaroline were less likely to experience (OR, 95% CI): 30/60/90-day hospital readmission (0.54, 0.29-0.98; 0.42, 0.23-0.76; 0.42, 0.23-0.75) and 30/60/90-day mortality (0.23, 0.04-0.82; 0.34, 0.10-0.93; 0.34, 0.11-0.86).Conclusion: In patients with sepsis, ceftaroline was associated with fewer hospital readmissions and lower mortality as compared to daptomycin. Prospective investigations in larger, more generalized cohorts are needed to examine outcomes with specific MRSA therapies.
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Affiliation(s)
- Marilyn L. Mootz
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Rachel S. Britt
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Allison A. Mootz
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Grace C. Lee
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kelly R. Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kirk E. Evoy
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health System, San Antonio, TX, USA
| | - Chengwen Teng
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Christopher R. Frei
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- University Health System, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
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Duss FR, Garcia de la Mària C, Croxatto A, Giulieri S, Lamoth F, Manuel O, Miró JM. Successful treatment with daptomycin and ceftaroline of MDR Staphylococcus aureus native valve endocarditis: a case report. J Antimicrob Chemother 2019; 74:2626-2630. [PMID: 31298264 DOI: 10.1093/jac/dkz253] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/13/2018] [Revised: 05/02/2019] [Accepted: 05/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The best therapeutic approach for treating MRSA endocarditis remains unknown, particularly in cases of high vancomycin MICs. We report here a case of daptomycin-non-susceptible, ceftaroline-resistant and fosfomycin-resistant MRSA native left valve endocarditis that was successfully treated with valve repair and a combination of high-dose daptomycin and ceftaroline. METHODS Antimicrobial testing of the clinical strain was performed using Etest and microdilution broth methods. Time-kill and chequerboard methodologies were used to test the activity of antibiotic combinations. RESULTS By Etest, the MIC of vancomycin was 2 mg/L, the MIC of daptomycin was 2 mg/L, the MIC of fosfomycin was 1024 mg/L and the MIC of ceftaroline was 1.5 mg/L. At the standard inoculum (105 cfu/mL), the three combinations of daptomycin plus ceftaroline, cloxacillin or fosfomycin were synergistic and bactericidal. However, when these combinations were tested using a higher inoculum (108 cfu/mL), all combinations were synergistic, but only daptomycin plus ceftaroline had bactericidal activity. CONCLUSIONS These results confirmed a synergistic effect between daptomycin plus ceftaroline and increased bactericidal activity against MRSA, suggesting that this combination may be effective for the treatment of invasive MRSA infection. Our experience highlights the potential clinical use of synergy testing to guide difficult treatment decisions in patients with MDR MRSA infection.
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Affiliation(s)
- François-Régis Duss
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Antony Croxatto
- Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stefano Giulieri
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
- Transplantation Center, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Hagiya H, Kimura K, Okuno H, Hamaguchi S, Morii D, Yoshida H, Mitsui T, Nishi I, Tomono K. Bacteremia due to high-level daptomycin-resistant Corynebacterium striatum: A case report with genetic investigation. J Infect Chemother 2019; 25:906-908. [PMID: 31101531 DOI: 10.1016/j.jiac.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/18/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 11/17/2022]
Abstract
Corynebacterium striatum, generally considered an opportunistic organism in humans, has recently been known to develop high-level daptomycin resistance (HLDR) shortly after drug exposure. To date, however, only several such clinical isolates have been described in the literature and clinical background of the resistant pathogen remains to be elucidated. Here, we report a case involving a C. striatum strain with HLDR harboring novel nucleotide mutations, together with a review of the relevant literature. To the best of our knowledge, this is the first well-investigated clinical report from Japan including a genetic investigation. Considering the rapid emergence of HLDR C. striatum in vitro experiment, there could be a number of underreporting cases. Scrupulous attention is required when administering daptomycin for the treatment of C. striatum infections, even if the organism has initially exhibited susceptibility.
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Affiliation(s)
- Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Japan.
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Hideo Okuno
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Shigeto Hamaguchi
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Daiichi Morii
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Tomomi Mitsui
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Isao Nishi
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
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Geriak M, Haddad F, Rizvi K, Rose W, Kullar R, LaPlante K, Yu M, Vasina L, Ouellette K, Zervos M, Nizet V, Sakoulas G. Clinical Data on Daptomycin plus Ceftaroline versus Standard of Care Monotherapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia. Antimicrob Agents Chemother 2019; 63:e02483-18. [PMID: 30858203 PMCID: PMC6496065 DOI: 10.1128/aac.02483-18] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/03/2019] [Indexed: 12/24/2022] Open
Abstract
Vancomycin (VAN) and daptomycin (DAP) are approved as a monotherapy for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. A regimen of daptomycin plus ceftaroline (DAP+CPT) has shown promise in published case series of MRSA salvage therapy, but no comparative data exist to compare up-front DAP+CPT head-to-head therapy versus standard monotherapy as an initial treatment. In a pilot study, we evaluated 40 adult patients who were randomized to receive 6 to 8 mg/kg of body weight per day of DAP and 600 mg intravenous (i.v.) CPT every 8 h (q8h) (n = 17) or standard monotherapy (n = 23) with vancomycin (VAN; dosed to achieve serum trough concentrations of 15 to 20 mg/liter; n = 21) or 6 to 8 mg/kg/day DAP (n = 2). Serum drawn on the first day of bacteremia was sent to a reference laboratory post hoc for measurement of interleukin-10 (IL-10) concentrations and correlation to in-hospital mortality. Sources of bacteremia, median Pitt bacteremia scores, Charlson comorbidity indices, and median IL-10 serum concentrations were similar in both groups. Although the study was initially designed to examine bacteremia duration, we observed an unanticipated in-hospital mortality difference of 0% (0/17) for combination therapy and 26% (6/23) for monotherapy (P = 0.029), causing us to halt the study. Among patients with an IL-10 concentration of >5 pg/ml, 0% (0/14) died in the DAP+CPT group versus 26% (5/19) in the monotherapy group (P = 0.057). Here, we share the full results of this preliminary (but aborted) assessment of early DAP+CPT therapy versus standard monotherapy in MRSA bacteremia, hoping to encourage a more definitive clinical trial of its potential benefits against this leading cause of infection-associated mortality. (The clinical study discussed in this paper has been registered at ClinicalTrials.gov under identifier NCT02660346.).
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Affiliation(s)
| | - Fadi Haddad
- Sharp Grossmont Hospital, La Mesa, California, USA
| | | | - Warren Rose
- University of Wisconsin School of Pharmacy, Madison, Wisconsin, USA
| | | | - Kerry LaPlante
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
| | - Marie Yu
- Sharp Grossmont Hospital, La Mesa, California, USA
| | - Logan Vasina
- Sharp Memorial Hospital, San Diego, California, USA
| | | | | | - Victor Nizet
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
| | - George Sakoulas
- Sharp Memorial Hospital, San Diego, California, USA
- University of California San Diego School of Medicine, La Jolla, California, USA
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Blanco MJ. Building upon Nature's Framework: Overview of Key Strategies Toward Increasing Drug-Like Properties of Natural Product Cyclopeptides and Macrocycles. Methods Mol Biol 2019; 2001:203-233. [PMID: 31134573 DOI: 10.1007/978-1-4939-9504-2_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The pharmaceutical industry has focused mainly in the development of small-molecule entities intended for oral administration for the past decades. As a result, the majority of existing drugs address only a narrow range of biological targets. In the era of post-genomics, transcriptomics, and proteomics, there is an increasing interest on larger modulators of proteins that can span larger surfaces, access new therapeutic mechanisms of action, and provide greater target specificity. Traditional drug-like molecules developed using "rule-of-five" (Ro5) guidelines have been proven ineffective against a variety of challenging targets, such as protein-protein interactions, nucleic acid complexes, and antibacterial modalities. However, natural products are known to be effective at modulating such targets, leading to a renewed focus by medicinal chemists on investigating underrepresented chemical scaffolds associated with natural products. Here we describe recent efforts toward identification of novel natural cyclopeptides and macrocycles as well as selected medicinal chemistry strategies to increase drug-like properties or further exploration of their activity.
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Hagiya H, Sugawara Y, Kimura K, Hamaguchi S, Nishi I, Hayashi M, Akeda Y, Tomono K. Emergence of daptomycin non-susceptible coagulase-negative Staphylococci in patients with cardiovascular device infections: Two cases report investigated by whole genome analysis. Medicine (Baltimore) 2018; 97:e13487. [PMID: 30544442 PMCID: PMC6310605 DOI: 10.1097/md.0000000000013487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Daptomycin (DAP) is a key drug for treating severe Staphylococcus infections. The emergence of DAP non-susceptible Staphylococcus aureus has been widely recognized in clinical situations, although the clinical status of DAP non-susceptible coagulase-negative Staphylococcus (CoNS) infections is unclear. We encountered 2 cases of cardiovascular device infections that were associated with DAP non-susceptible CoNS. PATIENT CONCERNS The first case involved a 60-year-old woman with a pump pocket infection in a left ventricular assist device. DAP non-susceptible Staphylococcus capitis subsp. ureolyticus was isolated from a blood culture after treatment using vancomycin (10 days) and DAP (6 days). The second case involved a 71-year-old man with an aortic graft infection. DAP non-susceptible S capitis subsp. ureolyticus was detected in pus after treatment using vancomycin (2 weeks) and DAP (1 week) without complete removal and debridement. DIAGNOSIS Cardiovascular device infections caused by DAP non-susceptible CoNS. INTERVENTIONS AND OUTCOMES Whole genome sequencing of these strains revealed multiple mutations in genes that are related to DAP-non-susceptibility in S aureus, which created amino acid substitutions in mprF, dltAB, dltD, rpoC, yycG, cls2, pgsA, and vraSR. To the very best of our knowledge, the substitution patterns were not identical to those previously reported in DAP non-susceptibile S aureus. LESSONS Clinicians should be cautious regarding the emergence of DAP non-susceptible CoNS, especially in cases with implanted prosthetic devices, inadequate debridement, and prior usage of vancomycin and DAP. Further studies are needed to understand the relevance of these genetic changes and DAP-non-susceptibility in CoNS strains.
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Affiliation(s)
- Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital
| | - Yo Sugawara
- Japan-Thailand Research Collaboration Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka
| | - Shigeto Hamaguchi
- Division of Infection Control and Prevention, Osaka University Hospital
| | - Isao Nishi
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka
| | - Masahiro Hayashi
- Center for Conservation of Microbial Genetic Resource, Gifu University, Gifu, Japan
| | - Yukihiro Akeda
- Division of Infection Control and Prevention, Osaka University Hospital
- Japan-Thailand Research Collaboration Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital
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Muri L, Grandgirard D, Buri M, Perny M, Leib SL. Combined effect of non-bacteriolytic antibiotic and inhibition of matrix metalloproteinases prevents brain injury and preserves learning, memory and hearing function in experimental paediatric pneumococcal meningitis. J Neuroinflammation 2018; 15:233. [PMID: 30131074 PMCID: PMC6103863 DOI: 10.1186/s12974-018-1272-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/08/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Pneumococcal meningitis is associated with high mortality and morbidity rates. Up to 50% of survivors show neurologic sequelae including hearing loss, cognitive impairments and learning disabilities, being particularly detrimental in affected infants and children where adjuvant therapy with dexamethasone has no proven beneficial effect. We evaluated the effect of concomitantly targeting specific pathophysiological mechanisms responsible for brain damage-i.e. matrix-metalloproteinase (MMP) activity and the exacerbated cerebral inflammation provoked through antibiotic-induced bacterial lysis. Here, we combined adjunctive therapies previously shown to be neuroprotective when used as single adjuvant therapies. METHODS Eleven-day-old Wistar rats were infected intracisternally with 6.44 ± 2.17 × 103 CFU Streptococcus pneumoniae and randomised for treatment with ceftriaxone combined with (a) single adjuvant therapy with daptomycin (n = 24), (b) single adjuvant therapy with Trocade (n = 24), (c) combined adjuvant therapy (n = 66) consisting of daptomycin and Trocade, or (d) ceftriaxone monotherapy (n = 42). Clinical parameters and inflammatory CSF cytokine levels were determined during acute meningitis. Cortical damage and hippocampal apoptosis were assessed 42 h after infection. Morris water maze and auditory brainstem responses were used to assess neurofunctional outcome 3 weeks after infection. RESULTS We found significantly reduced apoptosis in the hippocampal subgranular zone in infant rats receiving adjuvant Trocade (p < 0.01) or combined adjuvant therapy (p < 0.001). Cortical necrosis was significantly reduced in rats treated with adjuvant daptomycin (p < 0.05) or combined adjuvant therapy (p < 0.05) compared to ceftriaxone monotherapy. Six hours after treatment initiation, CSF cytokine levels were significantly reduced for TNF-α (p < 0.01), IL-1β (p < 0.01), IL-6 (p < 0.001) and IL-10 (p < 0.01) in animals receiving combined adjuvant intervention compared to ceftriaxone monotherapy. Importantly, combined adjuvant therapy significantly improved learning and memory performance in infected animals and reduced hearing loss (77.14 dB vs 60.92 dB, p < 0.05) by preserving low frequency hearing capacity, compared to ceftriaxone monotherapy. CONCLUSION Combined adjuvant therapy with the non-bacteriolytic antibiotic daptomycin and the MMP inhibitor Trocade integrates the neuroprotective effects of both single adjuvants in experimental paediatric pneumococcal meningitis by reducing neuroinflammation and brain damage, thereby improving neurofunctional outcome. This strategy represents a promising therapeutic option to improve the outcome of paediatric patients suffering from pneumococcal meningitis.
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Affiliation(s)
- Lukas Muri
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001 Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Freiestrasse 1, 3012 Bern, Switzerland
| | - Denis Grandgirard
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001 Bern, Switzerland
| | - Michelle Buri
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001 Bern, Switzerland
| | - Michael Perny
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001 Bern, Switzerland
| | - Stephen L. Leib
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001 Bern, Switzerland
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Affiliation(s)
- Jennifer Cortes
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin St., Houston, TX 77030, USA
| | - Ala-Eddin S Sagar
- Division of Critical Care Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin St., Houston, TX 77030, USA
| | - Yeunju Lee
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin St., Houston, TX 77030, USA
| | - Uday Sandhu
- Division of Critical Care Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin St., Houston, TX 77030, USA
| | - Kamran Boka
- Division of Critical Care Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin St., Houston, TX 77030, USA
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Lund LC, Holzknecht BJ, Justesen US. [Treatment of vancomycin-resistant enterococcal infections]. Ugeskr Laeger 2018; 180:V07170530. [PMID: 29690991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Vancomycin-resistant enterococci (VRE) are a growing healthcare concern, and since 2012 the incidence has increased eightfold in Denmark. Treatment options for infections with ampicillin-resistant VRE are sparse, and there are no Danish guidelines concerning this topic. For treatment of uncomplicated VRE urinary tract infections, ciprofloxacin or nitrofurantoin can be used. The mainstay of treatment of bacteraemia and other severe infections caused by VRE is linezolid or high-dose daptomycin. Combination treatment is recommended for complicated infections and/or prolonged therapy.
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Ortwine JK, Bhavan K. Morbidity, mortality, and management of methicillin-resistant S. aureus bacteremia in the USA: update on antibacterial choices and understanding. Hosp Pract (1995) 2018; 46:64-72. [PMID: 29400119 DOI: 10.1080/21548331.2018.1435128] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 06/07/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with significant healthcare costs, morbidity, and mortality in the United States. Complications of MRSA bacteremia include infective endocarditis, osteomyelitis, and sepsis, all of which are difficult to treat. Time to effective therapy and antibacterial choice greatly affect patient outcomes. Vancomycin and daptomycin remain first-line therapies; however, reports of vancomycin-associated treatment failure and reduced daptomycin susceptibility highlight the need to define alternative strategies for MRSA bacteremia treatment. In addition, several patient- and pathogen-specific factors influence the outcomes of MRSA bacteremia. It is, therefore, critical to explore the interaction between host- and pathogen-specific factors and its effect on MRSA bacteremia pathogenesis and mortality. This review discusses the factors that drive the development of MRSA bacteremia and examines alternative treatment strategies.
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Affiliation(s)
- Jessica K Ortwine
- a Infectious Diseases/Antimicrobial Stewardship Clinical Pharmacist, Department of Pharmacy Services , Parkland Health and Hospital System , Dallas , TX , USA
| | - Kavita Bhavan
- b Department of Internal Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA
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Turner RB, Wilson DE, Saedi-Kwon H, Chang E, Won R, Chan D, Schwartz J. Comparative analysis of neutropenia in patients receiving prolonged treatment with ceftaroline. J Antimicrob Chemother 2018; 73:772-778. [PMID: 29237024 DOI: 10.1093/jac/dkx452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/02/2017] [Indexed: 12/17/2023] Open
Abstract
Objectives Ceftaroline is often used in durations greater than that studied in clinical trials. Several retrospective, non-comparative studies have suggested a higher than anticipated incidence of neutropenia in patients receiving prolonged treatment with ceftaroline. We sought to determine if ceftaroline was associated with neutropenia by comparing the incidence with ceftaroline treatment with treatment with several comparative antibiotics. Methods Patients receiving 14 or more consecutive days of treatment with ceftaroline were compared with patients receiving cefazolin, daptomycin, linezolid, nafcillin or vancomycin (control group). The primary outcome was the development of neutropenia. Multivariate logistic regression and propensity score weighting using inverse probability weights with regression adjustment were used to control for confounding variables. Results A total of 753 patients were included (53 that received ceftaroline and 700 that received a comparative antibiotic). Ceftaroline was associated with a greater incidence of neutropenia as compared with the control group (17.0% versus 3.9%, P < 0.001). Several covariates were also associated with neutropenia and included younger age, lower baseline absolute neutrophil count, liver disease and bone and joint infections. After controlling for these confounders, receipt of ceftaroline continued to be associated with the development of neutropenia (adjusted OR 3.97, P = 0.003). Analysis after propensity score weighting confirmed this finding. Conclusions The results of this study suggest that prolonged treatment with ceftaroline is associated with a greater incidence of neutropenia as compared with other antibiotics that are often used for treatment of staphylococcal infections. Careful monitoring of absolute neutrophil count is recommended in patients receiving >14 days of ceftaroline.
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Affiliation(s)
- R Brigg Turner
- School of Pharmacy, Pacific University, 222 SE 8th Ave Suite 451, Hillsboro, OR, USA
- Department of Pharmacy, Legacy Health, 2801 N Gantenbein Ave, Portland, OR, USA
| | - D Erin Wilson
- School of Pharmacy, Pacific University, 222 SE 8th Ave Suite 451, Hillsboro, OR, USA
| | - Henry Saedi-Kwon
- School of Pharmacy, Pacific University, 222 SE 8th Ave Suite 451, Hillsboro, OR, USA
| | - Eric Chang
- Department of Medicine, Legacy Health, 2801 N Gantenbein Ave, Portland, OR, USA
| | - Regina Won
- Department of Medicine, Legacy Health, 2801 N Gantenbein Ave, Portland, OR, USA
| | - Dominic Chan
- Department of Pharmacy, Legacy Health, 2801 N Gantenbein Ave, Portland, OR, USA
| | - Jacqueline Schwartz
- School of Pharmacy, Pacific University, 222 SE 8th Ave Suite 451, Hillsboro, OR, USA
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Arnaiz de Las Revillas F, Fernandez-Sampedro M, Arnaiz-García AM, Gutierrez-Cuadra M, Armiñanzas C, Pulitani I, Ponton A, Tascon V, García I, Fariñas MC. Daptomycin treatment in Gram-positive vascular graft infections. Int J Infect Dis 2018; 68:69-73. [PMID: 29373845 DOI: 10.1016/j.ijid.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/23/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Daptomycin is a bactericidal antibiotic approved for the treatment of skin and soft tissue infections and right-side endocarditis. However, there is a lack of published data outlining its usefulness in vascular graft infections (VGI). The aim of this study was to describe the clinical experience of daptomycin use in the treatment of VGI caused by Gram-positive bacteria. METHODS This was a retrospective cohort study of patients diagnosed with VGI receiving daptomycin at a tertiary care hospital during the period January 2010 to December 2012. RESULTS Of a total 1066 consecutive patients who had undergone vascular grafts (VG), 25 were diagnosed with VGI. Fifteen of these patients (11 prosthetic VG, three autologous VG, one both types) received daptomycin (median dose 6.7mg/kg/day, range 4.1-7.1mg/kg/day; median age 69 years, range 45-83 years; 80% male). The infected bypass was removed in 13 cases. The most common reason for selecting daptomycin was kidney failure (53%). The Gram-positive organisms isolated were coagulase-negative Staphylococcus (n=10), Staphylococcus aureus (n=3) (two methicillin-resistant S. aureus), Enterococcus faecium (n=2), and Enterococcus faecalis (n=1). The mean follow-up was 69 months (interquartile range 48-72 months). Ten patients (66.7%) achieved complete healing of the VGI. A recurrence of the infection was observed in 100% of patients in whom the bypass was not removed. Among patients who did not achieve complete healing, one needed a supracondylar amputation and one died as a consequence of infection. Five patients received treatment with rifampicin in addition to daptomycin and they were all cured. CONCLUSIONS The use of daptomycin and surgery for Gram-positive VGI was effective and well tolerated, and this may be a good alternative for the treatment of VGI in patients with peripheral arterial disease in whom renal insufficiency is common.
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Affiliation(s)
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ana María Arnaiz-García
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Manuel Gutierrez-Cuadra
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Carlos Armiñanzas
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ivana Pulitani
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Alejandro Ponton
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Valentin Tascon
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ivan García
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - María Carmen Fariñas
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
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San-Juan R, Viedma E, Chaves F, Lalueza A, Fortún J, Loza E, Pujol M, Ardanuy C, Morales I, de Cueto M, Resino-Foz E, Morales-Cartagena A, Rico A, Romero MP, Orellana MÁ, López-Medrano F, Fernández-Ruiz M, Aguado JM. High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus. Emerg Infect Dis 2018; 22:1057-66. [PMID: 27192097 PMCID: PMC4880091 DOI: 10.3201/eid2206.151709] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Patients infected with these bacteria were more likely to have local endovascular complications. We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications.
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