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Welte T, Scheeren TW, Overcash JS, Saulay M, Engelhardt M, Hamed K. Efficacy and safety of ceftobiprole in patients aged 65 years or older: a post hoc analysis of three Phase III studies. Future Microbiol 2021; 16:543-555. [PMID: 33960817 DOI: 10.2217/fmb-2021-0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: To evaluate the efficacy and safety of ceftobiprole in patients aged ≥65 years. Materials & methods: We conducted a post hoc analysis of three randomized, double-blind, Phase III studies in patients with acute bacterial skin and skin structure infections, community-acquired pneumonia and hospital-acquired pneumonia. Results: Findings for patients aged ≥65 years (n = 633) were consistent with those for the overall study populations, although a trend toward improved outcomes was reported in some subgroups, for example, patients aged ≥75 years with community-acquired pneumonia were more likely to achieve an early clinical response with ceftobiprole than comparator (treatment difference 16.3% [95% CI:1.8-30.8]). The safety profile was similar between treatment groups in all studies. Conclusion: This analysis further supports the efficacy and safety of ceftobiprole in older patients with acute bacterial skin and skin structure infections or pneumonia. Clinicaltrials.gov trial identifiers: NCT03137173, NCT00326287, NCT00210964, NCT00229008.
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Affiliation(s)
- Tobias Welte
- Department of Respiratory Medicine & Member of the German Centre for Lung Research, Medizinische Hochschule Hannover, Hannover, Germany
| | - Thomas Wl Scheeren
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Mikael Saulay
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Marc Engelhardt
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Kamal Hamed
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
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52
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Shakeel F, Anwer MK, Youssof AME, Haq N, Alanazi FK, Alsarra IA. Solubilization, Hansen solubility parameters, and thermodynamic studies of delafloxacin in (transcutol + 1-butyl-3-methyl imidazolium hexafluorophosphate) mixtures. Drug Dev Ind Pharm 2021; 47:654-662. [PMID: 33823120 DOI: 10.1080/03639045.2021.1908338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The solubilization, Hansen solubility parameters (HSPs), and thermodynamic properties of delafloxacin (DLN) in various unique combination of Transcutol-HP® (THP) and 1-butyl-3-methyl imidazolium hexafluorophosphate ionic liquid (BMIM-PF6) mixtures were evaluated for the first time in this research. The 'mole fraction solubilities (x3)' of DLN in different (THP + BMIM-PF6) compositions were determined at 'T = 298.2-318.2 K' and 'p = 0.1 MPa'. The HSPs of DLN, neat THP, neat BMIM-PF6, and binary (THP + BMIM-PF6) compositions free of DLN were also determined. The x3 data of DLN was regressed using 'van't Hoff, Apelblat, Yalkowsky-Roseman, Jouyban-Acree and Jouyban-Acree-van't Hoff models' with overall error values of less than 3.0%. The highest and lowest x3 value of DLN was recorded in neat THP (5.48 × 10-3 at T = 318.2 K) and neat BMIM-PF6 (6.50 × 10-4 at T = 298.2 K), respectively. The solubility of DLN was found to be enhanced significantly with an arise in temperature in all (THP + BMIM-PF6) compositions including pure THP and pure BMIM-PF6. However, there was slight increase in DLN solubility with increase in THP mass fraction in all (THP + BMIM-PF6) mixtures. The HSP of pure THP and pure BMIM-PF6 were found very close to each other, suggesting the great potential of both solvents in DLN solubilization. The maximum solute-solvent interactions at molecular level were recorded in DLN-THP compared to DLN-BMIM-PF6. An 'apparent thermodynamic analysis' study indicated an 'endothermic and entropy-driven dissolution' of DLN in all (THP + BMIM-PF6) compositions including neat THP and BMIM-PF6.
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Affiliation(s)
- Faiyaz Shakeel
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Md Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdullah M E Youssof
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nazrul Haq
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Fars K Alanazi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim A Alsarra
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Perni S, Preedy EC, Prokopovich P. Amplify antimicrobial photo dynamic therapy efficacy with poly-beta-amino esters (PBAEs). Sci Rep 2021; 11:7275. [PMID: 33790379 PMCID: PMC8012660 DOI: 10.1038/s41598-021-86773-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
Light-activated antimicrobial agents (photosensitisers) are promising alternatives to antibiotics for the treatment of skin infections and wounds through antimicrobial photo dynamic therapy (aPDT); utilisation of this technique is still restricted by general low efficacy requiring long exposure time (in the order of tens of minutes) that make the treatment very resource intensive. We report for the first time the possibility of harvesting the cell penetrating properties of poly-beta-amino esters (PBAEs) in combination with toluidine blue O (TBO) to shorten aPDT exposure time. Candidates capable of inactivation rates 30 times quicker than pure TBO were discovered and further improvements through PBAE backbone optimisation could be foreseen. Efficacy of the complexes was PBAE-dependent on a combination of TBO uptake and a newly discovered and unexpected role of PBAEs on reactive species production. Chemometric approach of partial least square regression was employed to assess the critical PBAE properties involved in this newly observed phenomenon in order to elicit a possible mechanism. The superior antimicrobial performance of this new approach benefits from the use of well established, low-cost and safe dye (TBO) coupled with inexpensive, widely tested and biodegradable polymers also known to be safe. Moreover, no adverse cytotoxic effects of the PBAEs adjuvated TBO delivery have been observed on a skin cells in vitro model demonstrating the safety profile of this new technology.
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Affiliation(s)
- Stefano Perni
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Emily C Preedy
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Polina Prokopovich
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK.
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Karauzum H, Venkatasubramaniam A, Adhikari RP, Kort T, Holtsberg FW, Mukherjee I, Mednikov M, Ortines R, Nguyen NTQ, Doan TMN, Diep BA, Lee JC, Aman MJ. IBT-V02: A Multicomponent Toxoid Vaccine Protects Against Primary and Secondary Skin Infections Caused by Staphylococcus aureus. Front Immunol 2021; 12:624310. [PMID: 33777005 PMCID: PMC7987673 DOI: 10.3389/fimmu.2021.624310] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus causes a wide range of diseases from skin infections to life threatening invasive diseases such as bacteremia, endocarditis, pneumonia, surgical site infections, and osteomyelitis. Skin infections such as furuncles, carbuncles, folliculitis, erysipelas, and cellulitis constitute a large majority of infections caused by S. aureus (SA). These infections cause significant morbidity, healthcare costs, and represent a breeding ground for antimicrobial resistance. Furthermore, skin infection with SA is a major risk factor for invasive disease. Here we describe the pre-clinical efficacy of a multicomponent toxoid vaccine (IBT-V02) for prevention of S. aureus acute skin infections and recurrence. IBT-V02 targets six SA toxins including the pore-forming toxins alpha hemolysin (Hla), Panton-Valentine leukocidin (PVL), leukocidin AB (LukAB), and the superantigens toxic shock syndrome toxin-1 and staphylococcal enterotoxins A and B. Immunization of mice and rabbits with IBT-V02 generated antibodies with strong neutralizing activity against toxins included in the vaccine, as well as cross-neutralizing activity against multiple related toxins, and protected against skin infections by several clinically relevant SA strains of USA100, USA300, and USA1000 clones. Efficacy of the vaccine was also shown in non-naïve mice pre-exposed to S. aureus. Furthermore, vaccination with IBT-V02 not only protected mice from a primary infection but also demonstrated lasting efficacy against a secondary infection, while prior challenge with the bacteria alone was unable to protect against recurrence. Serum transfer studies in a primary infection model showed that antibodies are primarily responsible for the protective response.
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Affiliation(s)
| | | | | | - Tom Kort
- Integrated BioTherapeutics, Rockville, MD, United States
| | | | | | - Mark Mednikov
- Integrated BioTherapeutics, Rockville, MD, United States
| | - Roger Ortines
- Integrated BioTherapeutics, Rockville, MD, United States
| | - Nhu T. Q. Nguyen
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Thien M. N. Doan
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Binh An Diep
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jean C. Lee
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - M. Javad Aman
- Integrated BioTherapeutics, Rockville, MD, United States
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55
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Oulee A, Ma F, Teles RMB, de Andrade Silva BJ, Pellegrini M, Klechevsky E, Harman AN, Rhodes JW, Modlin RL. Identification of Genes Encoding Antimicrobial Proteins in Langerhans Cells. Front Immunol 2021; 12:695373. [PMID: 34512625 PMCID: PMC8426439 DOI: 10.3389/fimmu.2021.695373] [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: 04/14/2021] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
Langerhans cells (LCs) reside in the epidermis where they are poised to mount an antimicrobial response against microbial pathogens invading from the outside environment. To elucidate potential pathways by which LCs contribute to host defense, we mined published LC transcriptomes deposited in GEO and the scientific literature for genes that participate in antimicrobial responses. Overall, we identified 31 genes in LCs that encode proteins that contribute to antimicrobial activity, ten of which were cross-validated in at least two separate experiments. Seven of these ten antimicrobial genes encode chemokines, CCL1, CCL17, CCL19, CCL2, CCL22, CXCL14 and CXCL2, which mediate both antimicrobial and inflammatory responses. Of these, CCL22 was detected in seven of nine transcriptomes and by PCR in cultured LCs. Overall, the antimicrobial genes identified in LCs encode proteins with broad antibacterial activity, including against Staphylococcus aureus, which is the leading cause of skin infections. Thus, this study illustrates that LCs, consistent with their anatomical location, are programmed to mount an antimicrobial response against invading pathogens in skin.
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Affiliation(s)
- Aislyn Oulee
- Division of Dermatology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Feiyang Ma
- Division of Dermatology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rosane M B Teles
- Division of Dermatology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bruno J de Andrade Silva
- Division of Dermatology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matteo Pellegrini
- Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eynav Klechevsky
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Andrew N Harman
- Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,School of Medical Sciences, Faculty of Medicine and Health Sydney, The University of Sydney, Westmead, NSW, Australia
| | - Jake W Rhodes
- Centre for Virus Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,School of Medical Sciences, Faculty of Medicine and Health Sydney, The University of Sydney, Westmead, NSW, Australia
| | - Robert L Modlin
- Division of Dermatology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, United States
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56
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Brasier N, Widmer A, Osthoff M, Mutke M, De Ieso F, Brasier-Lutz P, Brown K, Yao L, Broeckling CD, Prenni J, Eckstein J. The Detection of Vancomycin in Sweat: A Next-Generation Digital Surrogate Marker for Antibiotic Tissue Penetration: A Pilot Study. Digit Biomark 2021; 5:24-28. [PMID: 33615119 PMCID: PMC7879282 DOI: 10.1159/000512947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Assuring adequate antibiotic tissue concentrations at the point of infection, especially in skin and soft tissue infections, is pivotal for an effective treatment and cure. Despite the global issue, a reliable AB monitoring test is missing. Inadequate antibiotic treatment leads to the development of antimicrobial resistances and toxic side effects. β-lactam antibiotics were already detected in sweat of patients treated with the respective antibiotics intravenously before. With the emergence of smartphone-based biosensors to analyse sweat on the spot of need, next-generation molecular digital biomarkers will be increasingly available for a non-invasive pharmacotherapy monitoring. OBJECTIVE Here, we investigated if the glycopeptide antibiotic vancomycin is detectable in sweat samples of in-patients treated with intravenous vancomycin. METHODS Eccrine sweat samples were collected using the Macroduct Sweat Collector®. Along every sweat sample, a blood sample was taken. Bio-fluid analysis was performed by Ultra-high Pressure Liquid Chromatograph-Tandem Quadrupole Mass Spectrometry coupled with tandem mass spectrometry. RESULTS A total of 5 patients were included. Results demonstrate that vancomycin was detected in 5 out of 5 sweat samples. Specifically, vancomycin concentrations ranged from 0.011 to 0.118 mg/L in sweat and from 4.7 to 8.5 mg/L in blood. CONCLUSION Our results serve as proof-of-concept that vancomycin is detectable in eccrine sweat and may serve as a surrogate marker for antibiotic tissue penetration. A targeted vancomycin treatment is crucial in patients with repetitive need for antibiotics and a variable antibiotic distribution such as in peripheral artery disease to optimize treatment effectiveness. If combined with on-skin smartphone-based biosensors and smartphone applications, the detection of antibiotic concentrations in sweat might enable a first digital, on-spot, lab-independent and non-invasive therapeutic drug monitoring in skin and soft tissue infections.
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Affiliation(s)
- Noé Brasier
- CMIO Research Group, Department of Digitalization and ICT, University Hospital Basel, Basel, Switzerland
| | - Andreas Widmer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Basel, Basel, Switzerland
| | - Markus Mutke
- CMIO Research Group, Department of Digitalization and ICT, University Hospital Basel, Basel, Switzerland
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Fiorangelo De Ieso
- CMIO Research Group, Department of Digitalization and ICT, University Hospital Basel, Basel, Switzerland
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Pascale Brasier-Lutz
- Department of Gynaecology, Kantonsspital Luzern, Standort Wolhusen, Wolhusen, Switzerland
| | - Kitty Brown
- Analytical Resources Core, Bioanalysis and Omics Center, Colorado State University, Fort Collins, Colorado, USA
| | - Linxing Yao
- Analytical Resources Core, Bioanalysis and Omics Center, Colorado State University, Fort Collins, Colorado, USA
| | - Corey D. Broeckling
- Analytical Resources Core, Bioanalysis and Omics Center, Colorado State University, Fort Collins, Colorado, USA
| | - Jessica Prenni
- Department of Horticulture and Landscape, Colorado State University, Fort Collins, Colorado, USA
| | - Jens Eckstein
- CMIO Research Group, Department of Digitalization and ICT, University Hospital Basel, Basel, Switzerland
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
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57
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Knaysi G, Ringelberg J, Stadlberger N, Soucy Z. Point of Care Ultrasound Use by Associate Providers for Differentiating Abscess Versus Cellulitis Skin and Soft Tissue Infection in the Emergency Department. J Emerg Med 2021; 60:e1-e7. [DOI: 10.1016/j.jemermed.2020.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 07/11/2020] [Indexed: 11/28/2022]
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58
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Shchelik IS, Sieber S, Gademann K. Green Algae as a Drug Delivery System for the Controlled Release of Antibiotics. Chemistry 2020; 26:16644-16648. [PMID: 32910832 PMCID: PMC7894466 DOI: 10.1002/chem.202003821] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 12/15/2022]
Abstract
New strategies to efficiently treat bacterial infections are crucial to circumvent the increase of resistant strains and to mitigate side effects during treatment. Skin and soft tissue infections represent one of the areas suffering the most from these resistant strains. We developed a new drug delivery system composed of the green algae, Chlamydomonas reinhardtii, which is generally recognized as safe, to target specifically skin diseases. A two-step functionalization strategy was used to chemically modify the algae with the antibiotic vancomycin. Chlamydomonas reinhardtii was found to mask vancomycin and the insertion of a photocleavable linker was used for the release of the antibiotic. This living drug carrier was evaluated in presence of Bacillus subtilis and, only upon UVA1-mediated release, growth inhibition of bacteria was observed. These results represent one of the first examples of a living organism used as a drug delivery system for the release of an antibiotic by UVA1-irradiation.
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Affiliation(s)
- Inga S. Shchelik
- Department of ChemistryUniversity of ZurichWinterthurerstrasse 1908057ZurichSwitzerland
| | - Simon Sieber
- Department of ChemistryUniversity of ZurichWinterthurerstrasse 1908057ZurichSwitzerland
| | - Karl Gademann
- Department of ChemistryUniversity of ZurichWinterthurerstrasse 1908057ZurichSwitzerland
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59
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Clegg J, Soldaini E, Bagnoli F, McLoughlin RM. Targeting Skin-Resident Memory T Cells via Vaccination to Combat Staphylococcus aureus Infections. Trends Immunol 2020; 42:6-17. [PMID: 33309137 DOI: 10.1016/j.it.2020.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
Tissue-resident memory T cells are important in adaptive immunity against many infections, rendering these cells attractive potential targets in vaccine development. Genetic and experimental evidence highlights the importance of cellular immunity in protection from Staphylococcus aureus skin infections, yet skin-resident memory T cells are, thus far, an untested component of immunity during such infections. Novel methods of generating and sampling vaccine-induced skin memory T cells are paralleled by discoveries of global, skin-wide immunosurveillance. We propose skin-resident memory CD4+ T cells as a potential missing link in the search for correlates of protection during S. aureus infections. A better appreciation of their phenotypes and functions could accelerate the development of preventive vaccines against this highly virulent and antibiotic-resistant pathogen.
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Affiliation(s)
- Jonah Clegg
- Host Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland; GlaxoSmithKline, Siena, Italy
| | | | | | - Rachel M McLoughlin
- Host Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
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60
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Abstract
Skin and soft tissue infections (SSTIs) frequently are encountered in clinical practice, and gram-negative bacilli (GNB) constitute an underrated portion of their etiology. The rate of GNB-causing SSTIs is increasing, especially with the rise in antimicrobial resistance. Although the diagnosis of SSTIs mostly is clinical, rapid diagnostic modalities can shorten the time to initiating proper therapy and improving outcomes. Novel antibiotics are active against GNB SSTIs and can be of great value in the management. This review provides an overview of the role of GNB in SSTIs and summarizes their epidemiology, risk factors, outcome, and clinical management.
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Affiliation(s)
- Jean-Francois Jabbour
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
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61
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Polk C, Sampson MM, Roshdy D, Davidson LE. Skin and Soft Tissue Infections in Patients with Diabetes Mellitus. Infect Dis Clin North Am 2020; 35:183-197. [PMID: 33303332 DOI: 10.1016/j.idc.2020.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Skin and soft tissue infections are common in diabetics. Diabetic foot infection usually results from disruption of the skin barrier, trauma, pressure, or ischemic wounds. These wounds may become secondarily infected or lead to development of adjacent soft tissue or deeper bone infection. Clinical assessment and diagnosis of these conditions using a multidisciplinary management approach, including careful attention to antibiotic selection, lead to the best outcomes in patient care.
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Affiliation(s)
- Christopher Polk
- Division of Infectious Diseases, Department of Medicine, Atrium Health, Charlotte, NC, USA
| | - Mindy M Sampson
- Division of Infectious Diseases, Department of Medicine, Atrium Health, Charlotte, NC, USA
| | - Danya Roshdy
- Antimicrobial Support Network, Division of Pharmacy, Atrium Health, 1000 Blythe Boulevard, Charlotte, NC 28203, USA
| | - Lisa E Davidson
- Division of Infectious Diseases, Department of Medicine, Atrium Health, 1540 Garden Terrace, Suite 211, Charlotte, NC 28203, USA.
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Jones JF, Legaspi J, Chen E, Lee K, Le J. Emerging Viral and Bacterial Infections: Within an Era of Opioid Epidemic. Infect Dis Ther 2020; 9:737-755. [PMID: 32918275 PMCID: PMC7680496 DOI: 10.1007/s40121-020-00335-0] [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: 06/29/2020] [Indexed: 11/09/2022] Open
Abstract
The opioid epidemic is a public health crisis that continues to impact healthcare in the United States of America (USA). While changes in opioid prescribing have curbed the medical use of opioids, the increase in nonmedical use, largely driven by injection drug use (IDU), has contributed to the escalating incidence of opioid use disorder (OUD). Furthermore, IDU is associated with high-risk injection practices that can increase the risk of acquiring viral and bacterial infections. Here in this comprehensive review, we aimed to summarize the epidemiology and management of OUD, along with the screening and antimicrobial treatment of associated infections, specifically focused on human immunodeficiency virus, hepatitis C virus, skin and soft tissue infections, endocarditis, and osteomyelitis. Medication-assisted therapy (MAT) and infection guidelines from the USA will be presented.
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Affiliation(s)
- Jessica F Jones
- University of California San Diego Health, San Diego, CA, USA.
| | - Jamie Legaspi
- University of California San Diego Health, San Diego, CA, USA
| | - Eric Chen
- University of California San Diego Health, San Diego, CA, USA
| | - Kelly Lee
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
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63
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The Cutaneous Wound Innate Immunological Microenvironment. Int J Mol Sci 2020; 21:ijms21228748. [PMID: 33228152 PMCID: PMC7699544 DOI: 10.3390/ijms21228748] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022] Open
Abstract
The skin represents the first line of defense and innate immune protection against pathogens. Skin normally provides a physical barrier to prevent infection by pathogens; however, wounds, microinjuries, and minor barrier impediments can present open avenues for invasion through the skin. Accordingly, wound repair and protection from invading pathogens are essential processes in successful skin barrier regeneration. To repair and protect wounds, skin promotes the development of a specific and complex immunological microenvironment within and surrounding the disrupted tissue. This immune microenvironment includes both innate and adaptive processes, including immune cell recruitment to the wound and secretion of extracellular factors that can act directly to promote wound closure and wound antimicrobial defense. Recent work has shown that this immune microenvironment also varies according to the specific context of the wound: the microbiome, neuroimmune signaling, environmental effects, and age play roles in altering the innate immune response to wounding. This review will focus on the role of these factors in shaping the cutaneous microenvironment and how this ultimately impacts the immune response to wounding.
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64
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Lee B, Olaniyi R, Kwiecinski JM, Wardenburg JB. Staphylococcus aureus toxin suppresses antigen-specific T cell responses. J Clin Invest 2020; 130:1122-1127. [PMID: 31873074 DOI: 10.1172/jci130728] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus remains a leading cause of human infection. These infections frequently recur when the skin is a primary site of infection, especially in infants and children. In contrast, invasive staphylococcal disease is less commonly associated with reinfection, suggesting that tissue-specific mechanisms govern the development of immunity. Knowledge of how S. aureus manipulates protective immunity has been hampered by a lack of antigen-specific models to interrogate the T cell response. Using a chicken egg OVA-expressing S. aureus strain to analyze OVA-specific T cell responses, we demonstrated that primary skin infection was associated with impaired development of T cell memory. Conversely, invasive infection induced antigen-specific memory and protected against reinfection. This defect in adaptive immunity following skin infection was associated with a loss of DCs, attributable to S. aureus α-toxin (Hla) expression. Gene- and immunization-based approaches to protect against Hla during skin infection restored the T cell response. Within the human population, exposure to α-toxin through skin infection may modulate the establishment of T cell-mediated immunity, adversely affecting long-term protection. These studies prompt consideration that vaccination targeting S. aureus may be most effective if delivered prior to initial contact with the organism.
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Affiliation(s)
- Brandon Lee
- Committee on Immunology, UChicago Biosciences, University of Chicago, Chicago, Illinois, USA
| | - Reuben Olaniyi
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jakub M Kwiecinski
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Mazlan MZ, Zainal Abidin H, Wan Hassan WMN, Nik Mohamad NA, Salmuna ZN, Ibrahim K, Omar M, Abdul-Aziz MH. A case report: Community-acquired Pseudomonas aeruginosa necrotizing fasciitis in a morbidly obese diabetic young man can be fatal. IDCases 2020; 22:e01001. [PMID: 33204633 PMCID: PMC7649619 DOI: 10.1016/j.idcr.2020.e01001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022] Open
Abstract
We present a case study of a 26-year-old morbidly obese man with a three-day history of right leg pain and swelling. The swelling was associated with low grade fever. He was alert and conscious upon presentation to the hospital. His physical examination showed gross swelling of the entire right lower limb with no systemic manifestations. There was no discharge and bullae from the swelling area of the leg. He had high blood sugar and was newly diagnosed with type 2 diabetes mellitus. He was diagnosed with necrotizing fasciitis. An intravenous imipenem-cilastatin 500 mg every 6 h together with clindamycin 900 mg every 8 h was started empirically. Extensive wound debridement was performed. The swab culture obtained intraoperatively grew Pseudomonas aeruginosa. He required an above knee amputation due to worsening infection despite wound debridement. Post-operatively, he developed acute kidney injury with severe metabolic acidosis, which required daily hemodialysis. However, the patient deteriorated due to septic shock with multi-organ failure, resulting in his death.
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Affiliation(s)
- Mohd Zulfakar Mazlan
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Huda Zainal Abidin
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Wan Mohd Nazaruddin Wan Hassan
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Nik Abdullah Nik Mohamad
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Zeti Norfidiyati Salmuna
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Kamaruddin Ibrahim
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Mahamarowi Omar
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Mohd Hafiz Abdul-Aziz
- Trauma and Critical Care Research Centre (BTCCRC),University of Queensland, Brisbane QLD 4072, Australia
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66
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Garg A, Reddy S, Kirby J, Strunk A. Development and Validation of HSCAPS-1: A Clinical Decision Support Tool for Diagnosis of Hidradenitis Suppurativa over Cutaneous Abscess. Dermatology 2020; 237:719-726. [PMID: 33099547 DOI: 10.1159/000511077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/22/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A clinical decision support tool may improve recognition of hidradenitis suppurativa (HS) and reduce diagnosis delay. OBJECTIVE To develop and initially validate a clinical decision support to predict diagnosis of HS and distinguish it from cutaneous abscess of the axilla, groin, perineum, and buttock. METHODS This was a retrospective, cross-sectional analysis between January 2012 and June 2017 (development set) and July 2017 and March 2019 (validation set). We used an electronic records sample of 56 million patients from the Explorys database to identify patients with an ambulatory visit associated with either HS or cutaneous of the axilla, groin, perineum, and buttock. The outcome was predicted probability of HS diagnosis. RESULTS Development set included 7,974 patients with mean age of 41.4 years, who were predominantly female (66%) and white (62%). Validation set included 1,560 patients with similar demographic composition. Factors which were stronger independent predictors of HS included female sex (OR 2.17 [95% CI 1.96-2.40]); African American race (1.28 [95% CI 1.15-1.44]); increasing BMI (OR 1.05 [95% CI 1.05-1.06)]; history of acne (OR 3.46 [95% CI 2.83-4.23]); Down syndrome (OR 5.35 [95% CI 2.03-14.12]); and prescription for at least 7 opioid medications in the past year (OR 1.05 [95% CI 0.83-1.33]). Up to age 45 years, increasing age was a stronger predictor of HS diagnosis. The simplified model showed good discrimination (c-statistic 0.746 [SE 0.013]) and moderate calibration (calibration intercept -0.260 [SE 0.055]; calibration slope 1.142 [SE 0.076]). CONCLUSION This clinical decision support tool shows good performance in predicting diagnosis of HS and distinguishing it from cutaneous abscess that involves the axilla, groin, perineum, and buttock.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA,
| | - Sarah Reddy
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Joslyn Kirby
- Department of Dermatology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
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The clinical value of metagenomic next-generation sequencing in the microbiological diagnosis of skin and soft tissue infections. Int J Infect Dis 2020; 100:414-420. [PMID: 32898669 DOI: 10.1016/j.ijid.2020.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS), with its comprehensiveness, is widely applied in microbiological diagnosis. Etiological diagnosis is of paramount clinical importance in patients with skin and soft tissue infections (SSTIs). However, the clinical application of mNGS in SSTIs is relatively less studied. MATERIALS AND METHODS From April 1, 2017 to December 31, 2019, 96 SSTI cases were collected. The positive rates of pathogens detected by mNGS and culture were compared by analyzing tissue samples, pus, swabs, and/or interstitial fluids obtained from the infected parts. Modification of the antibiotic treatment strategy due to mNGS was also assessed. RESULTS The sensitivity of mNGS for detecting pathogens in SSTI cases was superior to that of culture testing (67.7% vs 35.4%; p < 0.01). Significantly higher identification rates for viruses (10.4% vs 0.0%; p < 0.01) and anaerobes (11.5% vs 1.0%; p < 0.01) were obtained with mNGS compared to culture. Of note, rare pathogens such as Vibrio vulnificus and Bartonella henselae were also detected by mNGS. Importantly, the proportion of multi-pathogen SSTIs detected by mNGS was higher than that of multi-pathogen SSTIs detected by culture (16.7% vs 6.3%; p = 0.035). The rate of targeted antibiotic treatment was significantly higher in mNGS-positive cases than in mNGS-negative cases (41.7% vs 3.8%; p < 0.01). In culture-negative and mNGS-positive cases, the improvement rate was higher than that in mNGS-negative cases, but this was not statistically significant (75.0% vs 73.1%; p = 0.864). CONCLUSIONS mNGS is a promising tool for the etiological diagnosis of SSTIs, particularly in identifying viruses, anaerobes, and multi-pathogen infections. The application of mNGS testing in clinical practice could change antibiotic treatment strategies and partly benefit clinical outcomes.
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68
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Abrahamian FM, Sakoulas G, Tzanis E, Manley A, Steenbergen J, Das AF, Eckburg PB, McGovern PC. Omadacycline for Acute Bacterial Skin and Skin Structure Infections. Clin Infect Dis 2020; 69:S23-S32. [PMID: 31367742 PMCID: PMC6669297 DOI: 10.1093/cid/ciz396] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Within the last decade, methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a frequent cause of purulent skin and soft tissue infections. New therapeutic options are being investigated for these infections. Methods We report an integrated analysis of 2 randomized, controlled studies involving omadacycline, a novel aminomethylcycline, and linezolid for the treatment of acute bacterial skin and skin structure infections (ABSSSI). Omadacycline in Acute Skin and Skin Structure Infections Study 1 (OASIS-1) initiated patients on intravenous omadacycline or linezolid, with the option to transition to an oral formulation after day 3. OASIS-2 was an oral-only study of omadacycline versus linezolid. Results In total, 691 patients received omadacycline and 689 patients received linezolid. Infection types included wound infection in 46.8% of patients, cellulitis/erysipelas in 30.5%, and major abscess in 22.7%. Pathogens were identified in 73.2% of patients. S. aureus was detected in 74.7% and MRSA in 32.4% of patients in whom a pathogen was identified. Omadacycline was noninferior to linezolid using the Food and Drug Administration primary endpoint of early clinical response (86.2% vs 83.9%; difference 2.3, 95% confidence interval –1.5 to 6.2) and using the European Medicines Agency primary endpoint of investigator-assessed clinical response at the posttreatment evaluation. Clinical responses were similar across different infection types and infections caused by different pathogens. Treatment-emergent adverse events, mostly described as mild or moderate, were reported by 51.1% of patients receiving omadacycline and 41.2% of those receiving linezolid. Conclusions Omadacycline was effective and safe in ABSSSI. Clinical Trials Registration NCT02378480 and NCT02877927.
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Affiliation(s)
- Fredrick M Abrahamian
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar.,David Geffen School of Medicine at University of California Los Angeles
| | - George Sakoulas
- Division of Host-Microbe Systems and Therapeutics, Center for Immunity, Infection and Inflammation, University of California San Diego School of Medicine, La Jolla
| | - Evan Tzanis
- Paratek Pharmaceuticals, Inc., King of Prussia, Pennsylvania
| | - Amy Manley
- Paratek Pharmaceuticals, Inc., King of Prussia, Pennsylvania
| | | | - Anita F Das
- AD Stats Consulting, Guerneville, California
| | - Paul B Eckburg
- Paratek Pharmaceuticals, Inc., King of Prussia, Pennsylvania
| | - Paul C McGovern
- Paratek Pharmaceuticals, Inc., King of Prussia, Pennsylvania
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Abstract
Skin and soft-tissue infection (SSTI) are one of the most common infections in both the community and hospital settings and account for nearly 4.8 million emergency department visits annually. These infections can vary in presentation, treatment, management, and potential for complication. As emergency medicine providers, early recognition and diagnosis of the disease are key. Point-of-care ultrasound is an invaluable tool that has contributed to the expeditious evaluation of these diseases with ultimate guidance for clinical management for SSTIs. This article reviews 3 SSTIs-cellulitis, abscess, and necrotizing fasciitis-and presents a common case study for consideration.
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70
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Kaye KS, Petty LA, Shorr AF, Zilberberg MD. Current Epidemiology, Etiology, and Burden of Acute Skin Infections in the United States. Clin Infect Dis 2020; 68:S193-S199. [PMID: 30957165 PMCID: PMC6452002 DOI: 10.1093/cid/ciz002] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The US burden of acute skin infections is substantial. While Staphylococcus aureus and Streptococcus spp. are the most common causes, gram-negative bacteria and mixed infections can occur in some settings. These mixed infections are more likely to result in inappropriate empiric antibiotic therapy. Important challenges remain in diagnosing and treating acute skin infections.
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Affiliation(s)
- Keith S Kaye
- Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor
| | - Lindsay A Petty
- Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor
| | - Andrew F Shorr
- Health Services Research, Washington Hospital Center, Washington, DC
| | - Marya D Zilberberg
- Division of Pulmonary and Critical Medicine, EviMed Research Group, LLC, Goshen.,Division of Pulmonary and Critical Medicine, University of Massachusetts School of Public Health and Health Sciences, Amherst
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71
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Alam P, Ezzeldin E, Iqbal M, Mostafa GA, Anwer MK, Alqarni MH, Foudah AI, Shakeel F. Determination of Delafloxacin in Pharmaceutical Formulations Using a Green RP-HPTLC and NP-HPTLC Methods: A Comparative Study. Antibiotics (Basel) 2020; 9:E359. [PMID: 32630451 PMCID: PMC7344820 DOI: 10.3390/antibiotics9060359] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022] Open
Abstract
In this work; delafloxacin (DLFX) was determined using a validated green RP-HPTLC and NP-HPTLC methods in commercial tablets and in-house developed solid lipid nanoparticles (SLNs). RP-HPTLC determination of DLFX was performed using "RP-18 silica gel 60 F254S HPTLC plates". However; NP-HPTLC estimation of DLFX was performed using "silica gel 60 F254S HPTLC plates". For a green RP-HPTLC method; the ternary combination of ethanol:water:ammonia solution (5:4:2 v/v/v) was used as green mobile phase. However; for NP-HPTLC method; the ternary mixture of ethyl acetate: methanol: ammonia solution (5:4:2 v/v/v) was used as normal mobile phase. The analysis of DLFX was conducted in absorbance/reflectance mode of densitometry at λmax = 295 nm for both methods. RP-HPTLC method was found more accurate, precise, robust and sensitive for the analysis of DLFX compared with the NP-HPTLC method. The % assay of DLFX in commercial tablets and in-house developed SLNs was determined as 98.2 and 101.0%, respectively, using the green RP-HPTLC technique, however; the % assay of DLFX in commercial tablets and in-house developed SLNs was found to be 94.4 and 95.0%, respectively, using the NP-HPTLC method. Overall, the green RP-HPTLC method was found superior over the NP-HPTLC. Therefore, the proposed green RP-HPTLC method can be successfully applied for analysis of DLFX in commercial tablets, SLNs and other formulations containing DLFX.
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Affiliation(s)
- Prawez Alam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (P.A.); (M.H.A.); (A.I.F.)
| | - Essam Ezzeldin
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (E.E.); (M.I.); (G.A.E.M.)
- Drug Bioavailability Unit, Central Laboratory, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Muzaffar Iqbal
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (E.E.); (M.I.); (G.A.E.M.)
- Drug Bioavailability Unit, Central Laboratory, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Gamal A.E. Mostafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (E.E.); (M.I.); (G.A.E.M.)
- Micro-Analytical Laboratory, Applied Organic Chemistry Department, National Research Center, Dokki, Cairo 12622, Egypt
| | - Md. Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Mohammed H. Alqarni
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (P.A.); (M.H.A.); (A.I.F.)
| | - Ahmed I. Foudah
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (P.A.); (M.H.A.); (A.I.F.)
| | - Faiyaz Shakeel
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Goudarzi M, Tayebi Z, Dadashi M, Miri M, Amirpour A, Fazeli M. Characteristics of community-acquired methicillin-resistant Staphylococcus aureus associated with wound infections in Tehran, Iran: High prevalence of PVL+ t008 and the emergence of new spa types t657, t5348, and t437 in Iran. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ceftobiprole Activity against Bacteria from Skin and Skin Structure Infections in the United States from 2016 through 2018. Antimicrob Agents Chemother 2020; 64:AAC.02566-19. [PMID: 32179519 DOI: 10.1128/aac.02566-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
Ceftobiprole medocaril is an advanced-generation cephalosporin prodrug that has qualified infectious disease product status granted by the US FDA and is currently being evaluated in phase 3 clinical trials in patients with acute bacterial skin and skin structure infections (ABSSSIs) and in patients with Staphylococcus aureus bacteremia. In this study, the activity of ceftobiprole and comparators was evaluated against more than 7,300 clinical isolates collected in the United States from 2016 through 2018 from patients with skin and skin structure infections. The major species/pathogen groups were S. aureus (53%), Enterobacterales (23%), Pseudomonas aeruginosa (7%), beta-hemolytic streptococci (6%), Enterococcus spp. (4%), and coagulase-negative staphylococci (2%). Ceftobiprole was highly active against S. aureus (MIC50/90, 0.5/1 mg/liter; 99.7% susceptible by EUCAST criteria; 42% methicillin-resistant S. aureus [MRSA]). Ceftobiprole also exhibited potent activity against other Gram-positive cocci. The overall susceptibility of Enterobacterales to ceftobiprole was 84.8% (>99.0% susceptible for isolate subsets that exhibited a non-extended-spectrum β-lactamase [ESBL] phenotype). A total of 74.4% of P. aeruginosa, 100% of beta-hemolytic streptococci and coagulase-negative staphylococci, and 99.6% of Enterococcus faecalis isolates were inhibited by ceftobiprole at ≤4 mg/liter. As expected, ceftobiprole was largely inactive against Enterobacterales that contained ESBL genes and Enterococcus faecium Overall, ceftobiprole was highly active against most clinical isolates from the major Gram-positive and Gram-negative skin and skin structure pathogen groups collected at U.S. medical centers participating in the SENTRY Antimicrobial Surveillance Program during 2016 to 2018. The broad-spectrum activity of ceftobiprole, including potent activity against MRSA, supports its further evaluation for a potential ABSSSI indication.
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Hagihara M, Kato H, Uchida S, Yamashita R, Tanaka S, Sakanashi D, Shiota A, Asai N, Koizumi Y, Suematsu H, Yamagishi Y, Namiki N, Mikamo H. The First Report on Pharmacokinetic/Pharmacodynamic Study of Trimethoprim/Sulfamethoxazole against Staphylococcus aureus with a Neutropenic Murine Thigh Infection Model. Chemotherapy 2020; 64:224-232. [PMID: 32434196 DOI: 10.1159/000507540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION With an increase in the incidence of Staphylococcus aureus infections in the healthcare settings and in the community, trimethoprim/sulfamethoxazole (TMP/SMX) has been suggested as a convenient treatment option. However, the appropriate dosage regimen of TMP/SMX is unclear. OBJECTIVE This study aimed to examine the pharmacokinetics/pharmacodynamics (PK/PD) of TMP/SMX against S. aureus using a neutropenic murine thigh infection model. METHODS Five S. aureus isolates with TMP/SMX (1:5 fixed ratio) minimum inhibitory concentrations (MICs) of 0.032-64 μg/mL were tested. The antimicrobial efficacy of TMP/SMX (1-689 mg/kg/day: dose shown as SMX dosage) was calculated as the change in bacterial density after 24 h of treatment. The plasma concentrations of TMP/SMX were detected using high-performance liquid chromatography. RESULTS After TMP/SMX single dose (130 mg/kg), the half-life, area under the blood concentration curve (AUC0-∞), and the protein binding ratio of SMX were 1.5 h, 718.2 μg h/mL, and 73.0 ± 8.3%, respectively. The free AUC/MIC and free %time (%T) above the MIC of SMX were better correlated with the in vivo antimicrobial activity than Cmax/MIC (free AUC/MIC, R2 = 0.69; free %T > MIC, R2 = 0.71; free Cmax/MIC, R2 = 0.53). The distributed doses (2-3 times per day) of TMP/SMX (130, 260, and 390 mg/kg/day) showed higher antimicrobial activity than the single dosage. However, TMP/SMX did not show its antimicrobial activity at <100% free %T > MIC. CONCLUSIONS The TMP/SMX treatment demonstrated that the free AUC/MIC of SMX was the better predictor of the PK/PD index of TMP/SMX.
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Affiliation(s)
- Mao Hagihara
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Aichi, Japan.,Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Shinya Uchida
- Department of Pharmacy Practice and Science, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Rieko Yamashita
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Aichi, Japan
| | - Shimako Tanaka
- Department of Pharmacy Practice and Science, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Daisuke Sakanashi
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Arufumi Shiota
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Hiroyuki Suematsu
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Noriyuki Namiki
- Department of Pharmacy Practice and Science, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan,
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Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTIs) are among the most common infections in outpatients and the most frequent infectious cause of referrals to emergency departments in developed world, contributing to significant morbidity and healthcare expenditures. We sought to review recent literature covering epidemiology of SSTIs. RECENT FINDINGS Staphylococcus aureus and streptococci predominate and methicillin-resistant S. aureus (MRSA) poses additional challenges; community-acquired-MRSA in some areas is superseding methicillin-susceptible S. aureus and multidrug resistance is evolving. Incidence data of SSTIs from United States show a decreasing trend, whereas trends of hospitalization rates were increasing. Despite low mortality associated with SSTIs, high rates of treatment failure and relapses are of concern. Diagnosis and management decisions in the emergency department (ED) lack validated tools for prediction of clinical response particularly among elderly, immunocompromised, obese, and patients with comorbidities. A variety of modifiable and nonmodifiable risk factors of the host and data from local epidemiology should be considered to prevent recurrence and treatment failure. SUMMARY An evolving epidemiology of SSTIs make microbiologic documentation and surveillance of local data imperative. New assessment algorithms with potential use in the ED are a priority. The universal applicability of international guidelines is questioned in this setting.
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Bassetti M, Del Puente F, Magnasco L, Giacobbe DR. Innovative therapies for acute bacterial skin and skin-structure infections (ABSSSI) caused by methicillin-resistant Staphylococcus aureus: advances in phase I and II trials. Expert Opin Investig Drugs 2020; 29:495-506. [PMID: 32242469 DOI: 10.1080/13543784.2020.1750595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is among the most frequent causative agents of acute bacterial skin and skin-structure infections (ABSSSI) and has been associated with increased risks of invasive disease and of treatment failure. AREAS COVERED In this review, we focus on those novel anti-MRSA agents currently in phase I or II of clinical development that may enrich the armamentarium against ABSSSI caused by MRSA in the future. EXPERT OPINION Promising agents belonging to either old or novel antibiotic classes are currently in early phases of clinical development and may become available in the future for the effective treatment of ABSSSI caused by MRSA. In particular, the future availability of agents belonging to novel classes will be important for guaranteeing an effective treatment and for allowing outpatient treatment/early discharge, with a consequent reduced impact on healthcare resources. However, this does not mean that we can relax our efforts directed toward improving the responsible use of already available agents. Indeed, preserving their activity in the long term is crucial for optimizing the use of healthcare resources.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS , Genoa, Italy.,Department of Health Sciences, University of Genoa , Genoa, Italy
| | - Filippo Del Puente
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS , Genoa, Italy.,Department of Health Sciences, University of Genoa , Genoa, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS , Genoa, Italy.,Department of Health Sciences, University of Genoa , Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS , Genoa, Italy.,Department of Health Sciences, University of Genoa , Genoa, Italy
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New Evidence and Insights on Dalbavancin and Wound Healing in a Mouse Model of Skin Infection. Antimicrob Agents Chemother 2020; 64:AAC.02062-19. [PMID: 31932371 DOI: 10.1128/aac.02062-19] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022] Open
Abstract
Dalbavancin is an effective antibiotic that is widely used to treat skin infection. Our aim was to determine the effect of dalbavancin administration on wound healing compared to that of vancomycin and to elucidate if epidermal growth factor receptor (EGFR), matrix metalloproteinase 1 (MMP-1), MMP-9, and vascular endothelial growth factor (VEGF) could be involved in its therapeutic mechanism. A mouse model of methicillin-resistant Staphylococcus aureus (MRSA) skin infection was established. Mice were treated daily with vancomycin (10 mg/kg) and weekly with dalbavancin at day 1 (20 mg/kg) and day 8 (10 mg/kg). After 14 days, wounds were excised, and bacterial counts were performed. Wound healing was assessed by histological and immunohistochemical staining, followed by protein extraction and immunoblotting. Our microbiological results confirmed that both dalbavancin and vancomycin are effective in reducing the bacterial load in wounds. The dalbavancin group showed a strong effect compared with infected untreated animals and the vancomycin-treated group. The wounds treated with dalbavancin showed robust epidermal coverage with reconstitution of the regular and keratinized epidermal lining and well-organized granulation tissue with numerous blood vessels, although slightly less than that in the uninfected group. While in the vancomycin-treated group the epithelium appeared, in general, still hypertrophic, the granulation tissue appeared even less organized. We observed elevated EGFR and VEGF expression in both treated groups, although it was higher in dalbavancin-treated mice. MMP-1 and MMP-9 were decreased in uninfected tissue and in both treated tissues compared with untreated infected wounds. This study showed faster healing with dalbavancin treatment that might be associated with higher EGFR and VEGF levels.
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Alam P, Iqbal M, Ezzeldin E, Khalil NY, Foudah AI, Alqarni MH, Shakeel F. Simple and Accurate HPTLC-Densitometric Method for Quantification of Delafloxacin (A Novel Fluoroquinolone Antibiotic) in Plasma Samples: Application to Pharmacokinetic Study in Rats. Antibiotics (Basel) 2020; 9:E134. [PMID: 32210014 PMCID: PMC7175235 DOI: 10.3390/antibiotics9030134] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/21/2022] Open
Abstract
Delafloxacin (DLX) is a recently-approved fluoroquinolone antibiotic, which is recommended for the treatment of "acute bacterial skin and skin structure infections". A thorough literature survey revealed only a single published method for the estimation of DLX using UPLC-MS/MS technique in biological samples. There is no high-performance thin-layer chromatography (HPTLC) method has been reported for the estimation of DLX in dosage forms and/or biological samples. Therefore, a selective, sensitive, rapid and validated HPTLC-densitometry technique has been used for the estimation of DLX in human plasma for the first time. HPTLC quantification of DLX and internal standard (IS; gatifloxacin) was carried out on glass coated silica gel 60 F254 HPTLC plates using the ternary mixture of ethyl acetate:methanol:ammonia solution 5:4:2 (%, v/v/v) as the mobile phase. Densitometric detection was done at 344 nm. The Rf values were recorded as 0.43 and 0.27 for the DLX and the IS, respectively. The linearity range of DLX was obtained as 16-400 ng/band. A simple protein precipitation method was used for the extraction of analyte from plasma using methanol. The proposed HPTLC technique was validated for "linearity, accuracy, precision, and robustness". The proposed HPTLC technique was successfully utilized for the assessment of pharmacokinetic profile of DLX in rats after oral administration. After oral administration, the peak plasma concentration of DLX was obtained as 194.19 ng/ml in 1 h. The proposed HPTLC method could be applied in study of pharmacokinetic profile and therapeutic drug monitoring of DLX in clinical practice.
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Affiliation(s)
- Prawez Alam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (P.A.); (A.I.F.); (M.H.A.)
| | - Muzaffar Iqbal
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (E.E.); (N.Y.K.)
- Bioavailability Unit, Central Laboratory, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Essam Ezzeldin
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (E.E.); (N.Y.K.)
- Bioavailability Unit, Central Laboratory, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Nasr Y. Khalil
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (E.E.); (N.Y.K.)
| | - Ahmed I. Foudah
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (P.A.); (A.I.F.); (M.H.A.)
| | - Mohammed H. Alqarni
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (P.A.); (A.I.F.); (M.H.A.)
| | - Faiyaz Shakeel
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
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Development of Lipomer Nanoparticles for the Enhancement of Drug Release, Anti-microbial Activity and Bioavailability of Delafloxacin. Pharmaceutics 2020; 12:pharmaceutics12030252. [PMID: 32168906 PMCID: PMC7151119 DOI: 10.3390/pharmaceutics12030252] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/04/2022] Open
Abstract
Delafloxacin (DFL) is a novel potent and broad-spectrum fluoroquinolone group of antibiotics effective against both Gram-positive and negative aerobic and anaerobic bacteria. In this study, DFL-loaded stearic acid (lipid) chitosan (polymer) hybrid nanoparticles (L-P-NPs) have been developed by single-emulsion-solvent evaporation technique. The mean particle size and polydispersity index (PDI) of optimized DFL-loaded L-P-NPs (F1-F3) were measured in the range of 299–368 nm and 0.215–0.269, respectively. The drug encapsulation efficiency (EE%) and loading capacity (LC%) of DFL-loaded L-P-NPs (F1-F3) were measured in the range of 64.9–80.4% and 1.7–3.8%, respectively. A sustained release of DFL was observed from optimized DFL-loaded L-P-NPs (F3). Minimum inhibitory concentration (MIC) values of the DFL-loaded L-P-NPs (F3) appeared typically to be four-fold lower than those of delafloxacin in the case of Gram-positive strains and was 2-4-fold more potent than those of delafloxacin against Gram-negative strains. The pharmacokinetic study in rats confirmed that the bioavailability (both rate and extent of absorption) of DFL-loaded L-P-NPs was significantly higher (2.3-fold) than the delafloxacin normal suspension. These results concluded that the newly optimized DFL-loaded L-P-NPs were more potent against both Gram-positive and negative strains of bacteria and highly bioavailable in comparison to delafloxacin normal suspension.
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80
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Delpech G, Ceci M, Lissarrague S, García Allende L, Baldaccini B, Sparo M. In vitro activity of the antimicrobial peptide AP7121 against the human methicillin-resistant biofilm producers Staphylococcus aureus and Staphylococcus epidermidis. BIOFOULING 2020; 36:266-275. [PMID: 32338055 DOI: 10.1080/08927014.2020.1756266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
In vitro activity against methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis biofilm producers from blood cultures of patients with prosthetic hip infections was evaluated. The Minimum Inhibitory Concentration (MIC) for AP7121 was determined and the bactericidal activity of AP7121 (MICx1, MICx4) against planktonic cells was studied at 4, 8 and 24 h. The biofilms formed were incubated with AP7121 (MICx1, MICx4) for 1 and 24 h. The anti-adhesion effect of an AP7121-treated inert surface over the highest MIC isolate was studied with scanning electron microscopy (SEM). The bactericidal activity of AP7121 against all the planktonic staphylococcal cells was observed at 4 h at both peptide concentrations. Dose-dependent anti-biofilm activity was detected. AP7121 (MICx4) showed bactericidal activity at 24 h in all isolates. SEM confirmed prevention of biofilm formation. This research showed the in vitro anti-biofilm activity of AP7121 against MRSA and S. epidermidis and the prevention of biofilm formation by them on an abiotic surface.
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Affiliation(s)
- Gastón Delpech
- Departamento Clínico, Universidad Nacional del Centro de la Provincia de Buenos Aires, Olavarría, Argentina
| | - Mónica Ceci
- Laboratorio de Microbiología, Centro de Estudios Bioquímicos, Tandil, Argentina
| | - Sabina Lissarrague
- Departamento Clínico, Universidad Nacional del Centro de la Provincia de Buenos Aires, Olavarría, Argentina
| | | | - Beatriz Baldaccini
- Departamento Clínico, Universidad Nacional del Centro de la Provincia de Buenos Aires, Olavarría, Argentina
| | - Mónica Sparo
- Departamento Clínico, Universidad Nacional del Centro de la Provincia de Buenos Aires, Olavarría, Argentina
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Scangarella-Oman NE, Ingraham KA, Tiffany CA, Tomsho L, Van Horn SF, Mayhew DN, Perry CR, Ashton TC, Dumont EF, Huang J, Brown JR, Miller LA. In Vitro Activity and Microbiological Efficacy of Gepotidacin from a Phase 2, Randomized, Multicenter, Dose-Ranging Study in Patients with Acute Bacterial Skin and Skin Structure Infections. Antimicrob Agents Chemother 2020; 64:e01302-19. [PMID: 31818823 PMCID: PMC7038298 DOI: 10.1128/aac.01302-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
A phase 2 study of gepotidacin demonstrated the safety and efficacy of 3 gepotidacin doses (750 mg every 12 h [q12h], 1,000 mg q12h, and 1,000 mg every 8 h [q8h]) in hospitalized patients with suspected/confirmed Gram-positive acute bacterial skin and skin structure infections (ABSSSIs). Evaluating microbiology outcomes and responses were secondary endpoints. Pretreatment isolates recovered from infected lesions underwent susceptibility testing per Clinical and Laboratory Standards Institute guidelines. Staphylococcus aureus accounted for 78/102 (76%) of Gram-positive isolates; 54/78 (69%) were methicillin-resistant S. aureus (MRSA), and 24/78 (31%) were methicillin-susceptible S. aureus (MSSA). Posttherapy microbiological success (culture-confirmed eradication of the pretreatment pathogen or presumed eradication based on a clinical outcome of success) for S. aureus was 90% for the gepotidacin 750-mg q12h group, 89% for the 1,000-mg q12h, and 73% in the 1000-mg q8h group. For 78 S. aureus isolates obtained from pretreatment lesions, gepotidacin MIC50/MIC90 values were 0.25/0.5 μg/ml against both MRSA and MSSA. Isolates recovered from the few patients with posttreatment cultures showed no significant reduction in gepotidacin susceptibility (≥4-fold MIC increase) between pretreatment and posttreatment isolates. Two of the 78 S. aureus isolates from pretreatment lesions had elevated gepotidacin MICs and had mutations known to occur in quinolone-resistant S. aureus (GyrA S84L, ParC S80Y, and ParE D422E) or to confer elevated MICs to novel bacterial topoisomerase inhibitors (GyrA D83N, both isolates; ParC V67A, one isolate). This first report of microbiological outcomes and responses of gepotidacin in patients with ABSSSIs supports further evaluation of gepotidacin as a novel first-in-class antibacterial agent. (This study has been registered at ClinicalTrials.gov under identifier NCT02045797.).
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Affiliation(s)
| | - Karen A Ingraham
- Medicine Opportunities Research Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Courtney A Tiffany
- Medicine Opportunities Research Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Lynn Tomsho
- Target and Pathway Validation, Target Sciences, GlaxoSmithKline Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Stephanie F Van Horn
- Target and Pathway Validation, Target Sciences, GlaxoSmithKline Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - David N Mayhew
- Computational Biology, Functional Genomics, GlaxoSmithKline Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Caroline R Perry
- Medicine Opportunities Research Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Theresa C Ashton
- Medicine Opportunities Research Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Etienne F Dumont
- Medicine Opportunities Research Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Jianzhong Huang
- Medicine Opportunities Research Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - James R Brown
- Computational Biology, Human Genetics, GlaxoSmithKline Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Linda A Miller
- Medicine Opportunities Research Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
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Iqbal M, Ezzeldin E, Herqash RN, Anwer MK, Azam F. Development and validation of a novel UPLC-MS/MS method for quantification of delafloxacin in plasma and aqueous humour for pharmacokinetic analyses. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1138:121961. [DOI: 10.1016/j.jchromb.2019.121961] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
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83
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Davis-Ajami ML, Pakyz A, Wu J, Baernholdt M. A Payer Perspective of the Costs of Urinary Tract and Skin and Soft Tissue Infections in Adults with Diabetes and the Relationship to Oral Antidiabetic Medication Nonadherence. J Manag Care Spec Pharm 2019; 25:1409-1419. [PMID: 31436479 PMCID: PMC10397633 DOI: 10.18553/jmcp.2019.19052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Controlling costs and improving quality outcomes are important considerations of the triple aim in health care. Medication adherence to oral antidiabetic (OAD) medications is an outcome measure for those with diabetes. However, there is little research reporting the costs associated with OAD medication adherence among adults with diabetes and comorbid infections. OBJECTIVE To provide nationally representative cost and utilization estimates from a payer perspective of 2 common comorbid infections: urinary tract infection (UTI) and skin and soft tissue infection (SSTI) among adults with diabetes in relation to OAD medication nonadherence to quantify cost per outcome. METHODS A retrospective observational study for years 2010-2015 used longitudinal panel data in the public domain from the Medical Expenditure Panel Survey (MEPS). The study included individuals aged ≥ 18 years with diabetes (excluding gestational diabetes) who were prescribed OAD medications and then stratified by infection status, that is, without infection versus with UTI and/or SSTI. Outcomes measured included medication adherence, defined as medication possession ratio (MPR); treated prevalence of UTI and SSTI; and associated direct medical costs paid by insurers. RESULTS 4,633 adults with diabetes were included; of those, 12% reported a UTI or SSTI, with the weighted sample representing 2.2 million U.S. residents. The mean MPR was 0.61 and 0.63 in the infection and noninfection groups, respectively. Less than 35% in each group were adherent to OAD medications. Having a UTI or SSTI increased the adjusted total health expenses by 53.7% (P < 0.001), but adherence to OAD medications did not significantly affect total health care costs. CONCLUSIONS In adults with diabetes, a UTI or SSTI diagnosis did not influence medication adherence to OAD medication but increased health care utilization and costs significantly. DISCLOSURES This study was supported by the Virginia Commonwealth University Presidential Research Quest Fund (PeRQ Fund). The authors have no financial conflicts of interest to disclose.
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Affiliation(s)
| | - Amy Pakyz
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond
| | - Jun Wu
- Presbyterian College School of Pharmacy, Clinton, South Carolina
| | - Marianne Baernholdt
- Department of Global Initiatives, The University of North Carolina at Chapel Hill School of Nursing
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84
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Lesion size is associated with genetic polymorphisms in TLR1, TLR6, and TIRAP genes in patients with major abscesses and diabetic foot infections. Eur J Clin Microbiol Infect Dis 2019; 39:353-360. [PMID: 31786695 PMCID: PMC7010613 DOI: 10.1007/s10096-019-03732-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/02/2019] [Indexed: 11/03/2022]
Abstract
Genetic variation in Toll-like receptors (TLRs) has previously been associated with susceptibility to complicated skin and skin structure infections (cSSSIs). The aim of this study was to investigate associations between the severity of cSSSIs, i.e., major abscesses and diabetic foot infections (DFIs), and a set of genetic polymorphisms in the Toll-like receptor pathway. A total of 121 patients with major abscesses and 132 with DFIs participating in a randomized clinical trial were genotyped for 13 nonsynonymous single-nucleotide polymorphisms (SNPs) in genes coding for TLRs and the signaling adaptor molecule TIRAP. Infection severity was defined by lesion size at clinical presentation for both types of infections. The PEDIS infection score was also used to define severity of DFIs. Linear regression models were used to study factors independently associated with severity. In patients with large abscesses, hetero- or homozygosity for the allelic variant TLR6 (P249S) was associated with significantly smaller lesions while homozygosity for the allelic variant TLR1 (R80T) was associated with significantly larger lesions. PRRs genes were not significantly associated with PEDIS. However, patients with DFI hetero- or homozygous for the allelic variant TLR1 (S248N) had significantly larger lesions. Polymorphisms in TLR1 and TLR6 influence the severity of cSSSIs as assessed by the lesion size of major abscesses and DFIs. ClinicalTrial.gov Identifier: NCT00402727.
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85
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Pearson T, Barger SD, Lininger M, Wayment H, Hepp C, Villa F, Tucker-Morgan K, Kyman S, Cabrera M, Hurtado K, Menard A, Fulbright K, Wood C, Mbegbu M, Zambrano Y, Fletcher A, Medina-Rodriguez S, Manone M, Aguirre A, Milner T, Trotter Ii RT. Health Disparities in Staphylococcus aureus Transmission and Carriage in a Border Region of the United States Based on Cultural Differences in Social Relationships: Protocol for a Survey Study. JMIR Res Protoc 2019; 8:e14853. [PMID: 31573953 PMCID: PMC6789426 DOI: 10.2196/14853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 01/19/2023] Open
Abstract
Background Health care–associated Staphylococcus aureus infections are declining but remain common. Conversely, rates of community-associated infections have not decreased because of the inadequacy of public health mechanisms to control transmission in a community setting. Our long-term goal is to use risk-based information from empirical socio-cultural-biological evidence of carriage and transmission to inform intervention strategies that reduce S aureus transmission in the community. Broad differences in social interactions because of cultural affiliation, travel, and residency patterns may impact S aureus carriage and transmission, either as risk or as protective factors. Objective This study aims to (1) characterize S aureus carriage rates and compare circulating pathogen genotypes with those associated with disease isolated from local clinical specimens across resident groups and across Hispanic and non-Hispanic white ethnic groups and (2) evaluate social network relationships and social determinants of health-based risk factors for their impact on carriage and transmission of S aureus. Methods We combine sociocultural survey approaches to population health sampling with S aureus carriage and pathogen genomic analysis to infer transmission patterns. Whole genome sequences of S aureus from community and clinical sampling will be phylogenetically compared to determine if strains that cause disease (clinical samples) are representative of community genotypes. Phylogenetic comparisons of strains collected from participants within social groups can indicate possible transmission within the group. We can therefore combine transmission data with social determinants of health variables (socioeconomic status, health history, etc) and social network variables (both egocentric and relational) to determine the extent to which social relationships are associated with S aureus transmission. Results We conducted a first year pilot test and feasibility test of survey and biological data collection and analytic procedures based on the original funded design for this project (#NIH U54MD012388). That design resulted in survey data collection from 336 groups and 1337 individuals. The protocol, described below, is a revision based on data assessment, new findings for statistical power analyses, and refined data monitoring procedures. Conclusions This study is designed to evaluate ethnic-specific prevalence of S aureus carriage in a US border community. The study will also examine the extent to which kin and nonkin social relationships are concordant with carriage prevalence in social groups. Genetic analysis of S aureus strains will further distinguish putative transmission pathways across social relationship contexts and inform our understanding of the correspondence of S aureus reservoirs across clinical and community settings. Basic community-engaged nonprobabilistic sampling procedures provide a rigorous framework for completion of this 5-year study of the social and cultural parameters of S aureus carriage and transmission.
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Affiliation(s)
- Talima Pearson
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States.,Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Steven D Barger
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Psycological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Monica Lininger
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, United States
| | - Heidi Wayment
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Psycological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Crystal Hepp
- School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, United States
| | - Francisco Villa
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Northern Arizona University-Yuma, Yuma, AZ, United States
| | | | - Shari Kyman
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Melissa Cabrera
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States.,Northern Arizona University-Yuma, Yuma, AZ, United States
| | - Kevin Hurtado
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States.,Northern Arizona University-Yuma, Yuma, AZ, United States
| | - Ashley Menard
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States.,Northern Arizona University-Yuma, Yuma, AZ, United States
| | - Kelly Fulbright
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Colin Wood
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Mimi Mbegbu
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | | | | | | | - Mark Manone
- Department of Geography, Planning and Recreation, Northern Arizona University, Flagstaff, AZ, United States
| | - Amanda Aguirre
- Regional Center for Border Health, Somerton, AZ, United States
| | - Trudie Milner
- Yuma Regional Medical Center, Yuma, AZ, United States
| | - Robert T Trotter Ii
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Anthropology, Northern Arizona University, Flagstaff, AZ, United States
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Lan SH, Lin WT, Chang SP, Lu LC, Chao CM, Lai CC, Wang JH. Tedizolid Versus Linezolid for the Treatment of Acute Bacterial Skin and Skin Structure Infection: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2019; 8:antibiotics8030137. [PMID: 31487837 PMCID: PMC6784229 DOI: 10.3390/antibiotics8030137] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/13/2022] Open
Abstract
This meta-analysis aims to assess the efficacy and safety of tedizolid, compared to linezolid, in the treatment of acute bacterial skin and skin structure infection (ABSSSI). PubMed, Web of Science, EBSCO (Elton B. Stephens Co.), Cochrane Library, Ovid Medline and Embase databases were accessed until 18 July 2019. Only randomized controlled trials (RCTs) comparing the efficacy of tedizolid with linezolid for adult patients with ABSSSIs were included. The outcomes included the clinical response, microbiological response, and risk of adverse events (AEs). A total of four RCTs involving 2056 adult patients with ABSSSI were enrolled. The early clinical response rate was 79.6% and 80.5% for patients receiving tedizolid and linezolid, respectively. The pooled analysis showed that tedizolid had a non-inferior early clinical response rate to linezolid (odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.77-1.19, I2 = 0%). The early response rate was similar between tedizolid and linezolid among patients with cellulitis/erysipelas (75.1% vs. 77.1%; OR = 0.90, 95% CI = 0.64-1.27, I2 = 25%), major cutaneous abscess (85.1% vs. 86.8%; OR = 0.93, 95% CI = 0.42-2.03, I2 = 37%) and wound infection (85.9% vs. 82.6%; OR = 1.29, 95% CI = 0.66-2.51, I2 = 45%). For methicillin-resistant Staphylococcus aureus patients, tedizolid had a favorable microbiological response rate of 95.2% which was comparable to linezolid (94%) (OR = 1.19, 95% CI = 0.49-2.90, I2 = 0%). In addition to the similar risk of treatment-emergent AEs (a serious event, the discontinuation of the study drug due to AEs and mortality between tedizolid and linezolid), tedizolid was associated with a lower risk of nausea, vomiting and abnormal neutrophil count than linezolid. In conclusion, once-daily tedizolid (200 mg for six days) compared to linezolid (600 mg twice-daily for 10 days) was non-inferior in efficacy in the treatment of ABSSSI. Besides, tedizolid was generally as well tolerated as linezolid, and had a lower incidence of gastrointestinal AEs and bone marrow suppression than linezolid.
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Affiliation(s)
- Shao-Huan Lan
- School of Pharmaceutical Sciences and Medical Technology, Putian University, Putian 351100, China.
| | - Wei-Ting Lin
- Department of Orthopedic, Chi Mei Medical Center, Tainan 71004, Taiwan.
- Department of Physical Therapy, Shu Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan.
| | | | - Li-Chin Lu
- School of Management, Putian University, Putian 351100, China.
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 71051, Taiwan.
| | - Jui-Hsiang Wang
- Department of Internal Medicine, Division of Infection Disease, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 71051, Taiwan.
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O'Riordan W, Cardenas C, Shin E, Sirbu A, Garrity-Ryan L, Das AF, Eckburg PB, Manley A, Steenbergen JN, Tzanis E, McGovern PC, Loh E. Once-daily oral omadacycline versus twice-daily oral linezolid for acute bacterial skin and skin structure infections (OASIS-2): a phase 3, double-blind, multicentre, randomised, controlled, non-inferiority trial. THE LANCET. INFECTIOUS DISEASES 2019; 19:1080-1090. [PMID: 31474458 DOI: 10.1016/s1473-3099(19)30275-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pathogen resistance and safety concerns limit oral antibiotic options for the treatment of acute bacterial skin and skin structure infections (ABSSSI). We aimed to compare the efficacy and safety of once-daily oral omadacycline, an aminomethylcycline antibiotic, versus twice-daily oral linezolid for treatment of ABSSSI. METHODS In this phase 3, double-blind, randomised, non-inferiority study, eligible adults with ABSSSI at 33 sites in the USA were randomly assigned (1:1) to receive omadacycline (450 mg orally every 24 h over the first 48 h then 300 mg orally every 24 h) or linezolid (600 mg orally every 12 h) for 7-14 days. Randomisation was done via an interactive response system using a computer-generated schedule, and stratified by type of infection (wound infection, cellulitis or erysipelas, or major abscess) and receipt (yes or no) of allowed previous antibacterial treatment. Investigators, funders, and patients were masked to treatment assignments. Primary endpoints were early clinical response, 48-72 h after first dose, in the modified intention-to-treat (mITT) population (randomised patients without solely Gram-negative ABSSSI pathogens at baseline), and investigator-assessed clinical response at post-treatment evaluation, 7-14 days after the last dose, in the mITT population and clinically evaluable population (ie, mITT patients who had a qualifying infection as per study-entry criteria, received study drug, did not receive a confounding antibiotic, and had an assessment of outcome during the protocol-defined window). The safety population included randomised patients who received any amount of study drug. We set a non-inferiority margin of 10%. This study is registered with ClinicalTrials.gov, NCT02877927, and is complete. FINDINGS Between Aug 11, 2016, and June 6, 2017, 861 participants were assessed for eligibility. 735 participants were randomly assigned, of whom 368 received omadacycline and 367 received linezolid. Omadacycline (315 [88%] of 360) was non-inferior to linezolid (297 [83%] of 360) for early clinical response (percentage-point difference 5·0, 95% CI -0·2 to 10·3) in the mITT population. For investigator-assessed clinical response at post-treatment evaluation, omadacycline was non-inferior to linezolid in the mITT (303 [84%] of 360 vs 291 [81%] of 360; percentage-point difference 3·3, 95% CI -2·2 to 9·0) and clinically evaluable (278 [98%] of 284 vs 279 [96%] of 292; 2·3, -0·5 to 5·8) populations. Mild to moderate nausea and vomiting were the most frequent treatment-emergent adverse events in omadacycline (111 [30%] of 368 and 62 [17%] of 368, respectively) and linezolid (28 [8%] of 367 and 11 [3%] of 367, respectively) groups. INTERPRETATION Once-daily oral omadacycline was non-inferior to twice-daily oral linezolid in adults with ABSSSI, and was safe and well tolerated. Oral-only omadacycline represents a new treatment option for ABSSSI, with potential for reduction in hospital admissions and cost savings. FUNDING Paratek Pharmaceuticals.
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Affiliation(s)
| | | | - Elliot Shin
- Jubilee Clinical Research, Las Vegas, NV, USA
| | - Alissa Sirbu
- Paratek Pharmaceuticals, King of Prussia, PA, USA
| | | | | | | | - Amy Manley
- Paratek Pharmaceuticals, King of Prussia, PA, USA
| | | | - Evan Tzanis
- Paratek Pharmaceuticals, King of Prussia, PA, USA
| | | | - Evan Loh
- Paratek Pharmaceuticals, King of Prussia, PA, USA
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88
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Zhang HC, Ai JW, Cui P, Zhu YM, Hong-Long W, Li YJ, Zhang WH. Incremental value of metagenomic next generation sequencing for the diagnosis of suspected focal infection in adults. J Infect 2019; 79:419-425. [PMID: 31442461 DOI: 10.1016/j.jinf.2019.08.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Microbiological diagnosis is essential during clinical management of focal infections. Metagenomic next generation sequencing (mNGS) has been reported as a promising diagnostic tool in infectious diseases. However, little is known about the clinical utility of mNGS in focal infections. METHODS We conducted a single-center retrospective study to investigate impact of mNGS on focal infection diagnosis and compared it with conventional methods, including culture, pathological examination, Xpert MTB/RIF, etc. 98 suspected focal infections cases were enrolled, and medical records were reviewed to determine their rates of detection, time-to-identification, and clinical outcomes. RESULTS mNGS showed a satisfying diagnostic positive percent agreement of 86.30% (95% CI: 75.79-92.88%) in a variety of tissues, compared to 45.21% (95% CI: 33.68-57.24%) for culture and 57.53% (95% CI: 45.43-68.84%)f for conventional methods (p < 0.0125), and detected an extra 34 pathogenic microorganisms. Time requirement for pathogen identification using mNGS ranges from 31 h to 55 h, which showed an advantage over culture. (82.36 h; 95%CI: 65.83, 98.89; P < 0.05) CONCLUSIONS: mNGS showed promising potential in pathogenic diagnosis during focal infections and might enable clinicians to make more timely and targeted therapeutic decisions.
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Affiliation(s)
- Hao-Cheng Zhang
- Department of Infectious Disease, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Jing-Wen Ai
- Department of Infectious Disease, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Peng Cui
- Department of Infectious Disease, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Yi-Min Zhu
- Department of Infectious Disease, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Wu Hong-Long
- Tianjin Medical Laboratory, BGI-Tianjin, BGI-Shenzhen, Tianjin 300308, China
| | - Yong-Jun Li
- BGI Genomics, BGI-Shenzhen, Shenzhen 518083, China
| | - Wen-Hong Zhang
- Department of Infectious Disease, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China.
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89
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Risk factors associated with methicillin-resistant Staphylococcus aureus skin and soft tissue infections in hospitalized patients in Colombia. Int J Infect Dis 2019; 87:60-66. [PMID: 31330321 DOI: 10.1016/j.ijid.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) represent a major clinical problem in Colombia. The aim of this study was to evaluate the risk factors associated with MRSA SSTI in Colombia. METHODS A multicenter cohort study with nested case-control design was performed. Patients with an SSTI with at least 48h of inpatient care were included. Patients with an MRSA SSTI were considered the case group and patients with either a non-MRSA SSTI or with an Methicillin-susceptible S. aureus (MSSA) SSTI were the control groups. A multivariate logistic regression approach was used to evaluate risk factors associated with MRSA SSTI with two different statistical models. RESULTS A total 1134 patients were included. Cultures were positive for 498 patients, of which 52% (n=259) were Staphylococcus aureus. MRSA was confirmed in 68.3% of the S. aureus cultures. In the first model, independent risk factors for MRSA SSTI were identified as the presence of abscess (P<0.0001), cellulitis (P=0.0007), age 18-44 years (P=0.001), and previous outpatient treatment in the previous index visit (P=0.003); surgical site infection was a protective factor (P=0.008). In the second model, the main risk factor found was previous outpatient treatment in the previous index visit (P=0.013). CONCLUSIONS Community-acquired SSTIs in Colombia are commonly caused by MRSA. Therefore, clinicians should consider MRSA when designing the initial empirical treatment for purulent SSTI in Colombia, although there seems to be low awareness of this fact.
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90
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Garcia DR, Deckey D, Haglin JM, Emanuel T, Mayfield C, Eltorai AE, Spake CS, Jarrell JD, Born CT. Commonly Encountered Skin Biome-Derived Pathogens after Orthopedic Surgery. Surg Infect (Larchmt) 2019; 20:341-350. [DOI: 10.1089/sur.2018.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dioscaris R. Garcia
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David Deckey
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jack M. Haglin
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Toby Emanuel
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cory Mayfield
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam E.M. Eltorai
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carole Sl Spake
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John D. Jarrell
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher T. Born
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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91
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Efficacy and Safety of Tedizolid Phosphate versus Linezolid in a Randomized Phase 3 Trial in Patients with Acute Bacterial Skin and Skin Structure Infection. Antimicrob Agents Chemother 2019; 63:AAC.02252-18. [PMID: 30988146 PMCID: PMC6591607 DOI: 10.1128/aac.02252-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/07/2019] [Indexed: 02/05/2023] Open
Abstract
Tedizolid phosphate is approved for the treatment of acute bacterial skin and skin structure infection (ABSSSI) caused by Gram-positive bacteria in the United States, Europe, and other countries. In this multicenter, double-blind, phase 3 study, 598 adult ABSSSI patients in China, Taiwan, the Philippines, and the United States were randomized to receive 200 mg of tedizolid, intravenously (i.v.)/orally (p.o.), once daily for 6 days or 600 mg of linezolid, i.v./p.o. Tedizolid phosphate is approved for the treatment of acute bacterial skin and skin structure infection (ABSSSI) caused by Gram-positive bacteria in the United States, Europe, and other countries. In this multicenter, double-blind, phase 3 study, 598 adult ABSSSI patients in China, Taiwan, the Philippines, and the United States were randomized to receive 200 mg of tedizolid, intravenously (i.v.)/orally (p.o.), once daily for 6 days or 600 mg of linezolid, i.v./p.o. twice daily for 10 days. The primary endpoint was early clinical response rate at 48 to 72 h. Secondary endpoints included programmatic and investigator-assessed outcomes at end-of-therapy (EOT) and posttherapy evaluation (PTE) visits. Safety was also evaluated. In the intent-to-treat (ITT) population, 75.3% of tedizolid-treated patients and 79.9% of linezolid-treated patients were early responders (treatment difference, –4.6%; 95% confidence interval [CI], –11.2, 2.2). After exclusion of patients who never received the study drug (tedizolid, n = 8; linezolid, n = 1; modified ITT), comparable early response rates were observed (tedizolid, 77.4%; linezolid, 80.1%; treatment difference, –2.7%; 95% CI, –9.4, 3.9). Secondary endpoints showed high and similar clinical success rates in the ITT and clinically evaluable (CE) populations at EOT and PTE visits (e.g., CE-PTE for tedizolid, 90.4%; for linezolid, 93.5%). Both drugs were well tolerated, and no death occurred. Eight patients experienced phlebitis with tedizolid while none did with linezolid; hence, drug-related treatment-emergent adverse events were reported in a slightly higher proportion in the tedizolid (20.9%) arm than in the linezolid arm (15.8%). The study demonstrated that tedizolid in a primarily Asian population was an efficacious and well-tolerated treatment option for ABSSSI patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT02066402.)
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92
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Collin SM, Shetty N, Guy R, Nyaga VN, Bull A, Richards MJ, van der Kooi TI, Koek MB, De Almeida M, Roberts SA, Lamagni T. Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis. Int J Infect Dis 2019; 83:116-129. [DOI: 10.1016/j.ijid.2019.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
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Carrothers TJ, Chittenden JT, Critchley I. Dalbavancin Population Pharmacokinetic Modeling and Target Attainment Analysis. Clin Pharmacol Drug Dev 2019; 9:21-31. [PMID: 31087630 PMCID: PMC7003773 DOI: 10.1002/cpdd.695] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/08/2019] [Indexed: 01/15/2023]
Abstract
Dalbavancin is indicated for the treatment of acute bacterial skin and skin structure infections caused by susceptible gram-positive microorganisms. This analysis represents the update of the population pharmacokinetics (popPK) modeling and target attainment simulations performed with data from the single-dose safety and efficacy study and an unrelated but substantial revision of the preclinical pharmacokinetic/pharmacodynamic target (fAUC/MIC, free area under concentration-time curve/minimum inhibitory concentration ratio). A 3-compartment distribution model with first-order elimination provided an appropriate fit, with typical dalbavancin clearance of 0.05 L/h and total volume of distribution of ∼15 L. Impact of intrinsic factors was modest, although statistically significant (P < .05) relationships with total clearance were found for the following covariates: creatinine clearance, weight, and albumin - dose adjustment was only indicated for severe renal impairment. Under the new nonclinical target, simulations of the popPK model projected that >99% of subjects would achieve the nonclinical target at MIC values up to and including 2 mg/L.
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94
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Shortridge D, Flamm RK. Comparative In Vitro Activities of New Antibiotics for the Treatment of Skin Infections. Clin Infect Dis 2019; 68:S200-S205. [PMID: 30957168 PMCID: PMC6451995 DOI: 10.1093/cid/ciz003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Bacterial skin infections result in significant morbidity and have contributed to enhanced health-care resource utilization. The problem is heightened by emerging antimicrobial resistance. Multiple novel agents active against resistant pathogens that cause skin infections-including dalbavancin, tedizolid phosphate, oritavancin, and delafloxacin-have been approved over the past 5 years. Common features of these agents include gram-positive activity and favorable safety. Of these agents, delafloxacin is unique in being active against both gram-positive and gram-negative pathogens that cause skin infections, including those resistant to other antimicrobial agents. It is, therefore, an effective option for the treatment of skin infections.
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95
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In Vitro Activity of Iclaprim against Isolates in Two Phase 3 Clinical Trials (REVIVE-1 and -2) for Acute Bacterial Skin and Skin Structure Infections. Antimicrob Agents Chemother 2019; 63:AAC.02239-18. [PMID: 30642922 DOI: 10.1128/aac.02239-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/03/2019] [Indexed: 11/20/2022] Open
Abstract
Iclaprim, a selective bacterial dihydrofolate reductase inhibitor, and other antibiotics were tested against Gram-positive isolates from two phase 3 studies of acute bacterial skin and skin structure infections (ABSSSIs) (REVIVE-1 and -2). Seven hundred ninety baseline isolates, including Staphylococcus aureus, β-hemolytic streptococci, and Streptococcus anginosus group, underwent antibacterial susceptibility testing. Iclaprim had an MIC90 of 0.12 μg/ml for S. aureus (0.12 μg/ml for methicillin susceptible, 0.25 μg/ml for methicillin resistant), 0.25 μg/ml for β-hemolytic streptococci, and 0.008 μg/ml for S. anginosus group. Iclaprim demonstrated potent activity against these Gram-positive ABSSSI isolates.
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96
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McNeil JC, Fritz SA. Prevention Strategies for Recurrent Community-Associated Staphylococcus aureus Skin and Soft Tissue Infections. Curr Infect Dis Rep 2019; 21:12. [PMID: 30859379 DOI: 10.1007/s11908-019-0670-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Staphylococcus aureus skin and soft tissue infections (SSTI) are a major source of morbidity. More than half of patients experiencing SSTI will have at least one recurrent infection. These infections frequently cluster in households. Given the burden these infections pose to patients and healthcare, prevention strategies are of major clinical importance and represent an active area of research. Bacterial colonization is frequently an early and critical step in the pathogenesis of infection. As such, strategies to prevent reinfection have aimed to decrease staphylococcal colonization of the skin and mucus membranes, a process referred to as decolonization. RECENT FINDINGS Treatment of acute SSTI with incision and drainage and systemic antibiotics is the mainstay of therapy for healing of the acute infection. Systemic antibiotics also provide benefit through reduced incidence of recurrent SSTI. Education for patients and families regarding optimization of personal and household hygiene measures, and avoidance of sharing personal hygiene items, is an essential component in prevention efforts. For patients experiencing recurrent SSTI, or in households in which multiple members have experienced SSTI, decolonization should be recommended for all household members. A recommended decolonization regimen includes application of intranasal mupirocin and antiseptic body washes with chlorhexidine or dilute bleach water baths. For patients who continue to experience recurrent SSTI, periodic decolonization should be considered. Personal decolonization with topical antimicrobials and antiseptics reduces the incidence of recurrent S. aureus SSTI. Future avenues for investigation include strategies for household environmental decontamination as well as manipulation of the host microbiota.
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Affiliation(s)
- J Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, CB 8116, St. Louis, MO, 63110, USA.
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O'Riordan W, Green S, Overcash JS, Puljiz I, Metallidis S, Gardovskis J, Garrity-Ryan L, Das AF, Tzanis E, Eckburg PB, Manley A, Villano SA, Steenbergen JN, Loh E. Omadacycline for Acute Bacterial Skin and Skin-Structure Infections. N Engl J Med 2019; 380:528-538. [PMID: 30726689 DOI: 10.1056/nejmoa1800170] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute bacterial skin and skin-structure infections are associated with substantial morbidity and health care costs. Omadacycline, an aminomethylcycline antibiotic that can be administered once daily either orally or intravenously, is active against pathogens that commonly cause such infections, including antibiotic-resistant strains. METHODS In this double-blind trial, we randomly assigned adults with acute bacterial skin and skin-structure infections (in a 1:1 ratio) to receive omadacycline (100 mg given intravenously every 12 hours for two doses, then 100 mg given intravenously every 24 hours) or linezolid (600 mg given intravenously every 12 hours). A transition to oral omadacycline (300 mg every 24 hours) or oral linezolid (600 mg every 12 hours) was allowed after 3 days; the total treatment duration was 7 to 14 days. The primary end point was an early clinical response at 48 to 72 hours, defined as survival with a reduction in lesion size of at least 20% without rescue antibacterial therapy. A secondary end point was an investigator-assessed clinical response at the post-treatment evaluation 7 to 14 days after the last dose, with clinical response defined as survival with resolution or improvement in signs or symptoms of infection to the extent that further antibacterial therapy was unnecessary. For both end points, the noninferiority margin was 10 percentage points. RESULTS In the modified intention-to-treat population, omadacycline (316 patients) was noninferior to linezolid (311 patients) with respect to early clinical response (rate of response, 84.8% and 85.5%, respectively; difference, -0.7 percentage points; 95% confidence interval [CI], -6.3 to 4.9). Omadacycline also was noninferior to linezolid with respect to investigator-assessed clinical response at the post-treatment evaluation in the modified intention-to-treat population (rate of response, 86.1% and 83.6%, respectively; difference, 2.5 percentage points; 95% CI, -3.2 to 8.2) and in the clinical per-protocol population (96.3% and 93.5%, respectively; difference, 2.8 percentage points; 95% CI, -1.0 to 6.9). In both groups, the efficacy of the trial drug was similar for methicillin-susceptible and methicillin-resistant Staphylococcus aureus infections. Adverse events were reported in 48.3% of the patients in the omadacycline group and in 45.7% of those in the linezolid group; the most frequent adverse events in both groups were gastrointestinal (in 18.0% and 15.8% of the patients in the respective groups). CONCLUSIONS Omadacycline was noninferior to linezolid for the treatment of acute bacterial skin and skin-structure infections and had a similar safety profile. (Funded by Paratek Pharmaceuticals; OASIS-1 ClinicalTrials.gov number, NCT02378480 .).
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Affiliation(s)
- William O'Riordan
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Sinikka Green
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - J Scott Overcash
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Ivan Puljiz
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Symeon Metallidis
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - J Gardovskis
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Lynne Garrity-Ryan
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Anita F Das
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Evan Tzanis
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Paul B Eckburg
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Amy Manley
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Stephen A Villano
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Judith N Steenbergen
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
| | - Evan Loh
- From eStudySite, San Diego (W.O., J.S.O.), and AD Stats Consulting, Guerneville (A.F.D.) - both in California; First Choice Emergency Room, Austin, TX (S.G.); University Hospital for Infectious Diseases "Dr. F. Mihaljević," Zagreb, Croatia (I.P.); AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (S.M.); Riga Stradins University, Paula Stradins Clinical Hospital, Riga, Latvia (J.G.); and Paratek Pharmaceuticals, King of Prussia, PA (L.G.-R., E.T., P.B.E., A.M., S.A.V., J.N.S., E.L.)
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Bazzi AM, Rabaan AA, Al-Tawfiq JA, Shannak BM. Comparison of Effectiveness of Germania Honey Compared to Manuka Honey in Methicillin-Resistant Staphylococcus aureus (MRSA) Killing. Open Microbiol J 2019. [DOI: 10.2174/1874285801913010021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
Manuka honey is currently used in medical-grade sterile wound treatment products and has been shown to be effective in methicillin-resistant Staphylococcus aureus (MRSA) killing in vitro and in wound healing in a number of case studies and series. Locally produced honey in Pakistan and Chile have been proposed to be as effective as Manuka honey in bacterial killing in vitro, presenting potentially more accessible and affordable alternatives. In this study, we compared the effectiveness of a local Germania honey from Saudi Arabia to Manuka honey MGO 550 for in vitro killing of MRSA.
Methodology:
Overnight Muller Hinton broth cultures of 50 wound culture isolates of MRSA from 50 patients were incubated with a series of dilutions of Manuka honey MGO 550 and corresponding Germania honey dilutions for 24 h. Turbidity was assessed to determine whether bacterial growth had occurred, and no growth was confirmed by a further 24 h sub-culture on blood agar.
Results/Key findings:
Manuka honey MGO 550 was significantly more effective than Germania honey at MRSA killing at 100% v/v, 50% v/v and 25% v/v (p=0.025, 0.000265, and 0.000112 respectively)
Conclusion:
Manuka honey MGO 550 is significantly more effective in killing MRSA in vitro than Germania honey. Germania honey does not appear to be a promising locally produced alternative to Manuka honey for the development of honey-based wound dressings. Further experiments could determine if Germania honey is effective against other bacterial species.
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Risk Factors for Bloodstream Infections Among an Urban Population with Skin and Soft Tissue Infections: A Retrospective Unmatched Case-Control Study. Infect Dis Ther 2018; 8:75-85. [PMID: 30560318 PMCID: PMC6374237 DOI: 10.1007/s40121-018-0227-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction The prevalence of acute bacterial skin and skin structure infections (ABSSSIs) continues to increase. Bloodstream infection (BSI) is a severe secondary complication of ABSSSI. The objective of this study was to determine clinical and sociodemographic risk factors for BSI in patients with acute bacterial skin and skin structure infections (ABSSSIs) and to determine if sociodemographic factors impact severity at presentation. Methods This was a retrospective unmatched (1:1) case-control study. Predictors of BSI and severe infection were sought through multivariable logistic regression analyses. Cases and controls were collected from two major medical centers located in downtown Detroit, Michigan: the Detroit Medical Center and the Henry Ford Health System. The population of interest included adult patients with community-onset (CO) ABSSSI treated at a participating hospital between January 2010 and December 2015. Cases were defined as those developing BSI within 48 h of admission with CO-ABSSSI as the primary source, while controls were those with CO-ABSSSI without BSI. Results A total of 392 patients (196 cases, 196 controls) were included. Independent predictors of BSI were male gender (aOR 1.85: 95% CI 1.11, 3.66), acute renal failure (aOR 2.08: 95% CI 1.18, 3.66), intravenous drug use (aOR 4.38, 95% CI 2.22, 8.62), and prior hospitalization (aOR 2.41, 95% CI 1.24, 4.93). African American race (aOR 2.18, 95% CI 1.38, 3.4), leukocytosis (aOR 2.24, 95% CI 1.41, 3.55), and prior hospitalization (aOR 2.07, 95% CI 1.19, 3.00) were significantly associated with infection severity. Conclusion Both clinical and sociodemographic factors were associated with BSI and severe infection underscoring the importance of social determinants of health in outcomes among underserved populations.
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Staphylococcus Aureus and Polymicrobial Skin and Soft Tissue Infections. Am J Med Sci 2018; 356:503-504. [PMID: 30447704 DOI: 10.1016/j.amjms.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 11/23/2022]
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