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Staudacher M, Hotz JF, Kriz R, Schefberger K, Schneider L, Spettel K, Starzengruber P, Hagemann JB, Leutzendorff A, Burgmann H, Lagler H. Differences in oxazolidinone resistance mechanisms and small colony variants emergence of Staphylococcus aureus induced in an in vitro resistance development model. Emerg Microbes Infect 2024; 13:2292077. [PMID: 38055244 PMCID: PMC10849000 DOI: 10.1080/22221751.2023.2292077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/03/2023] [Indexed: 12/07/2023]
Abstract
Invasive Staphylococcus aureus infections are associated with a high burden of disease, case fatality rate and healthcare costs. Oxazolidinones such as linezolid and tedizolid are considered potential treatment choices for conditions involving methicillin resistance or penicillin allergies. Additionally, they are being investigated as potential inhibitors of toxins in toxin-mediated diseases. In this study, linezolid and tedizolid were evaluated in an in vitro resistance development model for induction of resistance in S. aureus. Whole genome sequencing was conducted to elucidate resistance mechanisms through the identification of causal mutations. After inducing resistance to both linezolid and tedizolid, several partially novel single nucleotide variants (SNVs) were detected in the rplC gene, which encodes the 50S ribosome protein L3 in S. aureus. These SNVs were found to decrease the binding affinity, potentially serving as the underlying cause for oxazolidinone resistance. Furthermore, in opposite to linezolid we were able to induce phenotypically small colony variants of S. aureus after induction of resistance with tedizolid for the first time in literature. In summary, even if different antibiotic concentrations were required and SNVs were detected, the principal capacity of S. aureus to develop resistance to oxazolidinones seems to differ between linezolid and tedizolid in-vivo but not in vitro. Stepwise induction of resistance seems to be a time and cost-effective tool for assessing resistance evolution. Inducted-resistant strains should be examined and documented for epidemiological reasons, if MICs start to rise or oxazolidinone-resistant S. aureus outbreaks become more frequent.
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Affiliation(s)
- Moritz Staudacher
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
- Department of Angiology, Medical University of Vienna, Vienna, Austria
| | - Julian Frederic Hotz
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Evangelic Hospital Vienna, Vienna, Austria
| | - Richard Kriz
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Schefberger
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Lisa Schneider
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Kathrin Spettel
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Peter Starzengruber
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | | | - Amelie Leutzendorff
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Heimo Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
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Solís N, Pérez C, Ramírez M, Castro J, Rodríguez C. Clinical presentation and microbiological characteristics of community-acquired Staphylococcus aureus bacteraemia at a tertiary hospital in Costa Rica. J Med Microbiol 2024; 73. [PMID: 39234813 DOI: 10.1099/jmm.0.001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
Introduction. Staphylococcus aureus is a leading agent in community-acquired bacteraemia (CAB) and has been linked to elevated mortality rates and methicillin resistance in Costa Rica.Gap statement and aim. To update and enhance previous data obtained in this country, we analysed the clinical manifestations of 54 S. aureus CAB cases in a tertiary hospital and delineated the sequence types (STs), virulome, and resistome of the implicated isolates.Methodology. Clinical information was retrieved from patient files. Antibiotic susceptibility profiles were obtained with disc diffusion and automated phenotypic tests. Genomic data were exploited to type the isolates and for detection of resistance and virulence genes.Results. Primary infections predominantly manifested as bone and joint infections, followed by skin and soft tissue infections. Alarmingly, 70% of patients continued to exhibit positive haemocultures beyond 48 h of treatment modification, with nearly a quarter requiring mechanical ventilation or developing septic shock. The 30-day mortality rate reached an alarming 40%. More than 60% of the patients were found to have received suboptimal or inappropriate antibiotic treatment, and there was an alarming tendency towards the overuse of third-generation cephalosporins as empirical treatment. Laboratory tests indicated elevated creatinine levels, leukocytosis, and bandaemia within the first 24 h of hospitalization. However, most showed improvement after 48 h. The isolates were categorized into 13 STs, with a predominance of representatives from the clonal complexes CC72 (ST72), CC8 (ST8), CC5 (ST5, ST6), and CC1 (ST188). Twenty-four isolates tested positive for mecA, with ST72 strains accounting for 20. In addition, we detected genes conferring acquired resistance to aminoglycosides, MLSB antibiotics, trimethoprim/sulfamethoxazole, and mutations for fluoroquinolone resistance in the isolate collection. Genes associated with biofilm formation, capsule synthesis, and exotoxin production were prevalent, in contrast to the infrequent detection of enterotoxins or exfoliative toxin genes.Conclusions. Our findings broaden our understanding of S. aureus infections in a largely understudied region and can enhance patient management and treatment strategies.
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Affiliation(s)
- Natalia Solís
- Department of Haematology, Hospital San Juan de Dios, San José, Costa Rica
| | - Cristian Pérez
- Clinical Laboratory, Hospital Nacional de Niños, San José, Costa Rica
| | - Manuel Ramírez
- Department of Infectious Diseases, Hospital San Juan de Dios, San José, Costa Rica
| | - José Castro
- Department of Biostatistics, Caja Costarricense del Seguro Social, San José, Costa Rica
| | - César Rodríguez
- Faculty of Microbiology and Research Center for Tropical Diseases (CIET), Universidad de Costa Rica, San José, Costa Rica
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Campbell AJ, Anpalagan K, Best EJ, Britton PN, Gwee A, Hatcher J, Manley BJ, Marsh J, Webb RH, Davis JS, Mahar RK, McGlothlin A, McMullan B, Meyer M, Mora J, Murthy S, Nourse C, Papenburg J, Schwartz KL, Scheuerman O, Snelling T, Strunk T, Stark M, Voss L, Tong SYC, Bowen AC. Whole-of-Life Inclusion in Bayesian Adaptive Platform Clinical Trials. JAMA Pediatr 2024:2822488. [PMID: 39158898 DOI: 10.1001/jamapediatrics.2024.2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Importance There is a recognized unmet need for clinical trials to provide evidence-informed care for infants, children and adolescents. This Special Communication outlines the capacity of 3 distinct trial design strategies, sequential, parallel, and a unified adult-pediatric bayesian adaptive design, to incorporate children into clinical trials and transform this current state of evidence inequity. A unified adult-pediatric whole-of-life clinical trial is demonstrated through the Staphylococcus aureus Network Adaptive Platform (SNAP) trial. Observations Bayesian methods provide a framework for synthesizing data in the form of a probability model that can be used in the design and analysis of a clinical trial. Three trial design strategies are compared: (1) a sequential adult-pediatric bayesian approach that involves a separate, deferred pediatric trial that incorporates existing adult trial data into the analysis model to potentially reduce the pediatric trial sample size; (2) a parallel adult-pediatric bayesian trial whereby separate pediatric enrollment occurs in a parallel trial, running alongside an adult randomized clinical trial; and (3) a unified adult-pediatric bayesian adaptive design that supports the enrollment of both children and adults simultaneously in a whole-of-life bayesian adaptive randomized clinical trial. The SNAP trial whole-of-life design uses a bayesian hierarchical model that allows information sharing (also known as borrowing) between trial age groups by linking intervention effects of children and adults, thereby improving inference in both groups. Conclusion and Relevance Bayesian hierarchical models may provide more precision for estimates of safety and efficacy of treatments in trials with heterogenous populations compared to traditional methods of analysis. They facilitate the inclusion of children in clinical trials and a shift from children deemed therapeutic orphans to the vision of no child left behind in clinical trials to ensure evidence for clinical practice exists across the life course. The SNAP trial provides an example of a bayesian adaptive whole-of-life inclusion design that enhances trial population inclusivity and diversity overall, as well as generalizability and translation of findings into clinical practice.
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Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Keerthi Anpalagan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Emma J Best
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
- The National Immunisation Advisory Centre, The University of Auckland, Auckland, New Zealand
- Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Philip N Britton
- Sydney Medical School and Sydney Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia
- Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Amanda Gwee
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Antimicrobials Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital for Children, London, United Kingdom
- Infection, Immunity, and Inflammation Research Department, University College London, London, United Kingdom
| | - Brett J Manley
- The Royal Women's Hospital, Melbourne, Victoria, Australia
- The Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Julie Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Centre for Child Health research, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Rachel H Webb
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
- Department of Paediatrics, Kidz First Children's 'Hospital, Auckland, New Zealand
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin Hospital, Darwin, Northern Territory, Australia
- John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Robert K Mahar
- Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Epidemiology and Biostatistics Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Brendan McMullan
- Department of Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Meyer
- Neonatal Unit, Kidz First Middlemore Hospital Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health University of Auckland, Auckland, Auckland, New Zealand
| | - Jocelyn Mora
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Srinivas Murthy
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clare Nourse
- Queensland Children's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kevin L Schwartz
- Division of Infectious Diseases, St Joseph's Health Centre - Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Oded Scheuerman
- Pediatrics B and Pediatric Infectious Diseases Unit, Schneider Children Medical Center Israel, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Thomas Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tobias Strunk
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate Child and Adolescent Health Service, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Michael Stark
- The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- The Department of Neonatal Medicine, The Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lesley Voss
- Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
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Omar A, El-Banna TE, Sonbol FI, El-Bouseary MM. Potential antivirulence and antibiofilm activities of sub-MIC of oxacillin against MDR S. aureus isolates: an in-vitro and in-vivo study. BMC Microbiol 2024; 24:295. [PMID: 39123138 PMCID: PMC11312681 DOI: 10.1186/s12866-024-03429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Multi-drug resistant Staphylococcus aureus is one of the most common causes of nosocomial and community-acquired infections, with high morbidity and mortality. Treatment of such infections is particularly problematic; hence, it is complicated by antibiotic resistance, and there is currently no reliable vaccine. Furthermore, it is well known that S. aureus produces an exceptionally large number of virulence factors that worsen infection. Consequently, the urgent need for anti-virulent agents that inhibit biofilm formation and virulence factors has gained momentum. Therefore, we focused our attention on an already-approved antibiotic and explored whether changing the dosage would still result in the intended anti-virulence effect. METHODS In the present study, we determined the antibiotic resistance patterns and the MICs of oxacillin against 70 MDR S. aureus isolates. We also investigated the effect of sub-MICs of oxacillin (at 1/4 and 1/8 MICs) on biofilm formation using the crystal violet assay, the phenol-sulphuric acid method, and confocal laser scanning microscopy (CLSM). We examined the effect of sub-MICs on virulence factors and bacterial morphology using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and electron microscopy, respectively. Moreover, we studied the effect of sub-MICs of oxacillin (OX) in-vivo using a wound infection model. RESULTS Oxacillin at 1/2 MIC showed a significant decrease in bacterial viability, while 1/4 and 1/8 MICs had negligible effects on treated bacterial isolates. Treatment of MDR isolates with 1/4 or 1/8 MICs of oxacillin significantly reduced biofilm formation (64% and 40%, respectively). The treated MDR S. aureus with sub-MICs of OX exhibited a dramatic reduction in several virulence factors, including protease, hemolysin, coagulase, and toxic shock syndrome toxin-1 (TSST-1) production. The sub-MICs of OX significantly decreased (P < 0.05) the gene expression of biofilm and virulence-associated genes such as agrA, icaA, coa, and tst. Furthermore, oxacillin at sub-MICs dramatically accelerated wound healing, according to the recorded scoring of histological parameters. CONCLUSION The treatment of MDR S. aureus with sub-MICs of oxacillin can help in combating the bacterial resistance and may be considered a promising approach to attenuating the severity of S. aureus infections due to the unique anti-biofilm and anti-virulence activities.
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Affiliation(s)
- Amira Omar
- Department of Microbiology and Immunology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
| | - Tarek E El-Banna
- Department of Microbiology and Immunology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Fatma I Sonbol
- Department of Microbiology and Immunology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Maisra M El-Bouseary
- Department of Microbiology and Immunology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
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5
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Desposito L, Bascara C. Review: sepsis guidelines and core measure bundles. Postgrad Med 2024:1-10. [PMID: 39092891 DOI: 10.1080/00325481.2024.2388021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
Sepsis is a major cause of mortality worldwide and is the third-leading cause of death in the United States. Sepsis is resource-intensive and requires prompt recognition and treatment to reduce mortality. The impact of sepsis is not only on in-hospital survival but extends into post-discharge quality of life and risk of re-admission. As the understanding of sepsis physiology evolved, so have the recommended screening tools and treatment protocol which challenge prior standards of care. There have been noteworthy efforts by the Surviving Sepsis Campaign, the Third International Consensus Definitions for Sepsis and the Centers for Medicare and Medicaid Services to establish core measure bundles. This review highlights both the 2021 SSC International Guidelines and the 2015 CMS Severe Sepsis/Septic Shock Core Measure Bundle, or SEP-1. Notably, the SEP-1 bundle was implemented as a value-based purchasing program, linking care of sepsis patients to financial incentives. The objective is to explore the most current evidence-based data to inform clinical practice while utilizing the available guidelines as a roadmap.
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Affiliation(s)
- Lia Desposito
- Internal Medicine, Division of Hospital Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Christina Bascara
- Internal Medicine, Division of Hospital Medicine, Lankenau Medical Center, Wynnewood, PA, USA
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de Oliveira LD, Ribeiro ALM, Dias SDO, da Cruz GM, de Menezes RT, de Carvalho LS, Diamantino MGG, Pereira TC, Marcucci MC, Abu Hasna A. Phytochemical Composition and Antimicrobial and Antibiofilm Effect of Myrciaria cauliflora Hydroethanolic Extract against Staphylococcus aureus and Acinetobacter baumannii. Methods Protoc 2024; 7:60. [PMID: 39195438 DOI: 10.3390/mps7040060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Staphylococcus aureus and Acinetobacter baumannii are opportunistic pathogens, and both are involved in different oral infections. This work aimed to analyze the phytochemical composition of Myrciaria cauliflora hydroethanolic extract and to evaluate its antimicrobial and antibiofilm action against Staphylococcus aureus (ATCC 6538) and Acinetobacter baumannii (ATCC 19606; multi-resistant clinical strains 58004, 50098, 566006, and H557). Myrciaria cauliflora hydroethanolic extract was prepared, and the content of soluble solids, flavonoids, and phenols was quantified. High-performance liquid chromatography (HPLC) was performed later. The minimum inhibitory concentration was determined using the broth microdilution method according to the Clinical and Laboratory Standards Institute, standard M7-A6, and subsequently, its minimum bactericidal concentration was determined. Then, the most effective concentrations were analyzed against biofilms. Statistical analysis was performed using the ANOVA method with Tukey's test. The soluble solids content in the prepared hydroethanolic extract of M. cauliflora was 2.22%. Additionally, the total flavonoid content, measured using the quercetin standard curve, was 0.040 mg/mL. Furthermore, the total phenol content, determined using the gallic acid standard curve, was 0.729 mg/mL. HPLC analysis presented peaks of gallic acid (11.80 m), p-coumaric acid (12.09 m), cinnamic acid derivative (19.02 m), and ellagic acid (29.83 m). The extract demonstrated antimicrobial and antibiofilm action against all tested strains. However, the most effective antibacterial concentration against all the tested bacteria was 5.55 mg/mL. Therefore, these chemical components justify that M. cauliflora hydroethanolic extract is effective in reducing biofilm formation in S. aureus (standard strain) and A. baumannii (standard and clinical strains).
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Affiliation(s)
- Luciane Dias de Oliveira
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
| | - Ana Luisa Monteiro Ribeiro
- Campus São José dos Campos, Universidade Paulista-UNIP, Highway Presidente Dutra, km 157.5, South Lane, São José dos Campos, São Paulo 12240-420, Brazil
| | - Sthéfani de Oliveira Dias
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
| | - Geovani Moreira da Cruz
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
| | - Raquel Teles de Menezes
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
| | - Lara Steffany de Carvalho
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
| | - Mariana Gadelho Gimenez Diamantino
- Department of Restorative Dentistry, Endodontics Division, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
| | - Thaís Cristine Pereira
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
| | - Maria Cristina Marcucci
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
| | - Amjad Abu Hasna
- Department of Restorative Dentistry, Endodontics Division, Institute of Science and Technology, São Paulo State University, Campus of São José dos Campos, São Paulo 12245-000, Brazil
- School of Dentistry, Universidad Espíritu Santo, Samborondón 092301, Ecuador
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Deshmukh M, Hu Z, Mohammad M, Jin T. Utilization of In Vivo Imaging System to Study Staphylococcal Sepsis and Septic Arthritis Progression in Mouse Model. Pathogens 2024; 13:652. [PMID: 39204252 PMCID: PMC11357683 DOI: 10.3390/pathogens13080652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 09/03/2024] Open
Abstract
Staphylococcus aureus [S. aureus] is a leading cause of sepsis and septic arthritis, conditions that pose significant medical challenges due to their high mortality and morbidity. No studies have used an in vivo imaging system [IVIS] to monitor S. aureus sepsis and septic arthritis. Here, we employed a bioluminescent reporter strain of S. aureus, Newman AH5016, administered intravenously to induce sepsis and intra-articularly to induce local septic arthritis in mice. Disease progression was monitored using IVIS to capture bioluminescent signals from kidneys, joints, and whole mice. Cytokines in the blood and joints were measured. The efficacy of cloxacillin treatment was evaluated. In the sepsis model, bioluminescent signals from kidneys, but not from whole mice, were correlated with kidney bacterial load and abscess formation. Ex vivo kidney imaging detected increased bacterial load and abscess formation from day 3 to day 10. Antibiotic treatment significantly reduced kidney signals, correlating with decreased bacterial counts and IL-6 levels, indicating effective infection control. In the local infection model, early-phase bioluminescent signals from joints were correlated with macroscopic arthritis and bacterial burden. Thus, signal detection from kidneys using IVIS is useful for monitoring S. aureus sepsis and assessing antibiotic efficacy, though it may only be effective for early-phase monitoring of local septic arthritis.
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Affiliation(s)
- Meghshree Deshmukh
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41346 Gothenburg, Sweden; (M.D.); (Z.H.); (M.M.)
| | - Zhicheng Hu
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41346 Gothenburg, Sweden; (M.D.); (Z.H.); (M.M.)
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China
| | - Majd Mohammad
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41346 Gothenburg, Sweden; (M.D.); (Z.H.); (M.M.)
| | - Tao Jin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41346 Gothenburg, Sweden; (M.D.); (Z.H.); (M.M.)
- Department of Rheumatology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Fukushima S, Hagiya H, Kuninaga N, Haruki Y, Yamada H, Iwamoto Y, Yoshida M, Sato K, Hanayama Y, Tanaka S, Miyoshi T, Otsuka Y, Ueda K, Otsuka F. Adherence to and clinical utility of "quality indicators" for Staphylococcus aureus bacteremia: a retrospective, multicenter study. Infection 2024; 52:1527-1538. [PMID: 38727926 PMCID: PMC11289132 DOI: 10.1007/s15010-024-02284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND We aimed to improve the prognosis, treatment, and management of Staphylococcus aureus bacteremia (SAB) by evaluating the association between adherence to quality indicators (QIs) and clinical outcomes in patients with their clinical outcomes. METHODS We retrospectively collected clinical and microbiological data on hospitalized patients with SAB from 14 hospitals (three with > 600, two with 401-600, five with 201-400, and four with ≤ 200 beds) in Japan from January to December 2022. The SAB management quality was evaluated using the SAB-QI score (ranging from 0 to 13 points), which consists of 13 QIs (grouped into five categories) based on previous literature. RESULTS Of the 4,448 positive blood culture episodes, 289 patients with SAB (6.5%) were enrolled. The SAB-QI scores ranged from 3 to 13, with a median score of 9 points. The SAB-QI score was highest in middle-sized hospitals with 401-600 beds. Adherence to each of the four QI categories (blood culture, echocardiography, source control, and antibiotic treatment) was significantly higher in survived cases than in fatal cases. Kaplan-Meier curves with log-rank tests demonstrated that higher adherence to SAB-QIs indicated a better prognosis. Logistic regression analysis revealed that age, methicillin resistance, multiple comorbidities (≥ 2), and low SAB-QI score were significantly associated with 30-day mortality in patients with SAB. CONCLUSIONS Our study highlights that greater adherence to the SAB-QIs correlates with improved patient outcomes. Management of patients with SAB should follow these recommended indicators to maintain the quality of care, especially for patients with poor prognosticators.
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Affiliation(s)
- Shinnosuke Fukushima
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Bacteriology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Infectious Diseases, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama, 700-8558, Japan
| | - Hideharu Hagiya
- Department of Infectious Diseases, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama, 700-8558, Japan.
| | - Naoki Kuninaga
- Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Yuto Haruki
- Department of Pharmacy, Tsuyama Chuo Hospital, Okayama, Japan
| | - Haruto Yamada
- Department of General Medicine, Okayama City Hospital, Okayama, Japan
| | - Yoshitaka Iwamoto
- Department of General Medicine, Okayama Medical Center, Okayama, Japan
| | - Masayo Yoshida
- Department of General Medicine, Okayama Kyoritsu Hospital, Okayama, Japan
| | - Kota Sato
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Yoshihisa Hanayama
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shuichi Tanaka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Miyoshi
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keigo Ueda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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9
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De Gregori S, Seminari E, Capone M, Giordani P, Bruno R, De Silvestri A. Daptomycin Exposure Prediction With a Limited Sampling Strategy. Ther Drug Monit 2024; 46:537-542. [PMID: 38666474 DOI: 10.1097/ftd.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Daptomycin is a cyclic lipopeptide antibiotic used to treat serious infectious endocarditis caused by Staphylococcus aureus . The pharmacodynamic parameter correlating best with efficacy is the ratio of the estimated area under the concentration (AUC 0-24 )-time curve to the minimum inhibitory concentration. The aim of the study is to develop a limited sampling strategy to estimate AUC 0-24 using a reduced number of samples. METHODS Sixty-eight daptomycin AUC 0-24 values were calculated for 50 White patients who underwent treatment for at least 5 consecutive days. Plasma concentrations were detected using a validated high-performance liquid chromatography-tandem mass spectrometry analytical method, with daptomycin-d5 as an internal standard. Multiple regression was used to evaluate the ability of 2 concentration-time points to predict the AUC 0-24 calculated from the entire pharmacokinetic profile. Prediction bias was calculated as the mean prediction error, whereas prediction precision was estimated as the mean absolute prediction error. The development and validation datasets comprised 40 and 10 randomly selected patients, respectively. RESULTS The AUC 0-24 (mg*h/L) was best estimated using the daptomycin trough concentration and plasma concentrations detected 2 hours after dosing. We calculated a mean prediction error of 1.6 (95% confidence interval, -10.7 to 10.9) and a mean absolute prediction error of 11.8 (95% confidence interval, 5.3-18.3), with 73% of prediction errors within ±15%. CONCLUSIONS An equation was developed to estimate daptomycin exposure (AUC 0-24 ), offering clinical applicability and utility in generating personalized dosing regimens, especially for individuals at high risk of treatment failure or delayed response.
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Affiliation(s)
- Simona De Gregori
- Department of Diagnostic Medicine and Services: Laboratory Medicine-Clinical and Experimental Pharmacokinetics Unit, Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy
| | - Elena Seminari
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy; and
| | - Mara Capone
- Department of Diagnostic Medicine and Services: Laboratory Medicine-Clinical and Experimental Pharmacokinetics Unit, Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy
| | - Paola Giordani
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy; and
| | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy; and
| | - Annalisa De Silvestri
- SSD Biostatistics and Clinical Trial Center, Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy
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10
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Shah S, Clarke LG, Ludwig J, Burgdorf S, Arbulu Guerra RD, Shields RK. Carbapenem combination therapy versus standard of care for persistent methicillin-susceptible Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2024; 79:1990-1997. [PMID: 38946294 DOI: 10.1093/jac/dkae198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/26/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Successful use of carbapenems in combination with cefazolin or oxacillin for treatment of MSSA bacteraemia has been described; however, comparative data to standard treatment approaches are lacking. METHODS This was a multicentre, retrospective study of adult patients with MSSA bacteraemia for >48 h. Standard treatment was considered monotherapy with cefazolin, oxacillin or nafcillin. Combination therapy was defined as the addition of ertapenem or meropenem to standard treatment for at least 24 h. The primary outcome was duration of bacteraemia defined as time from administration of an antibiotic with in vitro activity to first negative blood culture. Time to blood culture sterilization was compared through risk-set matching with aid of a propensity score. RESULTS Overall, 238 patients were included; 66% (157/238) received standard treatment and 34% (81/238) received combination therapy. The median (IQR) time to carbapenem initiation was 4.7 (3.63-6.5) days. Patients who received combination therapy were younger (P = 0.012), more likely to have endocarditis (P = 0.034) and had longer median duration of bacteraemia (P < 0.001). After applying risk-set matching, patients who received combination therapy experienced faster time to blood culture sterilization compared with control patients [HR = 1.618 (95% CI; 1.119-2.339) P = 0.011]. Using a paired hazard model, 90 day mortality rates were not statistically different among patients who received combination therapy versus matched controls [HR = 1.267 (95% CI; 0.610-2.678), P = 0.608]. DISCUSSION Carbapenem combination therapy resulted in faster time to blood culture sterilization, but no differences in overall mortality rates. Randomized trials are critical to determine the utility of carbapenem combination therapy.
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Affiliation(s)
- Sunish Shah
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lloyd G Clarke
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Justin Ludwig
- Office of Quality and Clinical Research Innovation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sarah Burgdorf
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ryan K Shields
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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11
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Lacey KA, Pickrum AM, Gonzalez S, Bartnicki E, Castellaw AH, Rodrick TC, Jones DR, Khanna KM, Torres VJ. Dietary and water restriction leads to increased susceptibility to antimicrobial resistant pathogens. SCIENCE ADVANCES 2024; 10:eadi7438. [PMID: 39047095 PMCID: PMC11268424 DOI: 10.1126/sciadv.adi7438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/18/2024] [Indexed: 07/27/2024]
Abstract
Dehydration and malnutrition are common and often underdiagnosed in hospital settings. Multidrug-resistant bacterial infections result in more than 35,000 deaths a year in nosocomial patients. The effect of temporal dietary and water restriction (DWR) on susceptibility to multidrug-resistant pathogens is unknown. We report that DWR markedly increased susceptibility to systemic infection by ESKAPE pathogens. Using a murine bloodstream model of methicillin-resistant Staphylococcus aureus infection, we show that DWR leads to significantly increased mortality and morbidity. DWR causes increased bacterial burden, severe pathology, and increased numbers of phagocytes in the kidney. DWR appears to alter the functionality of these phagocytes and is therefore unable to control infection. Mechanistically, we show that DWR impairs the ability of macrophages to phagocytose multiple bacterial pathogens and efferocytose apoptotic neutrophils. Together, this work highlights the crucial impact that diet and hydration play in protecting against infection.
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Affiliation(s)
- Keenan A. Lacey
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Adam M. Pickrum
- Department of Host-Microbe Interactions, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Sandra Gonzalez
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Eric Bartnicki
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Ashley H. Castellaw
- Department of Host-Microbe Interactions, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Tori C. Rodrick
- Metabolomics Core Resource Laboratory, New York University Langone Health, New York, NY 10016, USA
| | - Drew R. Jones
- Metabolomics Core Resource Laboratory, New York University Langone Health, New York, NY 10016, USA
| | - Kamal M. Khanna
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Victor J. Torres
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Department of Host-Microbe Interactions, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
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12
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Recht J, Evans TJ, Chansamouth V, Phommasone K, Mayxay M, Ashley EA. Which trial do we need? A pragmatic randomized trial of trimethoprim-sulfamethoxazole vs. vancomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteraemia in low-resource settings. Clin Microbiol Infect 2024:S1198-743X(24)00350-1. [PMID: 39067512 DOI: 10.1016/j.cmi.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/13/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Judith Recht
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Terry John Evans
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vilada Chansamouth
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Elizabeth A Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
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13
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Kim SO, Park I, Vernet T, Moreau C, Hong S, Park TH. Duffy Antigen Receptor for Chemokines (DARC) Nanodisc-Based Biosensor for Detection of Staphylococcal Bicomponent Pore-Forming Leukocidins. ACS APPLIED MATERIALS & INTERFACES 2024; 16:37390-37400. [PMID: 39007843 DOI: 10.1021/acsami.4c02079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Staphylococcus aureus (S. aureus) is an opportunistic infectious pathogen, which causes a high mortality rate during bloodstream infections. The early detection of virulent strains in patients' blood samples is of medical interest for rapid diagnosis. The main virulent factors identified in patient isolates include leukocidins that bind to specific membrane receptors and lyse immune cells and erythrocytes. Duffy antigen receptor for chemokines (DARC) on the surface of specific cells is a main target of leukocidins such as gamma-hemolysin AB (HlgAB) and leukocidin ED (LukED). Among them, HlgAB is a conserved and critical leukocidin that binds to DARC and forms pores on the cell membranes, leading to cell lysis. Current methods are based on ELISA or bacterial culture, which takes hours to days. For detecting HlgAB with faster response and higher sensitivity, we developed a biosensor that combines single-walled carbon nanotube field effect transistors (swCNT-FETs) with immobilized DARC receptors as biosensing elements. DARC was purified from a bacterial expression system and successfully reconstituted into nanodiscs that preserve binding capability for HlgAB. Dynamic light scattering (DLS) and scanning electron microscopy (SEM) showed an increase of the DARC-containing nanodisc size in the presence of HlgAB, indicating the formation of HlgAB prepore or pore complexes. We demonstrate that this sensor can specifically detect the leukocidins HlgA and HlgAB in a quantitative manner within the dynamic range of 1 fM to 100 pM with an LOD of 0.122 fM and an LOQ of 0.441 fM. The sensor was challenged with human serum spiked with HlgAB as simulated clinical samples. After dilution for decreasing nonspecific binding, it selectively detected the toxin with a similar detection range and apparent dissociation constant as in the buffer. This biosensor was demonstrated with remarkable sensitivity to detect HlgAB rapidly and has the potential as a tool for fundamental research and clinical applications, although this sensor cannot differentiate between HlgAB and LukED as both have the same receptor.
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Affiliation(s)
- So-Ong Kim
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Inkyoung Park
- Department of Physics and Astronomy, Institute of Applied Physics, Seoul National University, Seoul 08826, Republic of Korea
| | - Thierry Vernet
- Univ. Grenoble Alpes, CNRS, CEA, IBS, Grenoble F-38000, France
| | | | - Seunghun Hong
- Department of Physics and Astronomy, Institute of Applied Physics, Seoul National University, Seoul 08826, Republic of Korea
| | - Tai Hyun Park
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Republic of Korea
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14
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Motomura Y, Miyazaki M, Kamada M, Morimoto S, Nakamura Y, Satho T, Takata T, Kashige N. Genotypic Shift and Diversification of MRSA Blood Stream Isolates in a University Hospital Setting: Evidence from a 12-Year Observational Study. Antibiotics (Basel) 2024; 13:670. [PMID: 39061352 PMCID: PMC11273934 DOI: 10.3390/antibiotics13070670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
There have been few reports regarding the long-term trends in the genotypes of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates. Therefore, this study was performed to investigate the longitudinal trends in the genotypes of MRSA bloodstream isolates obtained from hospitalized patients during a 12-year study period from 2010 to 2021 at a tertiary care university hospital. Over the 12-year period from 2010 to 2021, we conducted a genetic investigation focusing on 245 MRSA strains isolated from the blood of hospitalized patients. The genotypes of the MRSA bloodstream isolates were determined by Staphylococcal Cassette Chromosome mec (SCCmec) typing, accessory gene regulator (agr) typing, PCR-based ORF typing (POT), and multilocus sequence typing (MLST). Strains with the same POT type detected in two or more isolates were designated as epidemic clones, while strains without a common POT type were classified as sporadic clones. Until 2015, isolates with SCCmec II/agr II were prevalent, but isolates with SCCmec IV/agr III increased from 2016. A total of 128 strains (52%) were identified as epidemic clones, while 117 strains (48%) were classified as sporadic clones. The detection rate of sporadic clones increased significantly since 2016 (p < 0.05). The epidemic clones were classified into three clusters, with MRSA of clonal complex (CC) 1 being prominent after 2016. This study showed that the genotypes of MRSA bloodstream isolates underwent a shift from SCCmec II/agr II type to SCCmec IV/agr III type, with a notable increase in MRSA of CC1, after 2016. There was a significant increase in the proportion of sporadic strains among the isolates, suggesting the diversification of genotypes.
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Affiliation(s)
- Yuka Motomura
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (Y.M.); (M.M.); (T.S.); (N.K.)
| | - Motoyasu Miyazaki
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (Y.M.); (M.M.); (T.S.); (N.K.)
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan
| | - Mitsuhiro Kamada
- Department of Pharmacy, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Shinichi Morimoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (S.M.); (Y.N.)
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (S.M.); (Y.N.)
| | - Tomomitsu Satho
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (Y.M.); (M.M.); (T.S.); (N.K.)
| | - Tohru Takata
- Department of Oncology, Hematology, and Infectious Diseases, Fukuoka University Hospital, Fukuoka 814-0180, Japan
- Department of Infection Control, Fukuoka University Hospital, Fukuoka 814-0180, Japan
| | - Nobuhiro Kashige
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (Y.M.); (M.M.); (T.S.); (N.K.)
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15
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Gallego Rodríguez A, Duch Llorach P, Grillo S, Piriz Marabajan M, Pomar Solchaga V, Hornero López A, Jimenez Martínez E, Oriol Bermudez I, Rivera A, Pujol Rojo M, López-Contreras González J. Risk factors for mortality and complications in peripheral venous catheter-associated Staphylococcus aureus bacteraemia: a large multicentre cohort study. J Hosp Infect 2024; 152:13-20. [PMID: 39032565 DOI: 10.1016/j.jhin.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Peripheral venous catheter-associated Staphylococcus aureus bacteraemia (PVC-SAB) is a potentially life-threatening nosocomial infection. AIM This cohort study aims to identify the risk factors associated with its mortality and complications. METHODS Retrospective analysis of a prospective cohort study conducted at two tertiary-care hospitals in Spain. Adult patients admitted between January 2011 and July 2019 which developed PVC-SAB during their hospital stay were included. Primary outcome was all-cause 30- and 90-day mortality. Secondary outcomes were sepsis or septic shock at the onset of bacteraemia, metastatic infection and length of hospital stay. Univariate and multivariate analyses were performed. FINDINGS A total of 256 PVC-SAB were diagnosed in 243 patients between 2011 and 2019. Thirty-day and 90-day all-cause mortality were 18.3% and 24.2%, respectively. Lack of susceptible antibiotic administration the day after blood culture collection (odds ratio: 4.14; 95% confidence interval: 1.55-11.03; P = 0.005), sepsis and complicated bacteraemia were identified as independent risk factors for 30- and 90-day mortality; meticillin-resistant S. aureus bacteraemia was identified as an independent risk factor only for 30-day mortality and functional dependence only for 90-day mortality. Persistent bacteraemia and sepsis were associated with septic metastases, which significantly increased hospital stay, and endocarditis. A greater proportion of patients experiencing septic shock were subsequently institutionalized compared to those without. CONCLUSION PVC-SAB remains linked to high mortality rates. Prompt administration of appropriate antibiotics is crucial for lowering mortality. A comprehensive diagnostic approach is essential, especially in patients with persistent bacteraemia and implanted cardiovascular devices, to rule out metastatic complications and endocarditis.
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Affiliation(s)
- A Gallego Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Duch Llorach
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Grillo
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - M Piriz Marabajan
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - V Pomar Solchaga
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Hornero López
- Infectious Diseases Department, Hospital Universitari de Bellvitge - IDIBELL, Bellvitge Institute of Biomedical Research, Nursing Research Group, Barcelona, Spain
| | - E Jimenez Martínez
- Infectious Diseases Department, Hospital Universitari de Bellvitge - IDIBELL, Bellvitge Institute of Biomedical Research, Nursing Research Group, Barcelona, Spain
| | - I Oriol Bermudez
- Infectious Diseases Department, Hospital Universitari de Bellvitge - IDIBELL, Bellvitge Institute of Biomedical Research, Nursing Research Group, Barcelona, Spain; CIBERINFEC, ISCIII CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - A Rivera
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; Microbiology Department, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - M Pujol Rojo
- Infectious Diseases Department, Hospital Universitari de Bellvitge - IDIBELL, Bellvitge Institute of Biomedical Research, Nursing Research Group, Barcelona, Spain; CIBERINFEC, ISCIII CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - J López-Contreras González
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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16
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Yang E, Cho YG, Kim E, Chang E, Bae S, Jung J, Kim MJ, Chong YP, Kim SH, Choi SH, Lee SO, Chung YS, Kim YS. Clinical and microbiological characteristics of persistent Staphylococcus aureus bacteremia, risk factors for mortality, and the role of CD4 + T cells. Sci Rep 2024; 14:15472. [PMID: 38969796 PMCID: PMC11226624 DOI: 10.1038/s41598-024-66520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024] Open
Abstract
This study evaluated the determinants of mortality and the T cell immune response in patients with persistent Staphylococcus aureus bacteremia (SAB). This was a prospective cohort study and patients with confirmed SAB were enrolled from 2008 to 2020. We compared clinical, microbiological, and genotypic features between surviving and deceased patients with persistent SAB. The concentrations of cytokines and the proportions of IFN-γ secreting CD4+ T cells were measured serially during the bacteremia period. Of the 1760 patients, 242 had persistent bacteremia (PB), and 49 PB patients died within 30 days. In the multivariate analysis, the APACHE II score and female sex were independently associated with 30 days mortality. The level of IL-10 was significantly increased in the plasma of patients with a high Pitt bacteremia score and those who died within 12 weeks from the index day. The proportion of IFN-γ-secreting CD4+ T cells were the highest just before the positive-to-negative conversion of blood cultures in patients with a low Pitt bacteremia score and those who survived for 12 weeks. The level of IL-10 is correlated with clinical outcomes in PB patients. IFN-γ secreting CD4+ T cells might play a pivotal role in SAB PB.
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Affiliation(s)
- Eunmi Yang
- Division of Infectious Diseases, Seoul Medical Center, Seoul, South Korea
| | - Yeong Geon Cho
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Institute for Life Science, Asan Medical Center, Seoul, South Korea
| | - Eunsil Kim
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Institute for Life Science, Asan Medical Center, Seoul, South Korea
| | - Euijin Chang
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seongman Bae
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, South Korea
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jiwon Jung
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min Jae Kim
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yong Pil Chong
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sung-Han Kim
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sang-Ho Choi
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sang-Oh Lee
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yun Shin Chung
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yang Soo Kim
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, South Korea.
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea.
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17
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Thornley EM, Alexander R, Popelka J, Montgomery CP. Risk Factors for Persistent Staphylococcus aureus Bacteremia in Children. Pediatr Infect Dis J 2024:00006454-990000000-00910. [PMID: 38905222 DOI: 10.1097/inf.0000000000004439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
BACKGROUND Staphylococcus aureus is a leading cause of pediatric bacteremia. Persistent S. aureus bacteremia (SAB) is associated with increased morbidity and mortality in adults and children. Risk factors for S. aureus bacteremia have been well established, but there is a limited understanding of the factors that contribute to the development of persistent SAB in children. METHODS This is a single-center retrospective secondary analysis of a prospective observational study of pediatric patients hospitalized with S. aureus infection over a 3.5-year period at a large, quaternary, children's hospital. RESULTS Two hundred fifty-nine children with confirmed S. aureus infection were enrolled in the study. Sixty-five of these were found to have bacteremia, with 28 (43%) developing persistent bacteremia. Patients with persistent SAB were culture-positive for a median of 3.5 days compared with 1 day for those without (P ≤ 0.001). Children with persistent SAB were more likely to have an identified osteoarticular source of infection (93%, n = 26 vs. 62%, n = 23; P = 0.008) and had a shorter median duration to culture positivity than those without persistent SAB (16 hours vs. 20 hours; P ≤ 0.001). In addition, children with persistent SAB had higher median values of presenting erythrocyte sedimentation rate, peak erythrocyte sedimentation rate, presenting C-reactive protein and peak C-reactive protein. Not surprisingly, hospital length of stay was longer in children with persistent SAB compared with those without. CONCLUSIONS These findings suggest that a shorter time to culture positivity, osteoarticular infection, and higher presenting and peak values for select inflammatory markers are potential risk factors for persistent SAB in children.
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Affiliation(s)
- Erin M Thornley
- From the Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Robin Alexander
- Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Columbus, OH
| | - Jill Popelka
- From the Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Christopher P Montgomery
- From the Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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18
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McGuire E, Collin SM, Brown CS, Saito M. Community-Acquired Staphylococcus aureus Bacteremia Among People Who Inject Drugs: A National Cohort Study in England, 2017-2020. Clin Infect Dis 2024; 78:1443-1450. [PMID: 38315893 PMCID: PMC11175704 DOI: 10.1093/cid/ciae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk of community-acquired Staphylococcus aureus bacteremia (CA-SAB), but little is known about clinical outcomes of CA-SAB in PWID compared with the wider population of patients with CA-SAB. METHODS Three national datasets were linked to provide clinical and mortality data on patients hospitalized with CA-SAB in England between 1 January 2017 and 31 December 2020. PWID were identified using the International Classification of Diseases, Tenth Revision code for "mental health and behavioral disorder due to opioid use" (F11). Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for associations of PWID with 30-day all-cause mortality and 90-day hospital readmission. RESULTS In 10 045 cases of CA-SAB, 1612 (16.0%) were PWID. Overall, 796 (7.9%) patients died within 30 days of CA-SAB admission and 1189 (11.8%) patients were readmitted to hospital within 90 days of CA-SAB. In those without infective endocarditis, there was strong evidence of lower odds of mortality among PWID compared with non-PWID (aOR, 0.47 [95% confidence interval {CI}: .33-.68]; P < .001), whereas there was no association in CA-SAB case fatality with endocarditis (aOR, 1.40 [95% CI: .87-2.25]; P = .163). PWID were less likely to be readmitted within 90 days of CA-SAB (aOR, 0.79 [95% CI: .65-.95]; P = .011). CONCLUSIONS In this large cohort study of patients with CA-SAB in England, PWID had lower odds of death in the absence of endocarditis and lower odds of readmission within 90 days compared to non-PWID patients. This study highlights the overrepresentation of PWID among patients with CA-SAB nationally.
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Affiliation(s)
- Emma McGuire
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU), and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon M Collin
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Colin S Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU), and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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19
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Volk CF, Proctor RA, Rose WE. The Complex Intracellular Lifecycle of Staphylococcus aureus Contributes to Reduced Antibiotic Efficacy and Persistent Bacteremia. Int J Mol Sci 2024; 25:6486. [PMID: 38928191 PMCID: PMC11203666 DOI: 10.3390/ijms25126486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Staphylococcus aureus bacteremia continues to be associated with significant morbidity and mortality, despite improvements in diagnostics and management. Persistent infections pose a major challenge to clinicians and have been consistently shown to increase the risk of mortality and other infectious complications. S. aureus, while typically not considered an intracellular pathogen, has been proven to utilize an intracellular niche, through several phenotypes including small colony variants, as a means for survival that has been linked to chronic, persistent, and recurrent infections. This intracellular persistence allows for protection from the host immune system and leads to reduced antibiotic efficacy through a variety of mechanisms. These include antimicrobial resistance, tolerance, and/or persistence in S. aureus that contribute to persistent bacteremia. This review will discuss the challenges associated with treating these complicated infections and the various methods that S. aureus uses to persist within the intracellular space.
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Affiliation(s)
- Cecilia F. Volk
- Pharmacy Practice and Translational Research Division, School of Pharmacy, Pharmacy University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Richard A. Proctor
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Warren E. Rose
- Pharmacy Practice and Translational Research Division, School of Pharmacy, Pharmacy University of Wisconsin-Madison, Madison, WI 53705, USA;
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA
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20
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Cabanilla MG, Bernauer ML, Briski MJ, Atallah LM, Koury J, Thompson CM, Rodriguez CN, Jakeman B, Byrd TF. A Retrospective Cohort Study Comparing Dual Therapy With Ceftaroline With Vancomycin or Daptomycin Monotherapy for High-Grade or Persistent MRSA Bacteremia. J Pharm Technol 2024; 40:134-141. [PMID: 38784026 PMCID: PMC11110729 DOI: 10.1177/87551225241227796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a serious clinical infection associated with a high risk of mortality. Dual therapy is often used in patients with persistent bacteremia. Objective: This study aimed to compare the outcomes of vancomycin or daptomycin monotherapy with those of dual therapy with ceftaroline in high-grade or persistent MRSA bacteremia. Methods: We conducted a retrospective cohort study at a university teaching hospital between January 2014 and June 2021, involving adults initially treated with vancomycin or daptomycin. Patients were categorized into monotherapy and dual therapy groups. The primary outcome was 30-day mortality. Secondary outcomes included microbiological relapse and antibiotic-related adverse events. Results: In a group of 155 patients, 30-day mortality rates were similar between the monotherapy (23.4%) and dual therapy (22.6%) groups, with comparable microbiological relapse rates (6.5%). In inverse probability of treatment weighting analysis, we found no significant association between dual therapy and mortality (adjusted risk ratio [ARR] 1.38, 95% CI 0.64-2.41, P = 0.38) or microbiological relapse (ARR 0.95, 95% CI 0.31-2.73, P = 0.93). Dual therapy was associated with a lower risk of antibiotic-related adverse events (ARR 0.45, 95% CI 0.21-0.89, P = 0.02). Infectious diseases (ID) consultation was associated with a reduced mortality risk (ARR 0.27, 95% CI 0.07-0.95, P = 0.04). Conclusions: Dual therapy with ceftaroline did not reduce mortality risk compared with monotherapy in patients with MRSA bacteremia. However, patients with ID consultations showed a 73% reduction in mortality rates. Large-scale, prospective, and randomized controlled trials are needed to provide conclusive evidence regarding the potential benefits of dual therapy with ceftaroline for MRSA bacteremia.
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Affiliation(s)
- M. Gabriela Cabanilla
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Matthew J. Briski
- Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Liana M. Atallah
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jason Koury
- Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Chelsea N. Rodriguez
- Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Bernadette Jakeman
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Thomas F. Byrd
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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21
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Siegrist EA, Sassine J. Ceftaroline in CNS and ocular infections: a case series. JAC Antimicrob Resist 2024; 6:dlae095. [PMID: 38887612 PMCID: PMC11180797 DOI: 10.1093/jacamr/dlae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/26/2024] [Indexed: 06/20/2024] Open
Abstract
Background There are limited data describing outcomes of patients treated with ceftaroline for infections with CNS or ocular involvement. Objectives To describe outcomes of patients treated with ceftaroline for methicillin-resistant staphylococcal infections involving the CNS or eye. Patients and methods This was a retrospective review of 10 patients at an academic medical centre who received ceftaroline for CNS or ocular infections. Results All patients were treated with ceftaroline as part of a combination for salvage therapy. Four patients died, whereas six patients experienced clinical cure. Only one experienced microbiological recurrence. Conclusions These preliminary data suggest that ceftaroline may be an option for salvage therapy of severe staphylococcal infections when used in combination.
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Affiliation(s)
- Emily A Siegrist
- Department of Pharmacy, OU Health, OU Medical Center, 700 NE 13th St., Oklahoma City, OK 73104, USA
| | - Joseph Sassine
- Infectious Diseases Section, Department of Medicine, The University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, Oklahoma City, OK 73104, USA
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22
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Kessel K, Forsblom E, Ruotsalainen E, Järvinen A. Staphylococcus aureus bacteremia in alcoholics. PLoS One 2024; 19:e0298612. [PMID: 38771740 PMCID: PMC11108141 DOI: 10.1371/journal.pone.0298612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/27/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Alcoholism associates with increased Staphylococcus aureus bacteremia incidence and mortality. The objective was to compare disease progression, treatment and prognosis of Staphylococcus aureus bacteremia in alcoholics versus non-alcoholics. METHODS The study design was a multicenter retrospective analysis of methicillin-sensitive Staphylococcus aureus bacteremia with 90-day follow-up. Patients were stratified as alcoholics or non-alcoholics based on electronic health record data. Altogether 617 Staphylococcus aureus bacteremia patients were included of which 83 (13%) were alcoholics. RESULTS Alcoholics, versus non-alcoholics, were younger, typically male and more commonly had community-acquired Staphylococcus aureus bacteremia. No differences in McCabe´s classification of underlying conditions was observed. Higher illness severity at blood culture sampling, including severe sepsis (25% vs. 7%) and intensive care unit admission (39% vs. 17%), was seen in alcoholics versus non-alcoholics. Clinical management, including infectious disease specialist (IDS) consultations and radiology, were provided equally. Alcoholics, versus non-alcoholics, had more pneumonia (49% vs. 35%) and fewer cases of endocarditis (7% vs. 16%). Mortality in alcoholics versus non-alcoholics was significantly higher at 14, 28 and 90 days (14% vs. 7%, 24% vs. 11% and 31% vs. 17%), respectively. Considering all prognostic parameters, male sex (OR 0.19, p = 0.021) and formal IDS consultation (OR 0.19, p = 0.029) were independent predictors of reduced mortality, whereas ultimately or rapidly fatal comorbidity in McCabe´s classification (OR 12.34, p < 0.001) was an independent predictor of mortality in alcoholics. CONCLUSIONS Alcoholism deteriorates Staphylococcus aureus bacteremia prognosis, and our results suggests that this is predominantly through illness severity at bacteremia onset. Three quarters of Staphylococcus aureus bacteremia patients we studied had identified deep infection foci, and of them alcoholics had significantly less endocarditis but nearly half of them had pneumonia.
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Affiliation(s)
- Klaus Kessel
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Erik Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Eeva Ruotsalainen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
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23
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De Decker I, Janssens D, De Mey K, Hoeksema H, Simaey M, De Coninck P, Verbelen J, De Pessemier A, Blondeel P, Monstrey S, Claes KE. Assessing antibacterial efficacy of a polyhexanide hydrogel versus alginate-based wound dressing in burns. J Wound Care 2024; 33:335-347. [PMID: 38683776 DOI: 10.12968/jowc.2024.33.5.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Burn injuries pose a heightened risk of infection, which is primarily responsible for increased morbidity and mortality. Factors such as extensive skin damage and compromised immunity exacerbate this vulnerability. Pseudomonas aeruginosa and Staphylococcus aureus are frequently identified in burns, with Gram-negative Pseudomonas aeruginosa often resistant to antibacterial agents. While Flaminal, an alginate-based wound dressing (Flen Health, Belgium), aids wound healing, its antibacterial effects are limited compared with 1% silver sulfadiazine (1% SSD). In contrast, Prontosan Wound Gel X, a betaine and polyhexanide-based hydrogel (B. Braun Medical AG, Switzerland), has been shown to effectively combat various microbes and promotes wound healing. METHOD In this study, two research cohorts were retrospectively established (control group: patients receiving standard of care with the alginate-based wound dressing; intervention group: patients receiving the polyhexanide hydrogel wound dressing), comprising patients admitted to a burn centre between 2019 and 2022. Patients were eligible when continuous wound treatment with either of the two wound dressings was performed. Laser Doppler imaging (LDI) scans were conducted. Regions of interest (ROIs) were selected based on LDI scans and divided into healing time categories. Wound swabs were collected and the presence of Pseudomonas aeruginosa and Staphylococcus aureus was documented. Bacterial load was evaluated using a semiquantitative scale. Wound healing was recorded. RESULTS The control group consisted of 31 patients with 93 ROIs, while the intervention group had 67 ROIs involving 29 patients. Both groups exhibited similar proportions of healing time categories (p>0.05). The polyhexanide hydrogel dressing outperformed the alginate-based dressing in antiseptic efficacy by significantly reducing the incidence of Pseudomonas aeruginosa- and Staphylococcus aureus-positive cultures in patients' wounds. Wound healing time for conservative treatment was comparable between groups. CONCLUSION In this study, the polyhexanide hydrogel dressing minimised Pseudomonas aeruginosa and Staphylococcus aureus colonisation in burn wounds, demonstrating strong antibacterial properties, emphasising its potential to minimise infections in burn injuries.
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Affiliation(s)
- Ignace De Decker
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Dries Janssens
- Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Kimberly De Mey
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Marie Simaey
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Petra De Coninck
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Jozef Verbelen
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Alina De Pessemier
- Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Phillip Blondeel
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Stan Monstrey
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Karel Ey Claes
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
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24
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Bashabsheh RH, AL-Fawares O, Natsheh I, Bdeir R, Al-Khreshieh RO, Bashabsheh HH. Staphylococcus aureus epidemiology, pathophysiology, clinical manifestations and application of nano-therapeutics as a promising approach to combat methicillin resistant Staphylococcus aureus. Pathog Glob Health 2024; 118:209-231. [PMID: 38006316 PMCID: PMC11221481 DOI: 10.1080/20477724.2023.2285187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
Abstract
Staphylococcus aureus is a Gram-positive bacterium and one of the most prevalent infectious disease-related causes of morbidity and mortality in adults. This pathogen can trigger a broad spectrum of diseases, from sepsis and pneumonia to severe skin infections that can be fatal. In this review, we will provide an overview of S. aureus and discuss the extensive literature on epidemiology, transmission, genetic diversity, evolution and antibiotic resistance strains, particularly methicillin resistant S. aureus (MRSA). While many different virulence factors that S. aureus produces have been investigated as therapeutic targets, this review examines recent nanotechnology approaches, which employ materials with atomic or molecular dimensions and are being used to diagnose, treat, or eliminate the activity of S. aureus. Finally, having a deeper understanding and clearer grasp of the roles and contributions of S. aureus determinants, antibiotic resistance, and nanotechnology will aid us in developing anti-virulence strategies to combat the growing scarcity of effective antibiotics against S. aureus.
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Affiliation(s)
- Raghad H.F. Bashabsheh
- Department of Medical Laboratory Analysis, Faculty of Science, Al-Balqa Applied University, Al-salt, Jordan
| | - O’la AL-Fawares
- Department of Medical Laboratory Analysis, Faculty of Science, Al-Balqa Applied University, Al-salt, Jordan
| | - Iyad Natsheh
- Department of Allied Medical Sciences, Zarqa College, Al-Balqa Applied University, Zarqa, Jordan
| | - Roba Bdeir
- Department of Allied Health Sciences, Faculty of Nursing, Al-Balqa Applied University, Al-salt, Jordan
| | - Rozan O. Al-Khreshieh
- Department of Medical Laboratory Analysis, Faculty of Science, Al-Balqa Applied University, Al-salt, Jordan
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25
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Kim T, Lee SR, Park SY, Moon SM, Jung J, Kim MJ, Sung H, Kim MN, Kim SH, Choi SH, Lee SO, Kim YS, Song EH, Chong YP. Validation of a new risk stratification system-based management for methicillin-resistant Staphylococcus aureus bacteraemia: analysis of a multicentre prospective study. Eur J Clin Microbiol Infect Dis 2024; 43:841-851. [PMID: 38411778 DOI: 10.1007/s10096-024-04790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Distinguishing between complicated and uncomplicated Staphylococcus aureus bacteraemia (SAB) is therapeutically essential. However, this distinction has limitations in reflecting the heterogeneity of SAB and encouraging targeted diagnostics. Recently, a new risk stratification system for SAB metastatic infection, involving stepwise approaches to diagnosis and treatment, has been suggested. We assessed its applicability in methicillin-resistant SAB (MRSAB) patients. METHODS We retrospectively analysed data of a 3-year multicentre, prospective cohort of hospitalised patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes. RESULTS Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection. No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 19.6% in the high-risk groups (P < 0.001). After an in-depth diagnostic work-up, patients were finally diagnosed as 'without metastatic infection (6.3%)', 'with metastatic infection (17.4%)', and 'uncertain for metastatic infection (76.3%)'. 30-day mortality increased as the severity of diagnosis shifted from 'without metastatic infection' to 'uncertain for metastatic infection' and 'with metastatic infection' (P = 0.09). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteraemia score ≥ 4, and persistent bacteraemia. CONCLUSIONS The new risk stratification system shows promise in predicting metastatic complications and guiding work-up and management of MRSAB. However, reducing the number of cases labelled as 'high-risk' and 'uncertain for metastatic infection' remains an area for improvement.
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Affiliation(s)
- Taeeun Kim
- Division of Infectious Diseases, Department of Medicine, Nowon Eulji University Hospital, Seoul, Republic of Korea
| | - Sang-Rok Lee
- Division of Infectious Diseases, Department of Internal Medicine, Cheongju St Mary's Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Seong Yeon Park
- Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Song Mi Moon
- Department of Internal Medicine at Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Department of Internal Medicine, Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Eun Hee Song
- Departments of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Republic of Korea.
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
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26
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Avent ML, Franks W, Redmond A, Allen MJ, Naicker S. Developing an intervention package to optimise the management of vancomycin therapy using theory informed co-design. Res Social Adm Pharm 2024; 20:498-505. [PMID: 38365521 DOI: 10.1016/j.sapharm.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Optimising the management of vancomycin by achieving target therapeutic concentrations early during therapy has been associated with reduced mortality and morbidity. Despite the availability of guidelines and training, the management of vancomycin remains suboptimal. OBJECTIVES The primary outcome was the development of interventions and associated implementation strategies to optimise the management of vancomycin therapy. This paper describes how co-design process was used to build a theory informed intervention package, which was implemented across a wide range of in-patient hospital settings in Queensland, Australia. METHODS This multiple methods study was conducted in four phases: 1) a baseline audit to identify the nature of the problem and associated determinants informed by stakeholder interviews 2) mapping these findings to the Theoretical Domains Framework (TDF) to identify behavioural correlates and modifiers 3) prioritising the behavioural modifiers and associated implementation strategies to inform a protype of the intervention in a series of co-design sessions and 4) implementing and evaluating the intervention package. The study was conducted across the four teaching hospitals in a large Queensland Hospital and Health Service across multiple healthcare disciplines namely nurses, doctors, and pharmacists. This intervention package was subsequently implemented across Queensland Health with the support of the local champions under the guidance of the steering group. RESULTS Clinicians identified that a multifaceted intervention package and training which can be tailored to the health-care professional disciplines, would be best suited to shift clinician behaviour to align with guidelines. The findings from the co-design process aligned with theory-informed intervention package. Each of the intervention strategies varied in their frequency and popularity of use. CONCLUSIONS The use of theory-informed and participatory approach assisted with the intervention development process and aligned the intervention content with the priorities of stakeholders. The TDF provided a structured process for developing intervention content which is both acceptable and useful to stakeholders and may improve the management of vancomycin.
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Affiliation(s)
- M L Avent
- Queensland Statewide Antimicrobial Stewardship Program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.
| | - W Franks
- Department of Pharmacy, Metro North Hospital and Health Service, Brisbane, Australia
| | - A Redmond
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - M J Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - S Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
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Ramírez-Guerrero G, de Cal M, Lorenzin A, Vigolo D, Toscano AI, Araya-Rojas M, Zanella M, Ronco C. Sorbent functionalization with vancomycin enhances bacteria killing in extracorporeal hemoadsorption. Artif Organs 2024; 48:543-549. [PMID: 38156403 DOI: 10.1111/aor.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The level of bacteremia in patients with sepsis and septic shock is a predictor of complications and mortality, regardless of the type of bacteria. Devices for bacteria, endotoxin and cytokines removal by adsorption have been recently developed. Thus, extracorporeal blood purification therapies have been proposed as adjunctive therapy in sepsis in combination with drugs. Some potentially useful drugs, however, are precluded due to their organ or metabolic toxicity. The present study represents a preliminary report on the in vitro effect of a sorbent device (minimodule with HA380 beads, Jafron medical, Zhuhai, China) in which the particles have been functionalized with vancomycin on the surface. The impact of the surface-modified beads on circulating bacteria (Staphylococcus aureus) has been tested in a simulated in vitro circulation. METHODS In vitro experiments were carried out with 800 mL of blood enriched with S. aureus species. Blood was circulated in the vancomycin-functionalized and non-functionalized mini-module cartridges in hemoadsorption setup (300 mL each) and the bactericidal effect was assessed. Also, 200 mL of blood was used as a control. RESULTS A significant increase in the time to positivity of blood cultures was observed after 60 min and also after 120 min of therapy with the mini-module functionalized with vancomycin as opposed to the non-functionalized cartridge. CONCLUSIONS These results suggest a possible way of treating sepsis by using drug- or antibiotic-functionalized cartridges without worrying about pharmacological toxicity. The prolongation of the time to bacterial culture positivity to S. aureus after a passage through a column packed with beads functionalized with vancomycin represents a proof of concept.
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Affiliation(s)
- Gonzalo Ramírez-Guerrero
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Nephrology and Dialysis Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Massimo de Cal
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Anna Lorenzin
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Dario Vigolo
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
| | - Anna Italia Toscano
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
| | | | - Monica Zanella
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
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Ho LC, Yu Chi C, You YS, Hsieh YW, Hou YC, Lin TC, Chen MT, Chou CH, Chen YC, Hsu KC, Yu J, Hsueh PR, Cho DY. Impact of the implementation of the Intelligent Antimicrobial System (iAMS) on clinical outcomes among patients with bacteraemia caused by methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2024; 63:107142. [PMID: 38490572 DOI: 10.1016/j.ijantimicag.2024.107142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES This study aimed to investigate the clinical impact of the Intelligent Antimicrobial System (iAMS) on patients with bacteraemia due to methicillin-resistant (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA). METHODS A total of 1008 patients with suspected SA infection were enrolled before and after the implementation of iAMS. Among them, 252 with bacteraemia caused by SA, including 118 in the iAMS and 134 in the non-iAMS groups, were evaluated. RESULTS The iAMS group exhibited a 5.2% (from 55.2% to 50.0%; P = 0.96) increase in the 1-year survival rate. For patients with MRSA and MSSA compared to the non-iAMS group, the 1-year survival rate increased by 17.6% (from 70.9% to 53.3%; P = 0.41) and 7.0% (from 52.3% to 45.3%; P = 0.57), respectively, both surpassing the rate of the non-iAMS group. The iAMS intervention resulted in a higher long-term survival rate (from 70.9% to 52.3%; P = 0.984) for MRSA patients than for MSSA patients. MRSA patients experienced a reduced length of hospital stay (from 23.3% to 35.6%; P = 0.038), and the 45-day discharge rate increased by 20.4% (P = 0.064). Furthermore, the intervention resulted in a significant 97.3% relative decrease in near miss medication incidents reported by pharmacists (P = 0.013). CONCLUSIONS Implementation of iAMS platform improved long-term survival rates, discharge rates, hospitalization days, and medical cost (although no significant differences were observed) among patients with MRSA bacteraemia. Additionally, it demonstrated significant benefits in ensuring drug safety.
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Affiliation(s)
- Lu-Ching Ho
- School of Pharmacy, China Medical University, Taichung, Taiwan; Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Chih Yu Chi
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Shu You
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yow-Wen Hsieh
- School of Pharmacy, China Medical University, Taichung, Taiwan; Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chi Hou
- School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Tzu-Ching Lin
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Ming Tung Chen
- Information Office, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hui Chou
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chieh Chen
- School of Pharmacy, China Medical University, Taichung, Taiwan; Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Cheng Hsu
- Artificial Intelligence Center, China Medical University Hospital, Taichung, Taiwan
| | - Jiaxin Yu
- Artificial Intelligence Center, China Medical University Hospital, Taichung, Taiwan
| | - Po-Ren Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Laboratory Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | - Der-Yang Cho
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
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Pinho JO, Ferreira M, Coelho M, Pinto SN, Aguiar SI, Gaspar MM. Liposomal Rifabutin-A Promising Antibiotic Repurposing Strategy against Methicillin-Resistant Staphylococcus aureus Infections. Pharmaceuticals (Basel) 2024; 17:470. [PMID: 38675432 PMCID: PMC11053623 DOI: 10.3390/ph17040470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/23/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Methicillin-resistant Staphylococcus aureus (M RSA) infections, in particular biofilm-organized bacteria, remain a clinical challenge and a serious health problem. Rifabutin (RFB), an antibiotic of the rifamycins class, has shown in previous work excellent anti-staphylococcal activity. Here, we proposed to load RFB in liposomes aiming to promote the accumulation of RFB at infected sites and consequently enhance the therapeutic potency. Two clinical isolates of MRSA, MRSA-C1 and MRSA-C2, were used to test the developed formulations, as well as the positive control, vancomycin (VCM). RFB in free and liposomal forms displayed high antibacterial activity, with similar potency between tested formulations. In MRSA-C1, minimal inhibitory concentrations (MIC) for Free RFB and liposomal RFB were 0.009 and 0.013 μg/mL, respectively. Minimum biofilm inhibitory concentrations able to inhibit 50% biofilm growth (MBIC50) for Free RFB and liposomal RFB against MRSA-C1 were 0.012 and 0.008 μg/mL, respectively. Confocal microscopy studies demonstrated the rapid internalization of unloaded and RFB-loaded liposomes in the bacterial biofilm matrix. In murine models of systemic MRSA-C1 infection, Balb/c mice were treated with RFB formulations and VCM at 20 and 40 mg/kg of body weight, respectively. The in vivo results demonstrated a significant reduction in bacterial burden and growth index in major organs of mice treated with RFB formulations, as compared to Control and VCM (positive control) groups. Furthermore, the VCM therapeutic dose was two fold higher than the one used for RFB formulations, reinforcing the therapeutic potency of the proposed strategy. In addition, RFB formulations were the only formulations associated with 100% survival. Globally, this study emphasizes the potential of RFB nanoformulations as an effective and safe approach against MRSA infections.
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Affiliation(s)
- Jacinta O. Pinho
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal; (J.O.P.); (M.F.); (M.C.)
| | - Magda Ferreira
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal; (J.O.P.); (M.F.); (M.C.)
- Center for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, Universidade de Lisboa, 1300-477 Lisboa, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Faculty of Veterinary Medicine, Universidade de Lisboa, 1300-477 Lisboa, Portugal
| | - Mariana Coelho
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal; (J.O.P.); (M.F.); (M.C.)
| | - Sandra N. Pinto
- iBB-Institute for Bioengineering and Biosciences and Associate Laboratory i4HB−Institute for Health and Bioeconomy at Department of Bioengineering, Instituto SuperiorTécnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal;
| | - Sandra I. Aguiar
- Center for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, Universidade de Lisboa, 1300-477 Lisboa, Portugal;
| | - Maria Manuela Gaspar
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal; (J.O.P.); (M.F.); (M.C.)
- IBEB, Institute of Biophysics and Biomedical Engineering, Faculty of Sciences, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
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Kunz Coyne AJ, Bleick C, Stamper K, Kebriaei R, Bayer AS, Lehman SM, Rybak MJ. Phage-antibiotic synergy against daptomycin-nonsusceptible MRSA in an ex vivo simulated endocardial pharmacokinetic/pharmacodynamic model. Antimicrob Agents Chemother 2024; 68:e0138823. [PMID: 38376187 PMCID: PMC10989002 DOI: 10.1128/aac.01388-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Phage-antibiotic combinations (PAC) offer a potential solution for treating refractory daptomycin-nonsusceptible (DNS) methicillin-resistant Staphylococcus aureus (MRSA) infections. We examined PAC activity against two well-characterized DNS MRSA strains (C4 and C37) in vitro and ex vivo. PACs comprising daptomycin (DAP) ± ceftaroline (CPT) and a two-phage cocktail (Intesti13 + Sb-1) were evaluated for phage-antibiotic synergy (PAS) against high MRSA inoculum (109 CFU/mL) using (i) modified checkerboards (CB), (ii) 24-h time-kill assays (TKA), and (iii) 168-h ex vivo simulated endocardial vegetation (SEV) models. PAS was defined as a fractional inhibitory concentration ≤0.5 in CB minimum inhibitory concentration (MIC) or a ≥2 log10 CFU/mL reduction compared to the next best regimen in time-kill assays and SEV models. Significant differences between regimens were assessed by analysis of variance with Tukey's post hoc modification (α = 0.05). CB assays revealed PAS with Intesti13 + Sb-1 + DAP ± CPT. In 24-h time-kill assays against C4, Intesti13 + Sb-1 + DAP ± CPT demonstrated synergistic activity (-Δ7.21 and -Δ7.39 log10 CFU/mL, respectively) (P < 0.05 each). Against C37, Intesti13 + Sb-1 + CPT ± DAP was equally effective (-Δ7.14 log10 CFU/mL each) and not significantly different from DAP + Intesti13 + Sb-1 (-Δ6.65 log10 CFU/mL). In 168-h SEV models against C4 and C37, DAP ± CPT + the phage cocktail exerted synergistic activities, significantly reducing bio-burdens to the detection limit [2 log10 CFU/g (-Δ7.07 and -Δ7.11 log10 CFU/g, respectively)] (P < 0.001). At 168 h, both models maintained stable MICs, and no treatment-emergent phage resistance occurred with DAP or DAP + CPT regimens. The two-phage cocktail demonstrated synergistic activity against two DNS MRSA isolates in combination with DAP + CPT in vitro and ex vivo. Further in vivo PAC investigations are needed.
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Affiliation(s)
- Ashlan J. Kunz Coyne
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Callan Bleick
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kyle Stamper
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Razieh Kebriaei
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Arnold S. Bayer
- The Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- The Lundquist Institution for Biomedical Innovation at Harbor-UCLA, Torrance, California, USA
| | - Susan M. Lehman
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
- Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, Michigan, USA
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Comba IY, Go JR, Vaillant J, O’Horo JC, Stevens RW, Palraj R, Abu Saleh O. Sequential Time to Positivity as a Prognostic Indicator in Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2024; 11:ofae173. [PMID: 38617074 PMCID: PMC11010313 DOI: 10.1093/ofid/ofae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background We aimed to determine the factors associated with sequential blood culture time to positivity (STTP) and validate the previously defined time to positivity (TTP) ratio threshold of 1.5 in predicting adverse disease outcomes and mortality of Staphylococcus aureus bacteremia (SAB). Methods We conducted an observational study of adult patients with SAB. The TTP ratio was calculated by dividing the TTP of the second blood culture by that of the first. Results Of 186 patients, 69 (37%) were female, with a mean age of 63.6 years. Median TTP was 12 hours (interquartile range [IQR], 10-15 hours) from the initial and 21 hours (17-29) from sequential blood cultures. Methicillin-resistant S aureus (MRSA)-infected patients had significantly shorter STTPs (P < .001) and lower TTP ratios (P < .001) compared to patients with methicillin-susceptible S aureus (MSSA). A significant correlation between initial and STTP was observed in patients with MRSA (r = 0.42, P = .002) but not in those with MSSA. A higher rate of native valve endocarditis (NVE) significantly correlated with a TTP ratio of ≤1.5 (odds ratio, 2.65 [95% confidence interval, 1.3-5.6]; P = .01). The subgroup having an initial TTP <12 hours combined with a TTP ratio ≤1.5 showed the highest prevalence of NVE. Conclusions The STTP varies based on methicillin susceptibility of S aureus isolate. This study suggests a potential clinical utility of the STTP to identify patients at a higher risk of NVE. However, prospective studies are required to validate these findings.
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Affiliation(s)
- Isin Y Comba
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John Raymond Go
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James Vaillant
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John C O’Horo
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan W Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Su J, Wang Y, Zhong W, Wang M, Wang Y. A retrospective study on the effect of statins on mortality and antimicrobial resistance among patients with Staphylococcus aureus bloodstream infection. Arch Med Sci 2024; 20:675-678. [PMID: 38757026 PMCID: PMC11094813 DOI: 10.5114/aoms/187004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/09/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction There is insufficient evidence in statin on the treatment of Staphylococcus aureus (SA) infection, we observe and analyze the clinical outcomes and antibiotic resistance of SA bloodstream infections in patients who received statins. Methods A retrospective study was carried out in SA bloodstream infection of hospitalized patients from January 2018 to August 2023. The 30-day attributable mortality, 30-day all-cause mortality and clinical data of patients who received statins and non-statins were compared. Results A total of 74 patients with SA bloodstream infection were included, 32 (43.2%) patients received treatment with statins and 42 (56.8%) with non-statins. The incidence of methicillin-resistant SA (MRSA) was significantly lower in the statins group (15.6% vs. 38.1%, p = 0.034), however, no significant differences were observed in the mortality rate (p = 0.410). Conclusions This study revealed the superiority of statins in reducing incidence of MRSA among SA bloodstream infection patients, but statins do not improve the 30-day mortality rate.
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Affiliation(s)
- Jianwei Su
- Department of Clinical Pharmacy, Dongguan Tungwah Hospital, Dongguan, Guangdong, China
| | - Yixuan Wang
- Department of Pharmacy, Chang’an Hospital of Dongguan, Dongguan, Guangdong, China
| | - Wanping Zhong
- Department of Clinical Pharmacy, Dongguan Tungwah Hospital, Dongguan, Guangdong, China
| | - Mengzhi Wang
- Department of Pharmacy, Chang’an Hospital of Dongguan, Dongguan, Guangdong, China
| | - Yanhong Wang
- Department of Clinical Pharmacy, Dongguan Tungwah Hospital, Dongguan, Guangdong, China
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Hicks AS, Dolan MA, Shah MD, Elwood SE, Platts-Mills JA, Madden GR, Elliott ZS, Eby JC. Early Initiation of Ceftaroline-Based Combination Therapy for Methicillin-resistant Staphylococcus aureus Bacteremia. RESEARCH SQUARE 2024:rs.3.rs-4095478. [PMID: 38559201 PMCID: PMC10980158 DOI: 10.21203/rs.3.rs-4095478/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Purpose Monotherapy with vancomycin or daptomycin remains guideline-based care for methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) despite concerns regarding efficacy. Limited data support potential benefit of combination therapy with ceftaroline as initial therapy. We present an assessment of outcomes of patients initiated on early combination therapy for MRSA-B. Methods This was a single-center, retrospective study of adult patients admitted with MRSA-B between July 1, 2017 and April 31, 2023. During this period, there was a change in institutional practice from routine administration of monotherapy to initial combination therapy for most patients with MRSA-B. Combination therapy included vancomycin or daptomycin plus ceftaroline within 72 hours of index blood culture and monotherapy was vancomycin or daptomycin alone. The primary outcome was a composite of persistent bacteremia, 30-day all-cause mortality, and 30-day bacteremia recurrence. Time to microbiological cure and safety outcomes were assessed. All outcomes were assessed using propensity score-weighted logistic regression. Results Of 213 patients included, 118 received monotherapy (115 vancomycin, 3 daptomycin) and 95 received combination therapy with ceftaroline (76 vancomycin, 19 daptomycin). The mean time from MRSA-positive molecular diagnostic blood culture result to combination therapy was 12.1 hours. There was no difference between groups for the primary composite outcome (OR 1.58, 95% CI 0.60, 4.18). Time to microbiological cure was longer with combination therapy (mean difference 1.50 days, 95% CI 0.60, 2.41). Adverse event rates were similar in both groups. Conclusions Early initiation of ceftaroline-based combination therapy did not improve outcomes for patients with MRSA-B in comparison to monotherapy therapy.
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Deguchi N, Ishikawa K, Tokioka S, Kobayashi D, Mori N. Relationship between blood culture time to positivity, mortality rate, and severity of bacteremia. Infect Dis Now 2024; 54:104843. [PMID: 38043910 DOI: 10.1016/j.idnow.2023.104843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES We investigated the association between patient severity or mortality and time to positivity in bacteremia caused by various pathogens. PATIENTS AND METHODS This single-center retrospective study included patients with positive blood culture results. RESULTS Longer time to positivity was associated with 30-day mortality for Staphylococcus aureus (221 cases, time to positivity: 17.4 h in the 30-day mortality group vs. 14.1 h in the survival group). Age, chronic kidney disease, cerebrovascular disease, hypertensive drug use, consciousness disorder, and minimal systolic blood pressure were significant predictors of 30-day mortality. For S. aureus, mortality within 30 days was significantly higher when time to positivity was > 24 h (p = 0.04). The time to positivity of Streptococcus pneumoniae, α, β-hemolytic Streptococcus, Enterococcus sp., Enterobacteriaceae, glucose-nonfermenting Gram-negative rods, Candida sp., and anaerobe was not significantly associated with 30-day mortality. CONCLUSIONS Among various pathogens, time to positivity > 24 h was associated with 30-day mortality for S. aureus.
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Affiliation(s)
- N Deguchi
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan
| | - K Ishikawa
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
| | - S Tokioka
- Department of Cardiovascular Medicine, Sendai Medical Center, Sendai, Japan
| | - D Kobayashi
- Department of Primary Care and General Medicine Tokyo Medical University Ibaraki Medical Center, Japan
| | - N Mori
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan
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Gulone L, Di Gregorio S, Morales M, Haim MS, García S, Perazzi B, Famiglietti A, Mollerach M. The Changing Epidemiology and Antimicrobial Susceptibility of Staphylococcus aureus Isolated from Blood Cultures in a University Hospital from Argentina. Microb Drug Resist 2024; 30:109-117. [PMID: 38133499 DOI: 10.1089/mdr.2023.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections worldwide. In this study, we demonstrated changes in SAB epidemiology in an Argentinean University Hospital during an 8-year period (2009-2016). A total of 326 S. aureus clinical isolates were recovered in three periods: P1: 2009-2010, P2: 2012-2014, and P3: 2015-2016. Among these, 127 were methicillin-resistant S. aureus (MRSA) and were characterized by phenotypic and molecular methods. We hereby report a significant decline in multiple drug resistance among MRSA isolates associated with an increase in SCCmec IV between the three periods. A diversity of MRSA-IV clones (mainly ST30-MRSA-IV, ST5-MRSA-IV, and ST8-MRSA-IV) replaced between 2009 and 2016 the previous prevalent MRSA clone causing bloodstream infections at this hospital (ST5-MRSA-I). MRSA population structure continued to diversify between P2 and P3. Notably, ST8-MRSA-IV-t008 related to USA300 was first detected during P2, and ST8-MRSA-IV together with ST30-MRSA-IV related to the Southwest Pacific clone were the more prevalent MRSA genotypes circulating during P3.
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Affiliation(s)
- Lucía Gulone
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sabrina Di Gregorio
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Maia Morales
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Sol Haim
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Susana García
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Beatriz Perazzi
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Angela Famiglietti
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marta Mollerach
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
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Quiñonez-Flores A, Martinez-Guerra BA, Román-Montes CM, Tamez-Torres KM, González-Lara MF, Ponce-de-León A, Rajme-López S. Cephalotin Versus Dicloxacillin for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteraemia: A Retrospective Cohort Study. Antibiotics (Basel) 2024; 13:176. [PMID: 38391562 PMCID: PMC10885996 DOI: 10.3390/antibiotics13020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND First-line treatments for methicillin-susceptible S. aureus (MSSA) bacteraemia are nafcillin, oxacillin, or cefazolin. Regional shortages of these antibiotics force clinicians to use other options like dicloxacillin and cephalotin. This study aims to describe and compare the safety and efficacy of cephalotin and dicloxacillin for the treatment of MSSA bacteraemia. METHODS This retrospective study was conducted in a referral centre in Mexico City. We identified MSSA isolates in blood cultures from 1 January 2012 to 31 December 2022. Patients ≥ 18 years of age, with a first episode of MSSA bacteraemia, who received cephalotin or dicloxacillin as the definitive antibiotic treatment, were included. The primary outcome was in-hospital all-cause mortality. RESULTS We included 202 patients, of which 48% (97/202) received cephalotin as the definitive therapy and 52% (105/202) received dicloxacillin. In-hospital all-cause mortality was 20.7% (42/202). There were no differences in all-cause in-hospital mortality between patients receiving cephalotin or dicloxacillin (20% vs. 21%, p = 0.43), nor in 30-day all-cause mortality (14% vs. 18%, p = 0.57) or 90-day all-cause mortality (24% vs. 22%, p = 0.82). No severe adverse reactions were associated with either antibiotic. CONCLUSIONS Cephalotin and dicloxacillin were equally effective for treating MSSA bacteraemia, and both showed an adequate safety profile.
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Affiliation(s)
- Alejandro Quiñonez-Flores
- Internal Medicine Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Bernardo A Martinez-Guerra
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Carla M Román-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Karla M Tamez-Torres
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - María F González-Lara
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Alfredo Ponce-de-León
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Sandra Rajme-López
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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Westgeest AC, Lambregts MMC, Ruffin F, Korn RE, Webster ME, Kair JL, Parsons JB, Maskarinec SA, Kaplan S, Dekkers OM, de Boer MGJ, Fowler VG, Thaden JT. Female Sex and Mortality in Patients with Staphylococcus aureus Bacteremia: A Systematic Review and Meta-analysis. JAMA Netw Open 2024; 7:e240473. [PMID: 38411961 PMCID: PMC10900971 DOI: 10.1001/jamanetworkopen.2024.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Importance Staphylococcus aureus is the leading cause of death due to bacterial bloodstream infection. Female sex has been identified as a risk factor for mortality in S aureus bacteremia (SAB) in some studies, but not in others. Objective To determine whether female sex is associated with increased mortality risk in SAB. Data Sources MEDLINE, Embase, and Web of Science were searched from inception to April 26, 2023. Study Selection Included studies met the following criteria: (1) randomized or observational studies evaluating adults with SAB, (2) included 200 or more patients, (3) reported mortality at or before 90 days following SAB, and (4) reported mortality stratified by sex. Studies on specific subpopulations (eg, dialysis, intensive care units, cancer patients) and studies that included patients with bacteremia by various microorganisms that did not report SAB-specific data were excluded. Data Extraction and Synthesis Data extraction and quality assessment were performed by 1 reviewer and verified by a second reviewer. Risk of bias and quality were assessed with the Newcastle-Ottawa Quality Assessment Scale. Mortality data were combined as odds ratios (ORs). Main Outcome and Measures Mortality at or before 90-day following SAB, stratified by sex. Results From 5339 studies retrieved, 89 were included (132 582 patients; 50 258 female [37.9%], 82 324 male [62.1%]). Unadjusted mortality data were available from 81 studies (109 828 patients) and showed increased mortality in female patients compared with male patients (pooled OR, 1.12; 95% CI, 1.06-1.18). Adjusted mortality data accounting for additional patient characteristics and treatment variables were available from 32 studies (95 469 patients) and revealed a similarly increased mortality risk in female relative to male patients (pooled adjusted OR, 1.18; 95% CI, 1.11-1.27). No evidence of publication bias was encountered. Conclusions and Relevance In this systematic review and meta-analysis, female patients with SAB had higher mortality risk than males in both unadjusted and adjusted analyses. Further research is needed to study the potential underlying mechanisms.
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Affiliation(s)
- Annette C. Westgeest
- Division of Infectious Diseases, Duke University, Durham, North Carolina
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Merel M. C. Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Felicia Ruffin
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Rachel E. Korn
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Maren E. Webster
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jackson L. Kair
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Joshua B. Parsons
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | | | - Samantha Kaplan
- Medical Center Library and Archives, Duke University, Durham, North Carolina
| | - Olaf M. Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark G. J. de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Vance G. Fowler
- Division of Infectious Diseases, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Joshua T. Thaden
- Division of Infectious Diseases, Duke University, Durham, North Carolina
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Nguyen N, Chua HC, Drake T, Jo J, Stramel SA, Vuong NN, Gonzales-Luna AJ, Olson K, On Behalf Of The Houston Infectious Diseases Network. Significant Publications on Infectious Diseases Pharmacotherapy in 2021. J Pharm Pract 2024; 37:198-211. [PMID: 36122416 DOI: 10.1177/08971900221128334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To summarize the most noteworthy infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2021. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were deemed to have significant contributions to ID pharmacotherapy in 2021. These nominations included articles pertaining to both general ID, including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. A total of 35 articles were nominated by HIDN: 30 articles pertaining to general ID pharmacotherapy and 5 articles with HIV/AIDS focus. To select the most influential articles of 2021, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 239 SIDP members who responded to the survey, there were 192 recorded votes for the top 10 general ID pharmacotherapy articles and 47 recorded votes for the top HIV/AIDS article, respectively. The top publications are summarized. Conclusion: Antimicrobial stewardship and the optimal management of infectious disease states continues to be a priority in the midst of the ongoing coronavirus disease 2019 (COVID-19) global pandemic. In light of the sheer volume of ID-related articles published in the past year, this review aims to aid clinicians in remaining up-to-date on key practice-changing ID pharmacotherapy publications from 2021.
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Affiliation(s)
- Nhi Nguyen
- Department of Pharmacy, The University of Texas Medical Branch, Galveston, TX, USA
| | - Hubert C Chua
- Department of Pharmacy, CHI Baylor St Luke's Medical Center, Houston, TX, USA
| | - Ty Drake
- Department of Pharmacy, Houston Methodist Willowbrook Hospital, Houston, TX, USA
| | - Jinhee Jo
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Stefanie Anne Stramel
- Department of Pharmacy, Memorial Hermann Memorial City Medical Center, Houston, TX, USA
| | - Nancy N Vuong
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Kelsey Olson
- Department of Pharmacy, HCA Houston Healthcare Clear Lake, Webster, TX, USA
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Abdollahi A, Nojomi M, Karimi Y, Ranjbar M. Mortality patterns in patients with Staphylococcus aureus bacteremia during the COVID-19 pandemic: Predictors and insights. Heliyon 2024; 10:e24511. [PMID: 38312595 PMCID: PMC10835178 DOI: 10.1016/j.heliyon.2024.e24511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Objectives This paper aims to determine the Staphylococcus aureus bacteremia (SAB) in-hospital mortality rate and its associated risk factors during the COVID-19 pandemic. Methods A total of 167 SAB samples were collected between March 2020 and March 2022 at a teaching hospital in Tehran, Iran. The patient's baseline data and antibiograms were collected. The outcome of the study was in-hospital mortality. Results The overall in-hospital mortality rate was 41.9 %, with higher mortality observed in patients over 60 years old (P = 0.032), those with community-acquired Staphylococcus aureus bacteremia (P = 0.010), and those admitted to the ICU (P = 0.016). Antibiotic resistance profiles indicated a higher mortality in resistant S.aureus strains but only significant for ciprofloxacin (P = 0.001), methicillin (P = 0.047), and sulfamethoxazole (P = 0.023). Multivariate analysis identified age, sex, ICU admission, and the source of bacteremia as independent predictors of mortality, while COVID-19 coinfection and resistance to antibiotics were not found to be significant predictors. Conclusion SAB remains a challenging infection that is amplified by the pandemic. Older age and ICU admission are significant mortality predictors. In settings with a high prevalence of MRSA, factors like age, sex, and quality of care outweigh pathogen-related factors such as antibiotic resistance.
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Affiliation(s)
- Arash Abdollahi
- Medical Doctor, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Karimi
- Medical Doctor, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Ranjbar
- Department of Infectious Diseases, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Sakoulas G, Nizet V. Measuring beta-lactam minimum inhibitory concentrations in Staphylococcus aureus in the clinical microbiology laboratory: pinning the tail on the donkey. J Clin Microbiol 2024; 62:e0036623. [PMID: 37966224 PMCID: PMC10793257 DOI: 10.1128/jcm.00366-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Significant shortcomings have been identified in standard methods of susceptibility testing in bacteriological media, not only because the media fails to recapitulate the in vivo environment, but susceptibility testing itself fails to capture sub-MIC effects that significantly attenuate bacterial virulence properties. Until susceptibility testing conditions better recapitulate the in vivo environment, attempts to establish the quantitative relevance of beta-lactam MIC using current clinical microbiology standards in Staphylococcus aureus infections will likely prove unsuccessful.
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Affiliation(s)
- George Sakoulas
- Sharp Rees-Stealy Medical Group, San Diego, California, USA
- UCSD School of Medicine, La Jolla, California, USA
| | - Victor Nizet
- UCSD School of Medicine, La Jolla, California, USA
- Skaggs School of Pharmacy, UCSD School of Medicine, La Jolla, California, USA
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Burlacchini G, Sandri A, Papetti A, Frosi I, Boschi F, Lleo MM, Signoretto C. Evaluation of Antibacterial and Antibiofilm Activity of Rice Husk Extract against Staphylococcus aureus. Pathogens 2024; 13:80. [PMID: 38251387 PMCID: PMC10820005 DOI: 10.3390/pathogens13010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Infections caused by Staphylococcus aureus are particularly difficult to treat due to the high rate of antibiotic resistance. S. aureus also forms biofilms that reduce the effects of antibiotics and disinfectants. Therefore, new therapeutic approaches are increasingly required. In this scenario, plant waste products represent a source of bioactive molecules. In this study, we evaluated the antimicrobial and antibiofilm activity of the rice husk extract (RHE) on S. aureus clinical isolates. In a biofilm inhibition assay, high concentrations of RHE counteracted the formation of biofilm by S. aureus isolates, both methicillin-resistant (MRSA) and -sensitive (MSSA). The observation of the MRSA biofilm by confocal laser scanning microscopy using live/dead cell viability staining confirmed that the bacterial viability in the RHE-treated biofilm was reduced. However, the extract showed no or little biofilm disaggregation ability. An additive effect was observed when treating S. aureus with a combination of RHE and oxacillin/cefoxitin. In Galleria mellonella larvae treated with RHE, the extract showed no toxicity even at high concentrations. Our results support that the rice husk has antimicrobial and antibiofilm properties and could potentially be used in the future in topical solutions or on medical devices to prevent biofilm formation.
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Affiliation(s)
- Gloria Burlacchini
- Diagnostic and Public Health Department, University of Verona, 37134 Verona, Italy; (G.B.); (C.S.)
| | - Angela Sandri
- Diagnostic and Public Health Department, University of Verona, 37134 Verona, Italy; (G.B.); (C.S.)
| | - Adele Papetti
- Nutraceutical and Food Chemical-Toxicological Analysis Laboratory, Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (I.F.)
| | - Ilaria Frosi
- Nutraceutical and Food Chemical-Toxicological Analysis Laboratory, Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (I.F.)
| | - Federico Boschi
- Department of Engineering for Innovation Medicine, University of Verona, 37134 Verona, Italy;
| | - Maria M. Lleo
- Diagnostic and Public Health Department, University of Verona, 37134 Verona, Italy; (G.B.); (C.S.)
| | - Caterina Signoretto
- Diagnostic and Public Health Department, University of Verona, 37134 Verona, Italy; (G.B.); (C.S.)
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Liu T, Hinch M, Leung V, Lee C. Characterization of Prescribing Practices for Uncomplicated Streptococcal and Enterococcal Bacteremias: The NARRATE Study. Can J Hosp Pharm 2024; 77:e3391. [PMID: 38204499 PMCID: PMC10754410 DOI: 10.4212/cjhp.3391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/03/2023] [Indexed: 01/12/2024]
Abstract
Background Bloodstream infections (BSIs) rank among the top causes of death in North America. Despite the prevalence of these infections, there remain significant practice variations in the prescribing of antibiotics. Objective To investigate current prescribing practices for management of uncomplicated streptococcal and enterococcal BSIs. Methods A retrospective cohort study was conducted using charts for patients admitted to an acute care centre in British Columbia between November 16, 2019, and October 20, 2020. Adult patients (≥ 18 years of age) with a diagnosis of uncomplicated streptococcal or enterococcal BSI were included. Patients were excluded if they had polymicrobial bacteremia or deep-seated infection or had been admitted for no more than 48 hours. The primary outcomes were duration of antibiotic therapy (IV and oral) and time to appropriate oral therapy for treatment of BSI. The secondary outcomes were observed rates of re-initiation of antibiotics and readmission with recurrent BSI. Descriptive statistics were calculated and regression analysis was performed for the primary and secondary outcomes. Results A total of 96 patients met the inclusion criteria. The median total duration of therapy for uncomplicated streptococcal and enterococcal BSI was about 2 weeks. Streptococcus pneumoniae BSIs were associated with a significantly shorter duration of IV therapy and were more likely to be associated with transition to oral antibiotics. No recurrent BSIs were observed in patients for whom therapy was transitioned to oral antibiotics. Conclusions Further study is warranted to explore shorter duration of antibiotic therapy and transition to oral therapy as treatment approaches for uncomplicated streptococcal and enterococcal BSI. Other outcomes of interest for future research include determining the optimal time for transition to oral therapy.
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Affiliation(s)
- Tracy Liu
- , PharmD, ACPR, is with Lower Mainland Pharmacy Services, Fraser Health Authority and the The University of British Columbia, Vancouver, British Columbia
| | - Michelle Hinch
- , BSc(Pharm), PharmD, is with the Departments of Antimicrobial Stewardship and of Pharmacy Services, St Paul's Hospital, Providence Health Authority - Lower Mainland Pharmacy Services, Vancouver, British Columbia
| | - Victor Leung
- , MD, is with the Department of Antimicrobial Stewardship, St Paul's Hospital, Providence Health Authority, Vancouver, British Columbia
| | - Colin Lee
- , BSc(Pharm), ACPR, PharmD, MSc, is with the Departments of Antimicrobial Stewardship and of Pharmacy Services, St Paul's Hospital, Providence Health Authority - Lower Mainland Pharmacy Services, Vancouver, British Columbia
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Witt LS, Sexton ME, Smith G, Farley M, Jacob JT. Evaluating indwelling devices and other risk factors for mortality in invasive Carbapenem-resistant Enterobacterales infections in Georgia, 2012-2019. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 3:e254. [PMID: 38178877 PMCID: PMC10762638 DOI: 10.1017/ash.2023.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
Objective Carbapenem-resistant Enterobacterales (CRE) infections are a public health threat due to the risk of transmission between patients and high associated mortality. We sought to identify risk factors for mortality in patients with invasive CRE infections and to specifically evaluate whether there was an association between indwelling medical devices and 90-day mortality. Design Retrospective observational cohort study of patients infected with CRE in the eight-county metropolitan Atlanta area between 2012 and 2019. Methods Patients with invasive CRE infections were identified via the Georgia Emerging Infections Program's active, population- and laboratory-based surveillance system and linked with the Georgia Vital Statistics database. We used bivariate analysis to identify risk factors for mortality and completed log binomial multivariable regression to estimate risk ratios (RR) for the association between indwelling devices and mortality. Results In total, 154 invasive CRE infections were identified, with indwelling devices present in most patients (87.7%) around the time of infection. Admission to an intensive care unit was found to be associated with 90-day mortality (adjusted RR [aRR] 1.55, 95% CI 1.07, 2.24); however, the presence of any indwelling device was not associated with increased risk of 90-day mortality in multivariable analysis (aRR 1.22, 95% CI 0.55, 2.73). Having at least two indwelling devices was associated with increased mortality (aRR 1.79, 95% CI 1.05, 3.05). Conclusions Indwelling devices were prevalent in our cohort but were not consistently associated with an increased risk of mortality. Further studies are needed to examine this relationship and the role of device removal.
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Affiliation(s)
- Lucy S. Witt
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Mary Elizabeth Sexton
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Gillian Smith
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Monica Farley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Jesse T. Jacob
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
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Borg MA, Suda D, Tartari E, Farrugia C, Xuereb D, Borg Inguanez M. Preventing healthcare-associated MRSA bacteremia: getting to the root of the problem. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e248. [PMID: 38156235 PMCID: PMC10753512 DOI: 10.1017/ash.2023.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023]
Abstract
Introduction Bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA) remain a major challenge in most countries worldwide. Setting We describe a quasi-experimental sequential intervention at Mater Dei Hospital, Malta, to reduce hyper-prevalence of healthcare-associated MRSA bacteremia (HA-MRSA-B). Interventions The hospital initiated a hand hygiene (HH) campaign in 2008 to improve alcohol hand rub (AHR) use. In 2011, this was followed by root cause analysis (RCA) of all HA-MRSA-B cases and finally universal MRSA admission screening in 2014. Change-point analysis was used to evaluate the impact of the interventions. Results The effect of the HH campaign became evident when AHR consumption reached 40 L/1000 occupied bed days (BD). RCAs identified intravascular devices as the likely risk factor in 83% of all HA-MRSA-B; specifically non-tunneled double-lumen hemodialysis catheters (36%), peripheral venous cannulas (25%), and central venous catheters (22%). Interventions to improve their management resulted in the greatest reduction of HA-MRSA-B rates. They were informed by the RCA findings and targeted behavior change through education, motivation, and system change. Universal MRSA admission screening provided the final decline in incidence. Each intervention affected HA-MRSA-B rates after a lag period of approximately 18-24 months. Overall, HA-MRSA-B incidence decreased from 1.72 cases/10000BD in 2008 to 0.18/10000BD in 2019; a reduction of almost 90%. Intravenous device interventions were also associated with a reduction of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia rates. Conclusions Significant improvement in HA-MRSA-B is possible, even in highly endemic regions. It requires well-planned behavior change interventions which are compatible with local context and culture.
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Affiliation(s)
- Michael A. Borg
- University of Malta, Msida, Malta
- Department of Infection Prevention & Control, Mater Dei Hospital, Msida, Malta
| | | | | | - Claire Farrugia
- Department of Infection Prevention & Control, Mater Dei Hospital, Msida, Malta
| | - Deborah Xuereb
- Department of Infection Prevention & Control, Mater Dei Hospital, Msida, Malta
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Dubey AK, Sharma M, Parul, Raut S, Gupta P, Khatri N. Healing wounds, defeating biofilms: Lactiplantibacillus plantarum in tackling MRSA infections. Front Microbiol 2023; 14:1284195. [PMID: 38116526 PMCID: PMC10728654 DOI: 10.3389/fmicb.2023.1284195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Methicillin-resistant Staphylococcus aureus (MRSA) infections are well-known hospital-borne infections and are a major contributing factor to global health concerns of antimicrobial resistance due to the formation of biofilms. Probiotics are known to assist in the healing of wounds through immunomodulation and also possess anti-pathogen properties via competitive inhibition. The probiotic bacterium, Lactiplantibacillus plantarum MTCC 2621 and its cell-free supernatant (Lp2621) have previously been reported to have antibacterial, excellent antioxidant, and wound healing activity in in vitro conditions and wounds contaminated with S. aureus in mice. Methods In the current study, we evaluated its anti-MRSA, biofilm inhibition and eradication efficacy, immunomodulatory activity in THP-1 cells, and wound healing potential in wounds contaminated with MRSA infection in mice. Results In agar well diffusion assay, Lp2621 showed anti-MRSA activity and revealed dose-dependent inhibition and eradication of biofilm by crystal violet assay as well as by Confocal Scanning Laser Microscopy (CLSM) analysis. Further, Lp2621 showed immunomodulatory activity at varied concentrations as measured by IL-6 and IL-10 gene expression in THP-1 cells. Similar findings were observed in serum samples of mice after treatment of excision wound contaminated with MRSA infection by Lp2621 gel, as evident by expression of IL-6 (pro-inflammatory) and IL-10 (anti-inflammatory) cytokines. Conclusions Overall, our results show that Lp2621 has potent anti-MRSA and antioxidant properties and can prevent and eliminate biofilm formation. It also showed promise when applied to mice with MRSA-infected wounds.
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Affiliation(s)
- Ashish Kumar Dubey
- IMTech Centre for Animal Resources & Experimentation (iCARE), CSIR-Institute of Microbial Technology (IMTECH), Chandigarh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Mohini Sharma
- IMTech Centre for Animal Resources & Experimentation (iCARE), CSIR-Institute of Microbial Technology (IMTECH), Chandigarh, India
| | - Parul
- IMTech Centre for Animal Resources & Experimentation (iCARE), CSIR-Institute of Microbial Technology (IMTECH), Chandigarh, India
| | - Sachin Raut
- IMTech Centre for Animal Resources & Experimentation (iCARE), CSIR-Institute of Microbial Technology (IMTECH), Chandigarh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Pawan Gupta
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
- Department of Molecular Biology, CSIR-Institute of Microbial Technology (IMTECH), Chandigarh, India
| | - Neeraj Khatri
- IMTech Centre for Animal Resources & Experimentation (iCARE), CSIR-Institute of Microbial Technology (IMTECH), Chandigarh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Phillip KI, Webster AS, Ray SM, Britton A, Swerdlow D, Fridkin SK. Estimating the Burden of Clinically Significant Staphylococcus aureus Infections and Predictors for Hospitalization for Skin and Soft Tissue Infections, Fulton County, Georgia, 2017. Open Forum Infect Dis 2023; 10:ofad601. [PMID: 38107016 PMCID: PMC10725309 DOI: 10.1093/ofid/ofad601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Indexed: 12/19/2023] Open
Abstract
Background Incidence estimates of Staphylococcus aureus infections rarely include the full spectrum of clinically relevant disease from both community and healthcare settings. Methods We conducted a prospective study capturing all S aureus infections in Fulton County, Georgia, during 2017. Medical records of patients with any incident infection (clinical cultures growing S aureus from any site, without prior positive culture in previous 14 days) were reviewed. Estimates of disease incidence were calculated using age-, race-, and sex-specific population denominators accounting for weighted sampling methods. Multivariable logistic regression models were used to identify risk factors for hospitalization among patients with skin and soft tissue infections (SSTIs). Results The overall incidence of clinically relevant S aureus infection was 405.7 cases per 100 000 people (standard error [SE], 5.62 [range, 400.1-411.3]). Overall incidence for those of Black race was 500.84 cases per 100 000 people (SE, 14.55), whereas White patients had overall incidence of 363.67 cases per 100 000 people (SE, 13.8). SSTIs were the most common infection (2351; 225.8 cases per 100 000 people [SE, 7.1]), and 30% required hospitalization. Among SSTIs, after adjusting for invasive disease, cellulitis, diabetes, and demographics, independent predictors of hospitalization included methicillin-resistant S aureus (adjusted odds ratio [aOR], 1.6 [95% confidence interval {CI}, 1.0-2.7]) and homelessness (aOR, 4.9 [95% CI, 1.1-22]). Conclusions The burden of clinically relevant S aureus infections is high, particularly among the Black population, and risks for hospitalization among SSTIs include isolate factors and factors related to patients' vulnerability.
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Affiliation(s)
- Katherine I Phillip
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrew S Webster
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
- Department of Research, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Georgia Emerging Infections Program, Decatur, Georgia, USA
| | - Susan M Ray
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Decatur, Georgia, USA
| | - Amber Britton
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
- Department of Research, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Georgia Emerging Infections Program, Decatur, Georgia, USA
| | - David Swerdlow
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania, USA
- Medical Affairs, HilleVax Inc, Boston, Massachusetts, USA
| | - Scott K Fridkin
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Decatur, Georgia, USA
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Yu FY, Zheng K, Wu YF, Gao SW, Weng QY, Zhu C, Wu YP, Li M, Qin ZN, Lou JF, Chen ZH, Ying SM, Shen HH, Li W. Rapamycin Exacerbates Staphylococcus aureus Pneumonia by Inhibiting mTOR-RPS6 in Macrophages. J Inflamm Res 2023; 16:5715-5728. [PMID: 38053607 PMCID: PMC10695130 DOI: 10.2147/jir.s434483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose This study aimed to explore the effect of Rapamycin (Rapa) in Staphylococcus aureus (S. aureus) pneumonia and clarify its possible mechanism. Methods We investigated the effects of Rapa on S. aureus pneumonia in mouse models and in macrophages cultured in vitro. Two possible mechanisms were investigated: the mTOR-RPS6 pathway phosphorylation and phagocytosis. Furthermore, for the mechanism verification in vivo, mice with specific Mtor knockout in myeloid cells were constructed for pneumonia models. Results Rapa exacerbated S. aureus pneumonia in mouse models, promoting chemokines secretion and inflammatory cells infiltration in lung. In vitro, Rapa upregulated the secretion of chemokines and cytokines in macrophages induced by S. aureus. Mechanistically, the mTOR-ribosomal protein S6 (RPS6) pathway in macrophages was phosphorylated in response to S. aureus infection, and the inhibition of RPS6 phosphorylation upregulated the inflammation level. However, Rapa did not increase the phagocytic activity. Accordingly, mice with specific Mtor knockout in myeloid cells experienced more severe S. aureus pneumonia. Conclusion Rapa exacerbates S. aureus pneumonia by increasing the inflammatory levels of macrophages. Inhibition of mTOR-RPS6 pathway upregulates the expression of cytokines and chemokines in macrophages, thus increases inflammatory cells infiltration and exacerbates tissue damage.
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Affiliation(s)
- Fang-Yi Yu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Kua Zheng
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Yin-Fang Wu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Shen-Wei Gao
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Qing-Yu Weng
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Chen Zhu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Yan-Ping Wu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Miao Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhong-Nan Qin
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Jia-Fei Lou
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhi-Hua Chen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Song-Min Ying
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Hua-Hao Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Wen Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
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Ong SWX, Zhabokritsky A, Daneman N, Tong SYC, Wijeysundera HC. Evaluating the use of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in the workup of Staphylococcus aureus bacteraemia: a cost-utility analysis. Clin Microbiol Infect 2023; 29:1417-1423. [PMID: 37353076 DOI: 10.1016/j.cmi.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES The use of positron emission tomography/computed tomography (PET/CT) in the evaluation of patients with Staphylococcus aureus bacteraemia can improve the diagnosis of infectious foci and guide clinical management. We aimed to evaluate the cost-utility of PET/CT among adults hospitalized with Staphylococcus aureus bacteraemia. METHODS A cost-utility analysis was conducted from the healthcare payer perspective using a probabilistic Markov cohort model assessing three diagnostic strategies: (a) PET/CT in all patients, (b) PET/CT in high-risk patients only, and (c) routine diagnostic workup. Primary outcomes were quality-adjusted life years (QALYs), costs in Canadian dollars, and an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty. RESULTS Routine workup resulted in an average of 16.64 QALYs from the time of diagnosis at a lifetime cost of $209 060/patient. This was dominated by PET/CT in high-risk patients (i.e. greater effectiveness at lower costs) with average 16.88 QALYs at a cost of $199 552. Compared with PET/CT in high-risk patients only, PET/CT for all patients cost on average $11 960 more but resulted in 0.14 more QALYs, giving an incremental cost-effectiveness ratio of $83 500 (cost per additional QALY gained); however, there was a high degree of uncertainty comparing these two strategies. At a willingness-to-pay threshold of $50 000/QALY, PET/CT in high-risk patients was the most cost-effective strategy in 58.6% of simulations vs. 37.9% for PET/CT in all patients. DISCUSSION Our findings suggest that a strategy of using PET/CT in high-risk patients is more cost-effective than no PET/CT. Randomized controlled trials should be conducted to evaluate the use of PET/CT in different patient groups.
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Affiliation(s)
- Sean W X Ong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
| | - Alice Zhabokritsky
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Nick Daneman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Steven Y C Tong
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Mia AK, Bora A, Hossain MT, Sinha S, Giri PK. Fast detection of Staphylococcus aureus using thiol-functionalized WS 2 quantum dots and Bi 2O 2Se nanosheets hybrid through a fluorescence recovery mechanism. J Mater Chem B 2023; 11:10206-10217. [PMID: 37853818 DOI: 10.1039/d3tb01465g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Ultrafast and sensitive detection of Staphylococcus aureus (S. aureus), a harmful Gram-positive human pathogenic bacterium, by two-dimensional layered materials continues to be a challenge. Herein, we have studied the sensing of S. aureus using a tungsten disulfide (WS2) quantum dot (QD) and bismuth oxyselenide (Bi2O2Se) nanosheet (NS) hybrid through their unique optical functionalities. The WS2 QDs of a mean diameter of 2.5 nm were synthesized by liquid exfoliation. Due to the quantum confinement and functional groups, the WS2 QDs exhibit high fluorescence (FL) yield under UV excitation. The addition of Bi2O2Se NSs resulted in the adsorption of WS2 QDs on their surface, resulting in quenching of the FL emission due to nonfluorescent complex formation between the WS2 QDs and Bi2O2Se NSs. A specific sequencing single-standard DNA (ssDNA) aptamer, which identifies and explicitly binds with S. aureus, was attached to the defect sites of the WS2 QDs for selective detection. The thiol-modified ssDNA aptamers attach covalently to the WS2 QD defect sites, which was confirmed by Raman and X-ray photoelectron spectroscopy (XPS). The interaction of S. aureus with the aptamer functionalized WS2 QDs weakens the van der Waals interaction between the WS2 QDs and Bi2O2Se NSs, which results in the detachment of the WS2 QDs from the Bi2O2Se NS surface and restores the FL intensity of the WS2 QDs, thus allowing the efficient detection of S. aureus. Similar measurements with non-targeted bacteria show that the system is quite selective towards S. aureus. Our FL-based biosensor has a linear response in the range of 103-107 CFU mL-1 (colony formation unit mL-1) with a detection limit of 580 CFU mL-1. We have observed a fast response time of 15 minutes for sensing, which is superior to the previous reports. The proposed system was tested in human urine and can detect S. aureus in human urine samples selectively, proving its potential in real-life applications. The reported approach is versatile enough for sensing other biomolecules and metal ions by choosing suitable receptors.
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Affiliation(s)
- Abdul Kaium Mia
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, 781039, India.
| | - Abhilasha Bora
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, 781039, India.
| | - Md Tarik Hossain
- Department of Physics, Indian Institute of Technology Guwahati, 781039, India
| | - Swapnil Sinha
- IITG TIDF BioNEST, Indian Institute of Technology Guwahati, 781039, India
| | - P K Giri
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, 781039, India.
- Department of Physics, Indian Institute of Technology Guwahati, 781039, India
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50
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Doernberg SB, Arias CA, Altman DR, Babiker A, Boucher HW, Creech CB, Cosgrove SE, Evans SR, Fowler VG, Fritz SA, Hamasaki T, Kelly BJ, Leal SM, Liu C, Lodise TP, Miller LG, Munita JM, Murray BE, Pettigrew MM, Ruffin F, Scheetz MH, Shopsin B, Tran TT, Turner NA, Williams DJ, Zaharoff S, Holland TL. Priorities and Progress in Gram-positive Bacterial Infection Research by the Antibacterial Resistance Leadership Group: A Narrative Review. Clin Infect Dis 2023; 77:S295-S304. [PMID: 37843115 PMCID: PMC10578051 DOI: 10.1093/cid/ciad565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
The Antibacterial Resistance Leadership Group (ARLG) has prioritized infections caused by gram-positive bacteria as one of its core areas of emphasis. The ARLG Gram-positive Committee has focused on studies responding to 3 main identified research priorities: (1) investigation of strategies or therapies for infections predominantly caused by gram-positive bacteria, (2) evaluation of the efficacy of novel agents for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci, and (3) optimization of dosing and duration of antimicrobial agents for gram-positive infections. Herein, we summarize ARLG accomplishments in gram-positive bacterial infection research, including studies aiming to (1) inform optimal vancomycin dosing, (2) determine the role of dalbavancin in MRSA bloodstream infection, (3) characterize enterococcal bloodstream infections, (4) demonstrate the benefits of short-course therapy for pediatric community-acquired pneumonia, (5) develop quality of life measures for use in clinical trials, and (6) advance understanding of the microbiome. Future studies will incorporate innovative methodologies with a focus on interventional clinical trials that have the potential to change clinical practice for difficult-to-treat infections, such as MRSA bloodstream infections.
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Affiliation(s)
- Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, University of California, SanFrancisco, California, 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
| | - Deena R Altman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, NewYork, New York, USA
| | - Ahmed Babiker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Helen W Boucher
- Tufts University School of Medicine, Medford, Massachusetts, USA
| | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott R Evans
- Department of Biostatistics, George Washington University, Washington, District of Columbia, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stephanie A Fritz
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Toshimitsu Hamasaki
- Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Brendan J Kelly
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sixto M Leal
- Department of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Thomas P Lodise
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Loren G Miller
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Division of Infectious Diseases, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Jose M Munita
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research on Bacterial Resistance, Santiago, Chile
| | - Barbara E Murray
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Melinda M Pettigrew
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Felicia Ruffin
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marc H Scheetz
- Pharmacometrics Center of Excellence, College of Pharmacy, Midwestern University, Downers Grove, Illinois, USA
| | - Bo Shopsin
- Division of Infectious Diseases, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Department of Microbiology, NewYork University Grossman School of Medicine, New York, New York, USA
| | - Truc T Tran
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Nicholas A Turner
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Derek J Williams
- Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Smitha Zaharoff
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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