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Molecular Diagnosis, Antimicrobial Resistance Profiles and Disease Patterns of Gram-Positive Pathogens Recovered from Clinical Infections in Major Ha’il Hospitals. MICROBIOLOGY RESEARCH 2022. [DOI: 10.3390/microbiolres13010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nosocomial resistance in staphylococci and enterococci is challenging. The aim of this work was to conduct a multipoint study using molecular detections, antimicrobial resistances profiles, patient demographics and disease patterns for objective assessments of Staphilococcus aureus and other Gram-positive pathogens recovered from clinical infections in the Ha’il region. We have surveyed 188 non-duplicate Gram-positives against 22 antimicrobials for molecular-differentiation, resistance, patient demographics, and disease patterns from January–April 2021. According to definitions for acquired resistance, Staphylococcus aureus was the most frequent with multidrug resistant (65.4%), where MRSA was 60% (n = 72 out of 121). In age-identified patients, 43% were seniors ≥50 years, 38% 21–49 years, and 19% 0–20 years. In gender-identified patients, 63% were males, and 37% were females. While 25% of specimens were from the ICU, the majority (60%) of specimens were from surgical infection in other wards. Staphylococcus epidermidis was the second (15.4%) species of infection identified with 81% from bloodstream infections at the ICU and other wards. The majority of S. epidermidis patients (69%) were seniors ≥50 years, while other age groups 0–20 and 21–49 each had 14% isolates. Although S. epidermidis was multidrug-resistant, it was susceptible to many drugs. Enterococcus faecalis (13%) ranked third with two major infections; bloodstream (64%) and urinary-tract infections (36%) in mainly seniors (86%). Its isolates were fully resistant to oxacillin, penicillin, cefoxitin, and cefotaxime but nearly 100% susceptible to seven others. Other Gram-positive bacteria (6%) were susceptible to many antibiotics. The use of combinations of objective criteria is a well thought out approach in infection control. While the low-frequency of Gram-positives is an impressive achievement, future large-scale investigations should include all private hospitals, clinics and other cities over a longer sampling time to gain more insights. Although geriatric susceptibility can be justified by age and comorbidities, the staphylococcal infections in young adults and children is a global concern and warrants more vertical studies.
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Marx G, Greiner W, Juhra C, Elkenkamp S, Gensorowsky D, Lemmen SW, Englbrecht J, Dohmen S, Gottschalk A, Haverkamp M, Hempen A, Flügel-Bleienheuft C, Bause D, Schulze-Steinen H, Rademacher S, Kistermann J, Hoch S, Beckmann HJ, Lanckohr C, Lowitsch V, Peine A, Juzek-Kuepper F, Benstoem C, Sperling K, Deisz R. An innovative telemedical network to improve infectious disease management in critically ill patients and outpatients: a stepped-wedge, cluster randomized controlled trial (TELnet@NRW). J Med Internet Res 2022; 24:e34098. [PMID: 35103604 PMCID: PMC8928042 DOI: 10.2196/34098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Evidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (e.g., no shared electronic health record, no digital transfer of patient findings). OBJECTIVE To establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases. METHODS We performed a multicentre, stepped-wedge cluster randomised trial (Feb 2017 - Jan 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine Westphalia, Germany. Patients ≥ 18 years of age in the intensive care unit (ICU) or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand resp. once per week to enhance treatment quality. The primary outcome was adherence to the ten Choosing Wisely® recommendations for infectious disease management. Guideline adherence was analysed using binary logistic regression models. RESULTS Overall, 159,424 patients (10,585 inpatients, 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (OR 4.00 [95% CI 1.83, 9.20], P<.01) and in sepsis management in critically ill patients (OR 6.82 [95% CI 1.27, 56.61], P=.04). There was a statistically non-significant decrease in sepsis related mortality from 28.8% (19/66) in the control group to 23.8% (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37 [95% CI 1.52, 111.47], P=.04). Patients treated by outpatient physicians, who were regularly taking part in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34 [95% CI 1.16, 1.56], P<.01) and asymptomatic bacteriuria (OR 9.31 [95% CI 3.79, 25.94], P<.01). For the other recommendations, we found no significant effects, or we had too few observations to generate models. Key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects. CONCLUSIONS Telemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management creating added value for critically ill patients. CLINICALTRIAL ClinicalTrials.gov, NCT03137589, https://clinicaltrials.gov/ct2/show/NCT03137589.
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Affiliation(s)
- Gernot Marx
- University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen, DE
| | | | | | | | | | | | | | - Sandra Dohmen
- University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen, DE
| | | | | | - Annette Hempen
- Physician Network, Medizin und Mehr eG (MuM), Buende, DE
| | | | | | | | | | | | - Stefan Hoch
- Physician Network, Gesundheitsnetz Köln-Süd (GKS) e.V., Cologne, DE
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Staphylococcus aureus-A Known Opponent against Host Defense Mechanisms and Vaccine Development-Do We Still Have a Chance to Win? Int J Mol Sci 2022; 23:ijms23020948. [PMID: 35055134 PMCID: PMC8781139 DOI: 10.3390/ijms23020948] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 02/07/2023] Open
Abstract
The main purpose of this review is to present justification for the urgent need to implement specific prophylaxis of invasive Staphylococcus aureus infections. We emphasize the difficulties in achieving this goal due to numerous S. aureus virulence factors important for the process of infection and the remarkable ability of these bacteria to avoid host defense mechanisms. We precede these considerations with a brief overview of the global necessitiy to intensify the use of vaccines against other pathogens as well, particularly in light of an impasse in antibiotic therapy. Finally, we point out global trends in research into modern technologies used in the field of molecular microbiology to develop new vaccines. We focus on the vaccines designed to fight the infections caused by S. aureus, which are often resistant to the majority of available therapeutic options.
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Alvarez-Payares JC, Palacios M JE, De la Peña E, Cabrera HB, Giraldo-Ramírez S, Loaiza M, Jaimes F, Rodelo J, Ágamez-Gómez J. Clindamycin Efficacy in Patients With Methicillin-Sensitive Staphylococcus aureus in a Fourth-Level Hospital in the City of Medellín. Cureus 2022; 14:e21124. [PMID: 35036237 PMCID: PMC8752345 DOI: 10.7759/cureus.21124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The antibiotic of choice for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is antistaphylococcal penicillins, such as oxacillin, but cefazolin has also risen as an equally effective alternative. Murine models have suggested that clindamycin is a therapeutic alternative for Staphylococcus aureus bacteremia (SAB). Methods: In this retrospective cohort study, patients from the Hospital Universitario San Vicente Fundación (HUSVF) in Medellín, Colombia, were recruited from January 2013 and December 2019. Patients with positive blood culture for MSSA, with at least one follow-up blood culture, and those with more than 72 hours of parenteral antibiotic therapy for SAB were selected. The main objective was to determine the efficacy of clindamycin compared to other antibiotics to achieve a microbiologic cure. Secondary results included in-hospital mortality and hospital stay. Results: A total of 486 patients were included (clindamycin = 50 and other anti-MSSA = 436). The patients in the clindamycin group had a lower rate of microbiological cure (n = 41 [84%]) compared to other antibiotics (n = 367 [84%]) (OR 1.08 IC 95% 0.74-1.58). In secondary outcomes, no statistically significant differences were observed in the in-hospital mortality. The main source of SAB was a central or peripheral catheter (58%). Conclusions: Our study found no differences in the rate of microbiological cure, in-hospital mortality, and hospital stay on the clindamycin group compared to other anti-MSSA antibiotics. However, in patients with metastatic complications, the rate of microbiological cure is reduced, and the in-hospital mortality is higher in patients with more severe disease.
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Jin Y, Zhou W, Zhan Q, Chen Y, Luo Q, Shen P, Xiao Y. Genomic epidemiology and characterisation of penicillin-sensitive Staphylococcus aureus isolates from invasive bloodstream infections in China: an increasing prevalence and higher diversity in genetic typing be revealed. Emerg Microbes Infect 2022; 11:326-336. [PMID: 34991434 PMCID: PMC8786255 DOI: 10.1080/22221751.2022.2027218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Many countries have reported increasing rates of penicillin-susceptible methicillin-sensitive Staphylococcus aureus (MSSA-PENS). To date, there is relatively little known about the current situation and molecular characteristics of MSSA-PENS in China. In this study, we carried out a laboratory-based multi-region retrospective study to investigate the genomic epidemiology and characterisation of MSSA-PENS isolated from invasive bloodstream infections (BSIs) across 17 provinces. The prevalence of MSSA-PENS isolates increased significantly over the 6-year period, with the proportion increasing from 3.51% in 2014-8.80% in 2019, an average relative increase of 22.14% per year (95% confidence interval 9.67%-34.61%, P for trend <0.001), suggesting that China is experiencing a resurgence of MSSA-PENS. Phylogenetic analysis showed a higher strain diversity occurred; the most frequent clonal complexes (CCs) identified were CC188 (17.14%), CC398 (15.71%) and CC5 (15.71%). Over half of MSSA-PENS strains were pan-susceptible, with erythromycin the most frequent resistance observed. Moreover, 25 isolates were identified as immune evasion cluster negative, including CC15, CC188 and CC1, and 6 strains encoded the Panton-Valentine leucocidin gene. Importantly, virulence assays showed that MSSA-PENS exhibited a level of virulence comparable to that of penicillin-resistant MSSA (MSSA-PENR), indicating that more-sensitive strains should not be mistaken for lacking aggressiveness in vivo. Furthermore, 11 of these isolates were confirmed as blaZ positive but phenotype sensitive, with different amino acid changes in blaZ. Our data support the recommendation to clinicians regarding the usage of penicillin in invasive BSIs caused by MSSA-PENS, which might create a novel opportunity for better antimicrobial stewardship in the future.
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Affiliation(s)
- Ye Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wangxiao Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qing Zhan
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qixia Luo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People's Republic of China
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156
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Wang L, Letsiou E, Wang H, Belvitch P, Meliton LN, Brown ME, Bandela M, Chen J, Garcia JGN, Dudek SM. MRSA-induced endothelial permeability and acute lung injury are attenuated by FTY720 S-phosphonate. Am J Physiol Lung Cell Mol Physiol 2022; 322:L149-L161. [PMID: 35015568 PMCID: PMC8794017 DOI: 10.1152/ajplung.00100.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Disruption of the lung endothelial barrier is a hallmark of acute respiratory distress syndrome (ARDS), for which no effective pharmacologic treatments exist. Prior work has demonstrated that FTY720 S-phosphonate (Tys), an analog of sphingosine-1-phosphate (S1P) and FTY720, exhibits potent endothelial cell (EC) barrier protective properties. In this study, we investigated the in vitro and in vivo efficacy of Tys against methicillin-resistant Staphylococcus aureus (MRSA), a frequent bacterial cause of ARDS. Tys-protected human lung EC from barrier disruption induced by heat-killed MRSA (HK-MRSA) or staphylococcal α-toxin and attenuated MRSA-induced cytoskeletal changes associated with barrier disruption, including actin stress fiber formation and loss of peripheral VE-cadherin and cortactin. Tys-inhibited Rho and myosin light chain (MLC) activation after MRSA and blocked MRSA-induced NF-κB activation and release of the proinflammatory cytokines, IL-6 and IL-8. In vivo, intratracheal administration of live MRSA in mice caused significant vascular leakage and leukocyte infiltration into the alveolar space. Pre- or posttreatment with Tys attenuated MRSA-induced lung permeability and levels of alveolar neutrophils. Posttreatment with Tys significantly reduced levels of bronchoalveolar lavage (BAL) VCAM-1 and plasma IL-6 and KC induced by MRSA. Dynamic intravital imaging of mouse lungs demonstrated Tys attenuation of HK-MRSA-induced interstitial edema and neutrophil infiltration into lung tissue. Tys did not directly inhibit MRSA growth or viability in vitro. In conclusion, Tys inhibits lung EC barrier disruption and proinflammatory signaling induced by MRSA in vitro and attenuates acute lung injury induced by MRSA in vivo. These results support the potential utility of Tys as a novel ARDS therapeutic strategy.
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Affiliation(s)
- Lichun Wang
- 1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Eleftheria Letsiou
- 1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Huashan Wang
- 1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Patrick Belvitch
- 1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Lucille N. Meliton
- 1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mary E. Brown
- 2Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota
| | - Mounica Bandela
- 1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jiwang Chen
- 1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Steven M. Dudek
- 1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:2288-2295. [DOI: 10.1093/jac/dkac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
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Punj J, Chaudhry R, Sagar T, Chandran D. Aerobic and anerobic contamination of mobile phones of health personnels with probable transfer of bacterial microbes to their hands at a tertiary care hospital of India. J Anaesthesiol Clin Pharmacol 2022; 38:405-410. [PMID: 36505191 PMCID: PMC9728432 DOI: 10.4103/joacp.joacp_535_20] [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: 09/05/2020] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/06/2022] Open
Abstract
Background and Aims Mobile phone (MP) contamination of health personnels (HPs) in hospitals is a potential health hazard to the patients and the HP themselves. However, transfer of microbes from MPs of HP to their hands has not been demonstrated before, which would make potential threat into an actual peril. The primary objective was to determine aerobic and anerobic bacterial contamination of MP and hands of HP. The secondary objective was to determine probable transfer of bacterial microbes from MP to hands of tested HP. Material and Methods Three swabs each were taken from 374 HP first from their MP, second from their dominant hand and third from their dominant hand after cleaning with disinfectant followed by a mock phone call of one minute (DHM). Aerobic and anerobic bacterial microbes were identified with standard methods. Results Three hundred twenty-two HPs were recruited. Bacterial contamination was seen in 92% MP, 85% dominant hands, and 68% DHM of tested HP. Of these, contamination with potentially pathogenic bacterias (PPB) was 50% in MP, 25.6% in hands, and 31% in DHM. Anerobic contamination (1.6%) was present on MP but not in hands or DHM. In 54.7% HP, there was presence of similar bacterial microbes in MP and DHM of which 30% were PPB. When disinfectant was used in non-protocolized way in DHM, decrease in aerobic spore forming bacteria (ASB) was seen but not of gram-positive and gram-negative bacterial microbes. Conclusion There is significant aerobic bacterial contamination, including PPB, seen in MP, hands, and DHM of HP in a tertiary care hospital of India; however, anerobic bacterias are found only in MP. Similar bacterial microbes in MP and DHM point to probable transfer of aerobic bacterias from MP to hands of HP which does not decrease when hand disinfectants are used in non-protocolized way, which is a point of concern.
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Affiliation(s)
- Jyotsna Punj
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Jyotsna Punj, Department of Anesthesiology, Pain Medicine and Critical Care, Room No. 5016, Academic Block, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail:
| | - Rama Chaudhry
- Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Dinu Chandran
- Physiology, All India Institute of Medical Sciences, New Delhi, India
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Impact of 18F-FDG-PET/CT on the management of Staphylococcus aureus bacteraemia: A retrospective observational study. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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160
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Thomas S, Doytchinova I. In Silico Identification of the B-Cell and T-Cell Epitopes of the Antigenic Proteins of Staphylococcus aureus for Potential Vaccines. Methods Mol Biol 2022; 2412:439-447. [PMID: 34918260 DOI: 10.1007/978-1-0716-1892-9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Staphylococcus aureus is a leading cause of community-acquired, healthcare-associated, and hospital-acquired infections. S. aureus bacteremia is a common and serious infection with significant morbidity and mortality in older patients. The rise of antibiotic-resistant strains of S. aureus has resulted in substantial loss and effective treatment in hospitalized patients. Thus, there is a need in the development of a vaccine that would provide protection against S. aureus. The antigens of our interest include proteins that are essential for bacterial attachment and colonization (ClfA and ClfB), dermonecrosis-driven toxin (Hla), antigens that are essential for abscess formation (EsxA and EsxB), and antigens that are essential for nutrient acquisition and resistance to phagocytes killing induced by reactive oxygen species (FhuD2 and MntC). Development of a structure-based vaccine based on the antigenic protein epitopes is a novel strategy to provide protection against S. aureus. Using bioinformatic tools, we have determined the B-cell and T-cell epitopes of the antigenic proteins of S. aureus. This chapter reports identification of B-cell and T-cell epitopes of the antigenic protein that could be used in the development of effective structure-based vaccines to protect against S. aureus.
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Affiliation(s)
- Sunil Thomas
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.
| | - Irini Doytchinova
- Department of Chemistry, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
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161
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Campbell AJ, Dotel R, Braddick M, Britton PN, Eisen DP, Francis JR, Lynar S, McMullan B, Meagher N, Nelson J, O’Sullivan MVN, Price DJ, Robinson JO, Whelan A, Tong SYC, Bowen AC, Davis JS. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac014. [PMID: 35237755 PMCID: PMC8884362 DOI: 10.1093/jacamr/dlac014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Combination antibiotic therapy with an antitoxin agent, such as clindamycin, is included in some guidelines for severe, toxin-mediated Staphylococcus aureus infections. The evidence to support this practice is currently limited to in vitro, animal and observational human case-series data, with no previous randomized controlled trials (RCTs). Objectives This pilot RCT aimed to determine the feasibility of conducting a clinical trial to examine if adjunctive clindamycin with standard therapy has greater efficacy than standard therapy alone for S. aureus infections. Methods We performed an investigator-initiated, open-label, multicentre, pilot RCT (ACTRN12617001416381p) in adults and children with severe S. aureus infections, randomized to standard antibiotic therapy with or without clindamycin for 7 days. Results Over 28 months, across nine sites, 127 individuals were screened and 34 randomized, including 11 children (32%). The primary outcome—number of days alive and free of systemic inflammatory response syndrome ≤14 days—was similar between groups: clindamycin (3 days [IQR 1–6]) versus standard therapy (4 days [IQR 0–8]). The 90 day mortality was 0% (0/17) in the clindamycin group versus 24% (4/17) in the standard therapy group. Secondary outcomes—microbiological relapse, treatment failure or diarrhoea—were similar between groups. Conclusions As the first clinical trial assessing adjunctive clindamycin for S. aureus infections, this study indicates feasibility and that adults and children can be incorporated into one trial using harmonized endpoints, and there were no safety concerns. The CASSETTE trial will inform the definitive S. aureus Network Adaptive Platform (SNAP) trial, which includes an adjunctive clindamycin domain and participants with non-severe disease.
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Affiliation(s)
- A. J. Campbell
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Corresponding author. E-mail:
| | - R. Dotel
- Department of Infectious Diseases, Blacktown Hospital, Sydney, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - M. Braddick
- Department of Infectious Diseases, Townsville University Hospital, Townsville, Queensland, Australia
| | - P. N. Britton
- Department of Infectious Diseases and Microbiology, Children’s Hospital Westmead, Sydney, Australia
- University of Sydney, Discipline of Child and Adolescent Health, Sydney Medical School, Sydney, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - D. P. Eisen
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - J. R. Francis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - S. Lynar
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
- Infectious Diseases, Royal Darwin Hospital, Northern Territory, Australia
| | - B. McMullan
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - N. Meagher
- Department of Infectious Diseases, Doherty Institute for Infection & Immunity, The University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Australia
| | - J. Nelson
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
| | - M. V. N. O’Sullivan
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, University of Sydney, Sydney, Australia
- New South Wales Health Pathology, Newcastle, Australia
| | - D. J. Price
- Department of Infectious Diseases, Doherty Institute for Infection & Immunity, The University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Australia
| | - J. O. Robinson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Australia
- Department of Microbiology, Pathwest Laboratory Medicine, Perth, Australia
- College of Science, Health, Engineering and Education, Discipline of Health, Murdoch University, Perth, Australia
| | - A. Whelan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - S. Y. C. Tong
- Department of Infectious Diseases, Doherty Institute for Infection & Immunity, The University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - A. C. Bowen
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
| | - J. S. Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
- John Hunter Hospital, University of Newcastle, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Fenoll RG, Pérez ME, Bayo SM, Millán VF, Jiménez MCM, Álvarez RMM, Ruiz MPP, Usón MCV, Paesa CR. [Clinical characteristics and prognosis of Staphylococcus aureus bacteremia]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:544-550. [PMID: 36205230 PMCID: PMC9728609 DOI: 10.37201/req/035.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Staphylococcus aureus bacteremia patients characteristics at a tertiary hospital are described, and complications, mortality and associated factors are analyzed. METHODS Data from patients with S. aureus bacteremia admitted between March 2020 and February2021 at Miguel Servet university hospital in Zaragoza were retrospectively analyzed. RESULTS Results showed a 14 days mortality of 24.2% and an 30 days mortality of 40%. Overall survival decreased with complications appearance [HR 3.1 (1.2-8.05)] and age over 65 years [HR 3.1 (1.4-6.6)]. The adjusted analysis showed correlation between a higher mortality at 14 and 30 days with age over 65 years [OR 6.3 (1.7-23.1)], sepsis presence [OR 19.3 (5.4-68.7)] and number of positive (+) blood cultures ≥3 [OR 5.4 (0.8-34.1)]. Mortality at 14 days was associated with sepsis presence [OR 58.2 (5.7-592.9)], number of positive (+) blood cultures ≥3 [OR 14.1 (1.1-173.7)] and an older age [OR 1.1 (1.03-1.1)]. Analyzing time to positive blood cultures ≤12 hours and number of positive blood cultures ≥ 3 at the same time, frequency of sepsis increased [30 patients (66.6%) vs 15 patients (33.3%); OR 3.4 (IC95% 1.5-8)]. CONCLUSIONS High 14- and 30-days mortality were found, as well as a worse evolution in older age patients, with sepsis presence, and with greater number of positive blood cultures and times to positive blood cultures ≤12 h.
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Affiliation(s)
- Rosa García Fenoll
- Servicio de Medicina Interna del Hospital universitario Miguel Servet de Zaragoza,Correspondencia: Rosa García Fenoll Servicio de Medicina Interna del Hospital universitario Miguel Servet de Zaragoza E-mail:
| | - María Espinosa Pérez
- Servicio de Medicina Interna del Hospital universitario Miguel Servet de Zaragoza
| | | | | | | | | | | | | | - Carlos Ramos Paesa
- Unidad de Enfermedades Infecciosas del Hospital universitario Miguel Servet de Zaragoza
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Braverman J, Monk IR, Ge C, Westall GP, Stinear TP, Wakim LM. Staphylococcus aureus specific lung resident memory CD4 + Th1 cells attenuate the severity of influenza virus induced secondary bacterial pneumonia. Mucosal Immunol 2022; 15:783-796. [PMID: 35637249 PMCID: PMC9148937 DOI: 10.1038/s41385-022-00529-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/25/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023]
Abstract
Staphylococcus aureus is a major cause of severe pulmonary infections. The evolution of multi-drug resistant strains limits antibiotic treatment options. To date, all candidate vaccines tested have failed, highlighting the need for an increased understanding of the immunological requirements for effective S. aureus immunity. Using an S. aureus strain engineered to express a trackable CD4+ T cell epitope and a murine model of S. aureus pneumonia, we show strategies that lodge Th1 polarised bacterium specific CD4+ tissue resident memory T cells (Trm) in the lung can significantly attenuate the severity of S. aureus pneumonia. This contrasts natural infection of mice that fails to lodge CD4+ Trm cells along the respiratory tract or provide protection against re-infection, despite initially generating Th17 bacterium specific CD4+ T cell responses. Interestingly, lack of CD4+ Trm formation after natural infection in mice appears to be reflected in humans, where the frequency of S. aureus reactive CD4+ Trm cells in lung tissue is also low. Our findings reveal the protective capacity of S. aureus specific respiratory tract CD4+ Th1 polarised Trm cells and highlight the potential for targeting these cells in vaccines that aim to prevent the development of S. aureus pneumonia.
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Affiliation(s)
- Jessica Braverman
- grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000 Australia
| | - Ian R. Monk
- grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000 Australia
| | - Chenghao Ge
- grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000 Australia ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, China
| | - Glen P. Westall
- grid.1002.30000 0004 1936 7857Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, VIC Australia
| | - Timothy P. Stinear
- grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000 Australia
| | - Linda M. Wakim
- grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000 Australia
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164
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Dunham-Snary KJ, Surewaard BG, Mewburn JD, Bentley RE, Martin AY, Jones O, Al-Qazazi R, Lima PA, Kubes P, Archer SL. Mitochondria in human neutrophils mediate killing of Staphylococcus aureus. Redox Biol 2021; 49:102225. [PMID: 34959099 PMCID: PMC8758915 DOI: 10.1016/j.redox.2021.102225] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background Neutrophils play a role in innate immunity and are critical for clearance of Staphylococcus aureus. Current understanding of neutrophil bactericidal effects is that NADPH oxidase produces reactive oxygen species (ROS), mediating bacterial killing. Neutrophils also contain numerous mitochondria; since these organelles lack oxidative metabolism, their function is unclear. We hypothesize that mitochondria in human neutrophils contribute to the bactericidal capacity of S. aureus. Methods and Findings: Using human neutrophils isolated from healthy volunteers (n = 13; 7 females, 6 males), we show that mitochondria are critical in the immune response to S. aureus. Using live-cell and fixed confocal, and transmission electron microscopy, we show mitochondrial tagging of bacteria prior to ingestion and surrounding of phagocytosed bacteria immediately upon engulfment. Further, we demonstrate that mitochondria are ejected from intact neutrophils and engage bacteria during vital NETosis. Inhibition of the mitochondrial electron transport chain at Complex III, but not Complex I, attenuates S. aureus killing by 50 ± 7%, comparable to the NADPH oxidase inhibitor apocynin. Similarly, mitochondrial ROS scavenging using MitoTEMPO attenuates bacterial killing 112 ± 60% versus vehicle control. Antimycin A treatment also reduces mitochondrial ROS production by 50 ± 12% and NETosis by 53 ± 5%. Conclusions We identify a previously unrecognized role for mitochondria in human neutrophils in the killing of S. aureus. Inhibition of electron transport chain Complex III significantly impairs antimicrobial activity. This is the first demonstration that vital NETosis, an early event in the antimicrobial response, occurring within 5 min of bacterial exposure, depends on the function of mitochondrial Complex III. Mitochondria join NADPH oxidase as bactericidal ROS generators that mediate the bactericidal activities of human neutrophils. This study evaluates the role of neutrophil mitochondria in the immune response to Staphylococcus aureus. Mitochondrial electron transport chain inhibition at Complex III significantly attenuates neutrophil bactericidal activity.
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Affiliation(s)
- Kimberly J Dunham-Snary
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Bas Gj Surewaard
- Department of Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
| | | | | | - Ashley Y Martin
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Oliver Jones
- Queen's CardioPulmonary Unit, Queen's University, Kingston, ON, Canada
| | - Ruaa Al-Qazazi
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Patricia Ad Lima
- Queen's CardioPulmonary Unit, Queen's University, Kingston, ON, Canada
| | - Paul Kubes
- Department of Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Stephen L Archer
- Department of Medicine, Queen's University, Kingston, ON, Canada; Queen's CardioPulmonary Unit, Queen's University, Kingston, ON, Canada.
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165
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Individualizing the use of [ 18F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center. Infection 2021; 50:491-498. [PMID: 34928493 PMCID: PMC8942890 DOI: 10.1007/s15010-021-01740-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
Purpose [18F]FDG-PET/CT scanning can help detect metastatic infectious foci and reduce mortality in patients with Staphylococcus aureus bacteremia (SAB), but it is unknown if patients with SAB and an indication for prolonged treatment because of possible endovascular, orthopaedic implant, or other metastatic infection still need [18F]FDG-PET/CT. Methods In a retrospective single-center cohort study, we included all consecutive adult patients with SAB between 2013 and 2020 if an [18F]FDG-PET/CT scan was performed and antibiotic treatment was planned for ≥ 6 weeks prior to [18F]FDG-PET/CT. We aimed to identify patients for whom treatment was adjusted due to the results of [18F]FDG-PET/CT, and assessed concordance of [18F]FDG-PET/CT and clinical diagnosis for infected prosthetic material. Results Among 132 patients included, the original treatment plan was changed after [18F]FDG-PET/CT in 22 patients (16.7%), in the majority (n = 20) due to diagnosing or rejecting endovascular (graft) infection. Antibiotic treatment modifications were shortening in 2, iv-oral switch in 3, extension in 13, and addition of rifampicin in 4 patients. Ninety additional metastatic foci based on [18F]FDG-PET/CT results were found in 69/132 patients (52.3%). [18F]FDG-PET/CT suggested vascular graft infection in 7/14 patients who lacked clinical signs of infection, but showed no infection of prosthetic joints or osteosynthesis material in eight patients who lacked clinical signs of such an infection. Conclusion [18F]FDG-PET/CT can help refine treatment for SAB in patients with clinically suspected endovascular infection or vascular grafts, even if 6 weeks treatment is already indicated, but can be safely omitted in other patients who are clinically stable. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01740-4.
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Moorthy GS, Greenberg RG, Hornik CD, Cassino C, Ghahramani P, Kumar KR, Fowler VG, Cohen-Wolkowiez M. Safety and Pharmacokinetics of Exebacase in an Infant With Disseminated Staphylococcus aureus Infection. Clin Infect Dis 2021; 75:338-341. [PMID: 34894129 PMCID: PMC9410717 DOI: 10.1093/cid/ciab1015] [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] [Received: 08/27/2021] [Indexed: 12/13/2022] Open
Abstract
Exebacase, an antistaphylococcal lysin produced from a bacteriophage-encoded gene, is a promising adjunctive therapy for severe methicillin-resistant Staphylococcus aureus infections. We describe the first infant to receive exebacase, dosing, and pharmacokinetics. Exebacase may be safe and efficacious in children; however, further clinical trials are needed to optimize dosing.
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Affiliation(s)
| | - Rachel G Greenberg
- Duke University Medical Center, Durham, North Carolina, USA,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Chi D Hornik
- Duke University Medical Center, Durham, North Carolina, USA,Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | - Karan R Kumar
- Duke University Medical Center, Durham, North Carolina, USA,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vance G Fowler
- Duke University Medical Center, Durham, North Carolina, USA,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Correspondence: M. Cohen-Wolkowiez, Duke Clinical Research Institute, 300 W Morgan St, Box 3850, Durham, NC 27701 ()
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167
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Stagg NJ, Katavolos P, Achilles Poon K, Zhong S, Ljumanovic N, Kamath A, Cai H, Carrasco-Triguero M, Halpern W. Nonclinical toxicology development of a novel antibody antibiotic conjugate for treating invasive Staphylococcus Aureus infections. Toxicol Appl Pharmacol 2021; 435:115811. [PMID: 34896194 DOI: 10.1016/j.taap.2021.115811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
Invasive Staphylococcus aureus (S. aureus) infections are a leading cause of death and not effectively treated with prolonged standard of care antibiotics. A novel THIOMAB™ antibody antibiotic conjugate (TAC) was developed that uses a bacterial-wall specific antibody to deliver the antibiotic (dmDNA31, a rifamycin analogue) to bacteria to minimize toxicities typically seen with prolonged use of traditional antibiotics. The TAC nonclinical toxicology package included repeat dose rat and cynomolgus monkey toxicology studies for 8 weekly intravenous (IV) doses, a 7-day daily repeat dose IV toxicology study of dmDNA31 and an assessment of genotoxicity, cardiovascular toxicity, neurotoxicity and sperm parameters. TAC and dmDNA31 were well tolerated in rats and monkeys, and there was no evidence of genotoxicity, cardiovascular toxicity or neurotoxicity. Non-adverse findings were observed and included blue discoloration in skin, blood, etc. due to the blue color of dmDNA31, increased globulin due to the high doses of antibodies, and abnormal sperm morphology of small heads in male rats with no histopathology correlate in testis. This is an example of antibody-mediated delivery of an antibiotic that has the potential to offer a more effective way of eradicating infection while providing a better safety profile compared to traditional antibiotics.
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Affiliation(s)
- Nicola J Stagg
- Safety Assessment, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| | - Paula Katavolos
- Nonclinical Safety, Bristol Myers Squibb, New Brunswick, NJ 08901, USA
| | - Kirsten Achilles Poon
- Department of Pharmacology and Toxicology, Ultragenyx Pharmaceutical, Inc., Novato, CA 94949, USA
| | - Shelly Zhong
- Safety Assessment, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Nina Ljumanovic
- Safety Assessment, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Amrita Kamath
- Department of Preclinical & Translational Pharmacokinetics & Pharmacodynamics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Hao Cai
- Department of Preclinical & Translational Pharmacokinetics & Pharmacodynamics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | | | - Wendy Halpern
- Safety Assessment, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
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168
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Febrinasari RP, Benedictus B, Azmiardi A. Systematic Review: A Comparison between Vancomycin and Daptomycin for Sepsis Infection Antibiotic Therapy. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Sepsis is a dangerous condition that threatens life because of immune system dysregulation caused by an infection resulting in organ failure. One of the most common resistant strain bacteria that can cause sepsis is Methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is the first-line therapy for treating sepsis infection caused by MRSA, but recently there have been some MRSA strains that are resistant to vancomycin therapy.
AIM: This study aimed to review comparison between vancomycin and daptomycin for sepsis infection antibiotics therapy.
MATERIALS AND METHODS: This research was a systematic review using three databases such as PubMed, ProQuest, and ScienceDirect. The journal articles included in this study were about randomized controlled trial (RCT) studies published from 2011 to 2020.
RESULTS: This research included seven RCT studies, but none of them discuss the usage of daptomycin for sepsis treatment caused by MRSA. They discuss more the effect of dose, method of administration, and side effects of vancomycin therapy in relation to the outcome of the patient.
CONCLUSIONS: Because of the lack of RCT articles that conducted experiments of daptomycin usage for sepsis treatment caused by MRSA infection, this research could not compare the effectiveness between vancomycin and daptomycin. However, from some case reports included in this research, there was evidence that the usage of daptomycin base after vancomycin treatment failure will cause another treatment failure.
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169
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Bloodstream Infection and Endocarditis Caused by Staphylococcus aureus in Patients with Cancer: A Multicenter Cohort Study. Infect Dis Ther 2021; 11:323-334. [PMID: 34855164 PMCID: PMC8847471 DOI: 10.1007/s40121-021-00575-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/24/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION In a large cohort of patients with Staphylococcus aureus bloodstream infection (SABSI), we aimed to analyze the incidence and risk factors for infective endocarditis (IE) among patients with active cancer (PAC) in comparison with those without cancer (PWC). METHODS Multicenter cohort study of patients with SABSI admitted to two tertiary care hospitals, from 2011 to 2019. PAC were defined as those with an active solid organ cancer or hematological malignancies. SABSI and S. aureus IE were compared between PAC and PWC. RESULTS Among 978 episodes of SABSI, 217 (22.2%) occurred in PAC. PAC were younger, had fewer comorbidities, carried cardiac devices less often, and had less community-acquired SABSI than PWC. Compared to PWC, PAC more frequently had catheter-related SABSI, less IE (2.8% vs 10.9%, p < 0.001) and osteoarticular infection (2.3% vs 14.3%, p < 0.001). Independent risk factors for IE were cardiopathy (aOR 4.392, 95% CI 2.719-7.094) and persistent bacteremia (aOR 3.545, 95% CI 2.159-5.820). Thirty-day mortality was high, and similar between groups (24.2% vs 25.5%, p = 0.282). CONCLUSIONS PAC with SABSI developed IE less frequently than PWC did. This finding seems related to the differences in baseline characteristics and may have significant clinical implications, such as transesophageal echocardiography in PAC without cardiopathy or persistent bacteremia.
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170
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Cheung GYC, Bae JS, Otto M. Pathogenicity and virulence of Staphylococcus aureus. Virulence 2021; 12:547-569. [PMID: 33522395 PMCID: PMC7872022 DOI: 10.1080/21505594.2021.1878688] [Citation(s) in RCA: 407] [Impact Index Per Article: 135.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
Staphylococcus aureus is one of the most frequent worldwide causes of morbidity and mortality due to an infectious agent. This pathogen can cause a wide variety of diseases, ranging from moderately severe skin infections to fatal pneumonia and sepsis. Treatment of S. aureus infections is complicated by antibiotic resistance and a working vaccine is not available. There has been ongoing and increasing interest in the extraordinarily high number of toxins and other virulence determinants that S. aureus produces and how they impact disease. In this review, we will give an overview of how S. aureus initiates and maintains infection and discuss the main determinants involved. A more in-depth understanding of the function and contribution of S. aureus virulence determinants to S. aureus infection will enable us to develop anti-virulence strategies to counteract the lack of an anti-S. aureus vaccine and the ever-increasing shortage of working antibiotics against this important pathogen.
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Affiliation(s)
- Gordon Y. C. Cheung
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | - Justin S. Bae
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, Maryland, USA
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171
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Aratani T, Tsukamoto H, Higashi T, Kodawara T, Yano R, Hida Y, Iwasaki H, Goto N. Association of methicillin resistance with mortality of hospital-acquired Staphylococcus aureus bacteremia. J Int Med Res 2021; 49:3000605211058872. [PMID: 34826374 PMCID: PMC8647257 DOI: 10.1177/03000605211058872] [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] [Indexed: 01/04/2023] Open
Abstract
Objective Methicillin-resistant (MR) Staphylococcus aureus bacteremia (SAB) is associated with higher mortality rates than methicillin-susceptible (MS) SAB. This study assessed potential predictors of mortality and evaluated the association of methicillin resistance with mortality in patients with SAB. Methods We conducted a retrospective cohort study in patients with hospital-acquired SAB, from 2009 to 2018. Clinical features of patients with MR-SAB were compared with those of patients with MS-SAB and predictors of 30-day mortality were determined using Cox regression analysis. Results Among 162 patients, 56.8% had MR-SAB. Overall 30-day mortality was 19.1%; MR-SAB had higher mortality (25.0%) than MS-SAB (11.4%). Univariate analysis highlighted long-term hospitalization, prior antibiotics use, and delayed initiation of appropriate antibiotics as risk factors. Cox regression analysis showed that respiratory tract source, Pitt bacteremia score, Charlson comorbidity index, and appropriate antibiotic therapy within 24 hours were independently and significantly associated with 30-day mortality outcome. Conclusions Methicillin resistance was not an independent risk factor for mortality in patients with SAB. Early, appropriate antibiotic treatment is an important prognostic factor.
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Affiliation(s)
- Tomonori Aratani
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Hitoshi Tsukamoto
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan.,Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Takashi Higashi
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Takaaki Kodawara
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Ryoichi Yano
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Yukio Hida
- Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan.,Clinical Laboratory, University of Fukui Hospital, Fukui, Japan
| | - Hiromichi Iwasaki
- Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Nobuyuki Goto
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
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172
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Berger NJ, Wright ME, Pouliot JD, Green MW, Armstrong DK. The Impact of a Pharmacist-Driven Staphylococcus aureus Bacteremia Initiative in a Community Hospital: A Retrospective Cohort Analysis. PHARMACY 2021; 9:pharmacy9040191. [PMID: 34941623 PMCID: PMC8703297 DOI: 10.3390/pharmacy9040191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: Staphylococcus aureus is a leading cause of bacteremia with a 30-day mortality of 20%. This study evaluated outcomes after implementation of a pharmacist-driven Staphylococcus aureus bacteremia (SAB) initiative in a community hospital. Methods: This retrospective cohort analysis compared patients admitted with SAB between May 2015 and April 2018 (intervention group) to those admitted between May 2012 and April 2015 (historical control group). Pharmacists were notified of and responded to blood cultures positive for Staphylococcus aureus by contacting provider(s) with a bundle of recommendations. Components of the SAB bundle included prompt source control, selection of appropriate intravenous antibiotics, appropriate duration of therapy, repeat blood cultures, echocardiography, and infectious diseases consult. Demographics (age, gender, and race) were collected at baseline. Primary outcome was in-hospital mortality. Compliance with bundle components was also assessed. Results: Eighty-three patients in the control group and 110 patients in the intervention group were included in this study. Demographics were similar at baseline. In-hospital mortality was lower in the intervention group (3.6% vs. 15.7%; p = 0.0033). Bundle compliance was greater in the intervention group (69.1% vs. 39.8%; p < 0.0001). Conclusions: We observed a significant reduction in in-hospital mortality and increased treatment bundle compliance in the intervention cohort with implementation of a pharmacist-driven SAB initiative. Pharmacists’ participation in the care of SAB patients in the form of recommending adherence to treatment bundle components drastically improved clinical outcomes. Widespread adoption and implementation of similar practice models at other institutions may reduce in-hospital mortality for this relatively common and life-threatening infection.
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Affiliation(s)
- Nate J. Berger
- Department of Pharmacy, Williamson Medical Center, Franklin, TN 37067, USA; (M.E.W.); (J.D.P.); (M.W.G.); (D.K.A.)
- Department of Pharmacy, Methodist Health System, Dallas, TX 75203, USA
- Correspondence: or
| | - Michael E. Wright
- Department of Pharmacy, Williamson Medical Center, Franklin, TN 37067, USA; (M.E.W.); (J.D.P.); (M.W.G.); (D.K.A.)
| | - Jonathon D. Pouliot
- Department of Pharmacy, Williamson Medical Center, Franklin, TN 37067, USA; (M.E.W.); (J.D.P.); (M.W.G.); (D.K.A.)
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN 37204, USA
| | - Montgomery W. Green
- Department of Pharmacy, Williamson Medical Center, Franklin, TN 37067, USA; (M.E.W.); (J.D.P.); (M.W.G.); (D.K.A.)
- Department of Pharmacy Practice, College of Pharmacy, Belmont University, Nashville, TN 37212, USA
| | - Deborah K. Armstrong
- Department of Pharmacy, Williamson Medical Center, Franklin, TN 37067, USA; (M.E.W.); (J.D.P.); (M.W.G.); (D.K.A.)
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173
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Al Sulaiman K, Alshaya A, Aljuhani O, Alsaeed A, Alshehri N, Vishwakarma R, Alzahrani H, Althewaibi S, Alghamdi N, Alhelal K, Alharbi A, Al Harbi S. The impact of early target attainment of vancomycin in critically ill patients with confirmed Gram-positive infection: A retrospective cohort study. BMC Infect Dis 2021; 21:1182. [PMID: 34819023 PMCID: PMC8613993 DOI: 10.1186/s12879-021-06840-y] [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: 07/29/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Vancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges, which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. This study aims to evaluate the timing to achieve therapeutic trough level of vancomycin on 30-day mortality in critically ill patients. METHOD A retrospective cohort study was conducted for all adult critically ill patients with confirmed Gram-positive infection who received IV vancomycin between January 1, 2017, and December 31, 2020. We compared early (< 48 h) versus late (≥ 48 h) attainment of vancomycin therapeutic trough levels. The primary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were the development of resistant organisms, microorganisms eradication within 4-5 days of vancomycin initiation, acute kidney injury (AKI), and length of stay (LOS). Propensity score-matched (1:1 ratio) used based on patient's age, serum creatinine, and albumin values at baseline. RESULTS A total of 326 patients were included; 110 patients attained the therapeutic trough levels within 48 h of vancomycin initiation. Late achievement of the therapeutic trough levels was associated with higher 30-day mortality (HR: 2.54; 95% CI [1.24-5.22]; p = 0.01). Additionally, patients who achieved therapeutic trough levels of vancomycin late were more likely to develop AKI (OR = 2.59; 95% CI [1.01-6.65]; p = 0.04). Other outcomes were not statistically significant between the two groups. CONCLUSION Early achievement of vancomycin therapeutic levels in patients with confirmed Gram-positive infection was associated with possible survival benefits.
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Affiliation(s)
- Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia. .,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,King Abdulaziz Medical City, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Abdulrahman Alshaya
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amjad Alsaeed
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nadiyah Alshehri
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ramesh Vishwakarma
- Statistics Department, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Hamdan Alzahrani
- Microbiology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sara Althewaibi
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nawaf Alghamdi
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid Alhelal
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Aisha Alharbi
- Pharmaceutical Care Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Shmeylan Al Harbi
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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174
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Rei Yan SL, Wakasuqui F, Du X, Groves MR, Wrenger C. Lipoic Acid Metabolism as a Potential Chemotherapeutic Target Against Plasmodium falciparum and Staphylococcus aureus. Front Chem 2021; 9:742175. [PMID: 34805091 PMCID: PMC8600131 DOI: 10.3389/fchem.2021.742175] [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: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022] Open
Abstract
Lipoic acid (LA) is an organic compound that plays a key role in cellular metabolism. It participates in a posttranslational modification (PTM) named lipoylation, an event that is highly conserved and that occurs in multimeric metabolic enzymes of very distinct microorganisms such as Plasmodium sp. and Staphylococcus aureus, including pyruvate dehydrogenase (PDH) and α-ketoglutarate dehydrogenase (KDH). In this mini review, we revisit the recent literature regarding LA metabolism in Plasmodium sp. and Staphylococcus aureus, by covering the lipoate ligase proteins in both microorganisms, the role of lipoate ligase proteins and insights for possible inhibitors of lipoate ligases.
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Affiliation(s)
- Sun Liu Rei Yan
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences-ICB, University of São Paulo, São Paulo, Brazil
| | - Felipe Wakasuqui
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences-ICB, University of São Paulo, São Paulo, Brazil
| | - Xiaochen Du
- Structural Biology in Drug Design, Department of Drug Design, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Matthew R Groves
- Structural Biology in Drug Design, Department of Drug Design, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Carsten Wrenger
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences-ICB, University of São Paulo, São Paulo, Brazil
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175
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Heme-Dependent Siderophore Utilization Promotes Iron-Restricted Growth of the Staphylococcus aureus hemB Small-Colony Variant. J Bacteriol 2021; 203:e0045821. [PMID: 34606375 DOI: 10.1128/jb.00458-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Respiration-deficient Staphylococcus aureus small-colony variants (SCVs) frequently cause persistent infections, which necessitates they acquire iron, yet how SCVs obtain iron remains unknown. To address this, we created a stable hemB mutant from S. aureus USA300 strain LAC. The hemB SCV utilized exogenously supplied hemin but was attenuated for growth under conditions of iron starvation. Transcriptome sequencing (RNA-seq) showed that both wild-type (WT) S. aureus and the hemB mutant sense and respond to iron starvation; however, growth assays show that the hemB mutant is defective for siderophore-mediated iron acquisition. Indeed, the hemB SCV demonstrated limited utilization of endogenous staphyloferrin B or exogenously provided staphyloferrin A, deferoxamine mesylate (Desferal), and epinephrine. Direct measurement of intracellular ATP in hemB and WT S. aureus revealed that both strains can generate comparable levels of ATP during exponential growth, suggesting defects in ATP production cannot account for the inability to efficiently utilize siderophores. Defective siderophore utilization by hemB bacteria was also evident in vivo, as administration of Desferal failed to promote hemB bacterial growth in every organ analyzed except for the kidneys. In support of the hypothesis that S. aureus accesses heme in kidney abscesses, in vitro analyses revealed that increased hemin availability enables hemB bacteria to utilize siderophores for growth when iron availability is restricted. Taken together, our data support the conclusion that hemin is used not only as an iron source itself but also as a nutrient that promotes utilization of siderophore-iron complexes. IMPORTANCE S. aureus small-colony variants (SCVs) are associated with chronic recurrent infection and worsened clinical outcome. SCVs persist within the host despite administration of antibiotics. This study yields insight into how S. aureus SCVs acquire iron, which during infection of a host is a difficult-to-acquire metal nutrient. Under hemin-limited conditions, hemB S. aureus is impaired for siderophore-dependent growth, and in agreement, murine infection indicates that hemin-deficient SCVs meet their nutritional requirement for iron through utilization of hemin. Importantly, we demonstrate that hemB SCVs rely upon hemin as a nutrient to promote siderophore utilization. Therefore, perturbation of heme biosynthesis and/or utilization represents a viable to strategy to mitigate the ability of SCV bacteria to acquire siderophore-bound iron during infection.
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Lin Y, Huang L, Zhang X, Yang J, Chen X, Li F, Liu J, Huang R. Multi-Omics Analysis Reveals Anti- Staphylococcus aureus Activity of Actinomycin D Originating from Streptomyces parvulus. Int J Mol Sci 2021; 22:ijms222212231. [PMID: 34830114 PMCID: PMC8621895 DOI: 10.3390/ijms222212231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus (S. aureus) is a common pathogen that causes various serious diseases, including chronic infections. Discovering new antibacterial agents is an important aspect of the pharmaceutical field because of the lack of effective antibacterial drugs. In our research, we found that one anti-S. aureus substance is actinomycin D, originating from Streptomyces parvulus (S. parvulus); then, we further focused on the anti-S. aureus ability and the omics profile of S. aureus in response to actinomycin D. The results revealed that actinomycin D had a significant inhibitory activity on S. aureus with a minimum inhibitory concentration (MIC) of 2 μg/mL and a minimum bactericidal concentration (MBC) of 64 μg/mL. Bacterial reactive oxygen species (ROS) increased 3.5-fold upon treatment with actinomycin D, as was measured with the oxidation-sensitive fluorescent probe DCFH-DA, and H2O2 increased 3.5 times with treatment by actinomycin D. Proteomics and metabolomics, respectively, identified differentially expressed proteins in control and treatment groups, and the co-mapped correlation network of proteomics and metabolomics annotated five major pathways that were potentially related to disrupting the energy metabolism and oxidative stress of S. aureus. All findings contributed to providing new insight into the mechanisms of the anti-S. aureus effects of actinomycin D originating from S. parvulus.
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Affiliation(s)
- Yuqi Lin
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China; (Y.L.); (L.H.); (J.Y.); (X.C.); (F.L.)
| | - Li Huang
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China; (Y.L.); (L.H.); (J.Y.); (X.C.); (F.L.)
| | - Xiaoyong Zhang
- Joint Laboratory of Guangdong Province and Hong Kong Region on Marine Bioresource Conservation and Exploitation, College of Marine Sciences, South China Agricultural University, Guangzhou 510642, China;
| | - Jiajia Yang
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China; (Y.L.); (L.H.); (J.Y.); (X.C.); (F.L.)
| | - Xiaodan Chen
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China; (Y.L.); (L.H.); (J.Y.); (X.C.); (F.L.)
| | - Fengming Li
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China; (Y.L.); (L.H.); (J.Y.); (X.C.); (F.L.)
| | - Jun Liu
- Laboratory of Pathogenic Biology, The Marine Biomedical Research Institute, Dongguan Key Laboratory of Medical Bioactive Molecular Developmental and Translational Research, Guangdong Medical University, Zhanjiang 524023, China
- Correspondence: (J.L.); (R.H.)
| | - Riming Huang
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou 510642, China; (Y.L.); (L.H.); (J.Y.); (X.C.); (F.L.)
- Correspondence: (J.L.); (R.H.)
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177
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Sakamoto Y, Yamauchi Y, Jo T, Michihata N, Hasegawa W, Takeshima H, Matsui H, Fushimi K, Yasunaga H, Nagase T. In-hospital mortality associated with community-acquired pneumonia due to methicillin-resistant Staphylococcus aureus: a matched-pair cohort study. BMC Pulm Med 2021; 21:345. [PMID: 34732194 PMCID: PMC8564271 DOI: 10.1186/s12890-021-01713-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It remains unclear whether methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is associated with higher mortality compared with non-MRSA pneumonia. This study's objective was to compare outcomes including in-hospital mortality and healthcare costs during hospitalisation between patients with MRSA pneumonia and those with non-MRSA pneumonia. METHODS Using a national inpatient database in Japan, we conducted a 1:4 matched-pair cohort study of inpatients with community-acquired pneumonia from 1 April 2012 to 31 March 2014. In-hospital outcomes (mortality, length of stay and healthcare costs during hospitalisation) were compared between patients with and without MRSA infection. We performed multiple imputation using chained equations followed by multivariable regression analyses fitted with generalised estimating equations to account for clustering within matched pairs. All-cause in-hospital mortality and healthcare costs during hospitalisation were compared for pneumonia patients with and without MRSA infection. RESULTS Of 450,317 inpatients with community-acquired pneumonia, 3102 patients with MRSA pneumonia were matched with 12,320 patients with non-MRSA pneumonia. The MRSA pneumonia patients had higher mortality, longer hospital stays and higher costs. Multivariable logistic regression analysis revealed that MRSA pneumonia was significantly associated with higher in-hospital mortality compared with non-MRSA pneumonia (adjusted odds ratio = 1.94; 95% confidence interval: 1.72-2.18; p < 0.001). Healthcare costs during hospitalisation were significantly higher for patients with MRSA pneumonia than for those with non-MRSA pneumonia (difference = USD 8502; 95% confidence interval: USD 7959-9045; p < 0.001). CONCLUSIONS MRSA infection was associated with higher in-hospital mortality and higher healthcare costs during hospitalisation, suggesting that preventing MRSA pneumonia is essential.
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Affiliation(s)
- Yukiyo Sakamoto
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taisuke Jo
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Wakae Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideyuki Takeshima
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Respiratory Medicine, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Mponponsuo K, Leal J, Spackman E, Somayaji R, Gregson D, Rennert-May E. Mathematical model of the cost-effectiveness of the BioFire FilmArray Blood Culture Identification (BCID) Panel molecular rapid diagnostic test compared with conventional methods for identification of Escherichia coli bloodstream infections. J Antimicrob Chemother 2021; 77:507-516. [PMID: 34734238 DOI: 10.1093/jac/dkab398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/05/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Gram-negative pathogens, such as Escherichia coli, are common causes of bloodstream infections (BSIs) and increasingly demonstrate antimicrobial resistance. Molecular rapid diagnostic tests (mRDTs) offer faster pathogen identification and susceptibility results, but higher costs compared with conventional methods. We determined the cost-effectiveness of the BioFire FilmArray Blood Culture Identification (BCID) Panel, as a type of mRDT, compared with conventional methods in the identification of E. coli BSIs. METHODS We constructed a decision analytic model comparing BCID with conventional methods in the identification and susceptibility testing of hospitalized patients with E. coli BSIs from the perspective of the public healthcare payer. Model inputs were obtained from published literature. Cost-effectiveness was calculated by determining the per-patient admission cost, the QALYs garnered and the incremental cost-effectiveness ratios (ICERs) where applicable. Monte Carlo probabilistic sensitivity analyses and one-way sensitivity analyses were conducted to assess the robustness of the model. All costs reflect 2019 Canadian dollars. RESULTS The Monte Carlo probabilistic analyses resulted in cost savings ($27 070.83 versus $35 649.81) and improved QALYs (8.65 versus 7.10) in favour of BCID. At a willingness to pay up to $100 000, BCID had a 72.6%-83.8% chance of being cost-effective. One-way sensitivity analyses revealed length of stay and cost per day of hospitalization to have the most substantial impact on costs and QALYs. CONCLUSIONS BCID was found to be cost-saving when used to diagnose E. coli BSI compared with conventional testing. Cost savings were most influenced by length of stay and cost per day of hospitalization.
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Affiliation(s)
- Kwadwo Mponponsuo
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jenine Leal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Gregson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.,Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Precision Laboratories, University of Calgary, Calgary, Alberta, Canada
| | - Elissa Rennert-May
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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Üstün E, Şahin N, Çelik C, Tutar U, Özdemir N, Gürbüz N, Özdemir İ. Synthesis, characterization, antimicrobial and antibiofilm activity, and molecular docking analysis of NHC precursors and their Ag-NHC complexes. Dalton Trans 2021; 50:15400-15412. [PMID: 34647935 DOI: 10.1039/d1dt02003j] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Microorganisms attach to surfaces and interfaces and form biofilms which create a sheltered area for host cell response. Therefore, biofilms provide troubles in fields such as medicine, food, and pharmaceuticals. Inhibition of formation of biofilms through hindering of quorum sensing could be a method for the production of new generation antibiotics. In this study, four new benzimidazole type NHC precursors (1-allyl-3-benzyl-5,6-dimethylbenzimidazolium chloride, 1-allyl-3-(2,4,6-trimethylbenzyl)-5,6-dimethylbenzimidazolium chloride, 1-allyl-3-(2,3,5,6-tetramethylbenzyl)-5,6-dimethylbenzimidazolium chloride, and 1-allyl-3-(2,3,4,5,6-pentamethylbenzyl)-5,6-dimethylbenzimidazolium chloride and Ag-NHC complexes of these molecules were synthesized and characterized by elemental analysis, FT-IR spectroscopy, 1H, and 13C{1H} NMR spectroscopy, LC-MS, and single crystal crystallography. Antimicrobial and biofilm formation inhibition activities of the molecules were evaluated. In addition, the activities of the molecules were examined in detail by molecular docking analysis. According to the results obtained, higher activity was achieved with the complex molecules when compared with the benzimidazole derivative ligands.
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Affiliation(s)
- Elvan Üstün
- Department of Chemistry, Faculty of Art and Science, Ordu University, 52200 Ordu, Turkey
| | - Neslihan Şahin
- Department of Basic Education, Faculty of Education, Cumhuriyet University, 58040, Sivas, Turkey. .,Department of Chemistry, Faculty of Science and Art, İnönü University, 44280 Malatya, Turkey.,Catalysis Research and Application Center, İnönü University, 44280, Malatya, Turkey
| | - Cem Çelik
- Department of Medical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Uğur Tutar
- Department of Botanica, Faculty of Pharmacy, Sivas Cumhuriyet University, Sivas, 58140, Turkey
| | - Namık Özdemir
- Department of Mathematics and Science Education, Faculty of Education, Ondokuz Mayıs University, 55139, Samsun, Turkey
| | - Nevin Gürbüz
- Department of Chemistry, Faculty of Science and Art, İnönü University, 44280 Malatya, Turkey.,Catalysis Research and Application Center, İnönü University, 44280, Malatya, Turkey.,Drug Application and Research Center, İnönü University, 44280, Malatya, Turkey
| | - İsmail Özdemir
- Department of Chemistry, Faculty of Science and Art, İnönü University, 44280 Malatya, Turkey.,Catalysis Research and Application Center, İnönü University, 44280, Malatya, Turkey.,Drug Application and Research Center, İnönü University, 44280, Malatya, Turkey
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Casillas-Ituarte NN, Staats AM, Lower BH, Stoodley P, Lower SK. Host blood proteins as bridging ligand in bacterial aggregation as well as anchor point for adhesion in the molecular pathogenesis of Staphylococcus aureus infections. Micron 2021; 150:103137. [PMID: 34392091 PMCID: PMC8484042 DOI: 10.1016/j.micron.2021.103137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/09/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022]
Abstract
Fibronectin (Fn) and fibrinogen (Fg) are major host proteins present in the extracellular matrix, blood, and coatings on indwelling medical devices. The ability of Staphylococcus aureus to cause infections in humans depends on favorable interactions with these host ligands. Closely related bacterial adhesins, fibronectin-binding proteins A and B (FnBPA, FnBPB) were evaluated for two key steps in pathogenesis: clumping and adhesion. Experiments utilized optical spectrophotometry, flow cytometry, and atomic force microscopy to probe FnBPA/B alone or in combination in seven different strains of S. aureus and Lactococcus lactis, a Gram-positive surrogate that naturally lacks adhesins to mammalian ligands. In the absence of soluble ligands, both FnBPA and FnBPB were capable of interacting with adjacent FnBPs from neighboring bacteria to mediate clumping. In the presence of soluble host ligands, clumping was enhanced particularly under shear stress and with Fn present in the media. FnBPB exhibited greater ability to clump compared to FnBPA. The strength of adhesion was similar for immobilized Fn to FnBPA and FnBPB. These findings suggest that these two distinct but closely related bacterial adhesins, have different functional capabilities to interact with host ligands in different settings (e.g., soluble vs. immobilized). Survival and persistence of S. aureus in a human host may depend on complementary roles of FnBPA and FnBPB as they interact with different conformations of Fn or Fg (compact in solution vs. extended on a surface) present in different physiological spaces.
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Affiliation(s)
- Nadia N Casillas-Ituarte
- School of Earth Sciences, The Ohio State University, Columbus, OH, 43210, USA; School of Environment and Natural Resources, The Ohio State University, Columbus, OH, 43210, USA.
| | - Amelia M Staats
- Departments of Microbiology and Microbial Infection and Immunity, The Ohio State University, 43210, Columbus, OH, USA
| | - Brian H Lower
- School of Environment and Natural Resources, The Ohio State University, Columbus, OH, 43210, USA
| | - Paul Stoodley
- Departments of Microbiology and Microbial Infection and Immunity, The Ohio State University, 43210, Columbus, OH, USA; Department of Orthopaedics, The Ohio State University, Columbus, OH, 43210, USA
| | - Steven K Lower
- School of Earth Sciences, The Ohio State University, Columbus, OH, 43210, USA; School of Environment and Natural Resources, The Ohio State University, Columbus, OH, 43210, USA; Departments of Microbiology and Microbial Infection and Immunity, The Ohio State University, 43210, Columbus, OH, USA
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181
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Chiang HY, Chen TC, Lin CC, Ho LC, Kuo CC, Chi CY. Trend and Predictors of Short-term Mortality of Adult Bacteremia at Emergency Departments: A 14-Year Cohort Study of 14 625 Patients. Open Forum Infect Dis 2021; 8:ofab485. [PMID: 34805430 PMCID: PMC8598924 DOI: 10.1093/ofid/ofab485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Bacteremia is a life-threatening condition with a high mortality rate in critical care and emergency settings. The current study investigated the trend of mortality and developed predictive models of mortality for adults with bacteremia at emergency departments (EDs). METHODS We conducted a retrospective cohort study of adults with bacteremia at the ED of China Medical University Hospital. Patient data were obtained from the Clinical Research Data Repository, and mortality information was obtained from the National Death Registry. We developed a new model to predict 7-day mortality in the derivation population and compared the model performance of the new model with Pitt Bacteremia Score (PBS) and Bloodstream Infection Mortality Risk Score (BSIMRS) in the validation population. RESULTS We identified 14625 adult patients with first-time bacteremia at the ED, of whom 8.4% died within 7 days. From 2003 to 2016, both the cumulative incidence and 7-day mortality rate of bacteremia decreased significantly. The ED bacteremia mortality (ED-BM) model included PBS parameters, age, infection source, baseline steroid use, and biochemical profiles (estimated glomerular filtration rate, platelet, blood urea nitrogen, potassium, and hemoglobin) for predicting 7-day mortality. The discrimination performance of the ED-BM model (area under curve [AUC], 0.903) was significantly better than that of PBS (AUC, 0.848) or BSIMRS (AUC, 0.885). CONCLUSIONS Although the cumulative incidence and mortality of ED bacteremia decreased, its mortality burden remains critical. The proposed ED-BM model had significantly better model performance than other scoring systems in predicting short-term mortality for adult patients with bacteremia at EDs.
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Affiliation(s)
- Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Tsung-Chia Chen
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Lu-Ching Ho
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yu Chi
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Dixon P, Hollingworth W, Pike K, Reynolds R, Stoddart M, MacGowan A. Cost-effectiveness of rapid laboratory-based mass-spectrometry diagnosis of bloodstream infection: evidence from the RAPIDO randomised controlled trial. BMJ Open 2021; 11:e044623. [PMID: 34663649 PMCID: PMC8524273 DOI: 10.1136/bmjopen-2020-044623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES AND INTERVENTION Bloodstream infection, the presence of viable micro-organisms in the blood, is a prevalent clinical event associated with substantial mortality. Patient outcomes may be improved when the causative micro-organism is identified quickly. We assessed the cost-effectiveness of rapid microbial identification by matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry. DESIGN Economic evaluation alongside a randomised multicentre trial (RAPIDO: RAPId Diagnosis on Outcome) assessing the impact of rapid identification by MALDI-TOF spectrometry. SETTING Adult inpatients with bloodstream infections at seven National Health Service hospital trusts in England and Wales. PRIMARY OUTCOME Net monetary benefit, estimated as incremental costs compared with incremental 28-day survival, of rapid identification by MALDI-TOF spectrometry compared with conventional identification. METHODS Patients were randomised (1:1) to receive diagnosis by conventional methods of microbial identification (conventional arm) only or by MALDI-TOF spectrometry in addition to conventional identification (RAPIDO arm). RESULTS Data from 5550 patients were included in primary analysis. Mean imputed costs in 2018/2019 prices per patient were lower by £126 in the RAPIDO arm (95% CI -£784 to £532) but the proportion of patients alive at day 28 was lower (81.4% vs 82.3%). The probability of cost-effectiveness of MALDI-TOF was <0.5 at cost-effectiveness thresholds between £20 000 and £50 000. CONCLUSIONS Adjunctive MALDI-TOF diagnosis was unlikely to be cost-effective when measured as cost per death avoided at 28 days. However, the differences between arms in cost and effect were modest, associated with uncertainty and may not accurately reflect 'real-world' routine use of MALDI-TOF technology in this patient group. TRIAL REGISTRATION NUMBERS ISRCTN97107018/UKCRN 11978.
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Affiliation(s)
- Padraig Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Katie Pike
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rosy Reynolds
- Bristol Medical School, University of Bristol, Bristol, UK
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183
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Increased Risk of Thrombocytopenia and Death in Patients with Bacteremia Caused by High Alpha Toxin-Producing Methicillin-Resistant Staphylococcus aureus. Toxins (Basel) 2021; 13:toxins13100726. [PMID: 34679019 PMCID: PMC8537302 DOI: 10.3390/toxins13100726] [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: 08/10/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 01/25/2023] Open
Abstract
Alpha toxin (Hla) is a major virulence factor of Staphylococcus aureus that targets platelets but clinical data on Hla pathogenesis in bacteremia (SAB) is limited. We examined the link between in vitro Hla activity and outcome. Study isolates obtained from 100 patients with SAB (50 survivors; 50 non-survivors) were assessed for in vitro Hla production by Western immunoblotting in a subset of isolates and Hla activity by hemolysis assay in all isolates. Relevant demographics, laboratory and clinical data were extracted from patients' medical records to correlate Hla activity of the infecting isolates with outcome. Hla production strongly correlated with hemolytic activity (rs = 0.93) in vitro. A trend towards higher hemolytic activity was observed for MRSA compared to MSSA and with high-risk source infection. Significantly higher hemolytic activity was noted for MRSA strains isolated from patients who developed thrombocytopenia (median 52.48 vs. 16.55 HU/mL in normal platelet count, p = 0.012) and from non survivors (median 30.96 vs. 14.87 HU/mL in survivors, p = 0.014) but hemolytic activity of MSSA strains did not differ between patient groups. In vitro Hla activity of MRSA strains obtained from patients with bacteremia is significantly associated with increased risk for thrombocytopenia and death which supports future studies to evaluate feasibility of bedside phenotyping and therapeutic targeting.
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184
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Douglas EJA, Duggan S, Brignoli T, Massey RC. The MpsB protein contributes to both the toxicity and immune evasion capacity of Staphylococcus aureus. MICROBIOLOGY-SGM 2021; 167. [PMID: 34618666 PMCID: PMC8698210 DOI: 10.1099/mic.0.001096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Understanding the role specific bacterial factors play in the development of severe disease in humans is critical if new approaches to tackle such infections are to be developed. In this study we focus on genes we have found to be associated with patient outcome following bacteraemia caused by the major human pathogen Staphylococcus aureus. By examining the contribution these genes make to the ability of the bacteria to survive exposure to the antibacterial factors found in serum, we identify three novel serum resistance-associated genes, mdeA, mpsB and yycH. Detailed analysis of an MpsB mutant supports its previous association with the slow growing small colony variant (SCV) phenotype of S. aureus, and we demonstrate that the effect this mutation has on membrane potential prevents the activation of the Agr quorum sensing system, and as a consequence the mutant bacteria do not produce cytolytic toxins. Given the importance of both toxin production and immune evasion for the ability of S. aureus to cause disease, we believe that these findings explain the role of the mpsB gene as a mortality-associated locus during human disease.
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Affiliation(s)
- Edward J A Douglas
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, BS8 1TD, UK
| | - Seána Duggan
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, BS8 1TD, UK
| | - Tarcisio Brignoli
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, BS8 1TD, UK
| | - Ruth C Massey
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, BS8 1TD, UK.,Schools of Microbiology and Medicine, University College Cork and APC Microbiome Ireland, Cork, Ireland
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185
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Understanding MRSA clonal competition within a UK hospital; the possible importance of density dependence. Epidemics 2021; 37:100511. [PMID: 34662751 DOI: 10.1016/j.epidem.2021.100511] [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] [Received: 10/28/2020] [Revised: 06/18/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Methicillin resistant Staphylococcus aureus (MRSA) bacteria cause serious, often healthcare-associated infections and are frequently highly resistant to diverse antibiotics. Multiple MRSA clonal complexes (CCs) have evolved independently and countries have different prevalent CCs. It is unclear when and why the dominant CC in a region may switch. METHODS We developed a mathematical deterministic model of MRSA CC competing for limited resource. The model distinguishes 'standard MRSA' and multidrug resistant sub-populations within each CC, allowing for resistance loss and transfer between same CC bacteria. We first analysed how dynamics of this system depend on growth-rate and resistance-potential differences between CCs, and on their resistance gene accumulation. We then fit the model to capture the longitudinal CC dynamics observed at a single UK hospital, which exemplified the UK-wide switch from mainly CC30 to mainly CC22. RESULTS We find that within a CC, gain and loss of resistance can allow for co-existence of sensitive and resistant sub-populations. Due to more efficient transfer of resistance at higher CC density, more drug resistance can accumulate in the population of a more prevalent CC. We show how this process of density dependent competition, together with prevalence disruption, could explain the relatively sudden switch from mainly CC30 to mainly CC22 in the UK hospital setting. Alternatively, the observed hospital dynamics could be reproduced by assuming that multidrug resistant CC22 evolved only around 2004. CONCLUSIONS We showed how higher prevalence may advantage a CC by allowing it to acquire antimicrobial resistances more easily. Due to this density dependence in competition, dominance in an area can depend on historic contingencies; the MRSA CC that happened to be first could stay dominant because of its high prevalence advantage. This then could help explain the stability, despite frequent stochastic introductions across borders, of geographic differences in MRSA CC.
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186
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Camp J, Glaubitz L, Filla T, Kaasch AJ, Fuchs F, Scarborough M, Kim HB, Tilley R, Liao CH, Edgeworth J, Nsutebu E, López-Cortés LE, Morata L, Llewelyn M, Fowler VG, Thwaites G, Seifert H, Kern WV, Kuss O, Rieg S. Impact of Immunosuppressive Agents on Clinical Manifestations and Outcome of Staphylococcus aureus Bloodstream Infection: A Propensity Score-Matched Analysis in 2 Large, Prospectively Evaluated Cohorts. Clin Infect Dis 2021; 73:1239-1247. [PMID: 33914861 DOI: 10.1093/cid/ciab385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection. The impact of immunosuppressive agents on the outcome of patients with SAB is incompletely understood. METHODS Data from 2 large prospective, international, multicenter cohort studies (Invasive Staphylococcus aureus Infections Cohort [INSTINCT] and International Staphylococcus aureus Collaboration [ISAC]) between 2006 and 2015 were analyzed. Patients receiving immunosuppressive agents were identified and a 1:1 propensity score-matched analysis was performed to adjust for baseline characteristics of patients. Overall survival and time to SAB-related late complications (SAB relapse, infective endocarditis, osteomyelitis, or other deep-seated manifestations) were analyzed by Cox regression and competing risk analyses, respectively. This approach was then repeated for specific immunosuppressive agents (corticosteroid monotherapy and immunosuppressive agents other than steroids [IMOTS]). RESULTS Of 3188 analyzed patients, 309 were receiving immunosuppressive treatment according to our definitions and were matched to 309 nonimmunosuppressed patients. After propensity score matching, baseline characteristics were well balanced. In the Cox regression analysis, we observed no significant difference in survival between the 2 groups (death during follow-up: 105/309 [33.9%] immunosuppressed vs 94/309 [30.4%] nonimmunosuppressed; hazard ratio [HR], 1.20 [95% confidence interval {CI}, .84-1.71]). Competing risk analysis showed a cause-specific HR of 1.81 (95% CI, .85-3.87) for SAB-related late complications in patients receiving immunosuppressive agents. The cause-specific HR was higher in patients taking IMOTS (3.69 [95% CI, 1.41-9.68]). CONCLUSIONS Immunosuppressive agents were not associated with an overall higher mortality. The risk for SAB-related late complications in patients receiving specific immunosuppressive agents such as IMOTS warrants further investigations.
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Affiliation(s)
- Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lina Glaubitz
- Institute for Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tim Filla
- Institute of Medical Biometry and Bioinformatics, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Matt Scarborough
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation, Oxford, United Kingdom
| | - Hong Bin Kim
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Robert Tilley
- Department of Microbiology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Chun-Hsing Liao
- Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jonathan Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London NHS Foundation Trust and Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Emmanuel Nsutebu
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Luis Eduardo López-Cortés
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Department of Medicine, University of Seville, Seville, Spain
| | - Laura Morata
- Service of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Martin Llewelyn
- Department of Infectious Diseases and Microbiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Vance G Fowler
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Guy Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Kuss
- German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Düsseldorf, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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187
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Cardenas-Alvarez JL, Suarez J, Motoa G, Anjan S, Natori Y, Loebe M, Breda JR, Thakkar-Rivera N, Phancao A, Ghodsizad A, Bauerlein JE, Munagala MR, Simkins J. Cefazolin plus ertapenem and heart transplantation as salvage therapy for refractory LVAD infection due to methicillin-susceptible Staphylococcus aureus: A case series. J Card Surg 2021; 36:4786-4788. [PMID: 34599521 DOI: 10.1111/jocs.16040] [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] [Received: 07/12/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
The use of left ventricular assist devices (LVADs) is increasingly more common as the availability of donor organs in relation to failing hearts is outstandingly limited. Infections are the most common complications in LVAD recipients, particularly those caused by Staphylococcus spp. Refractory LVAD-related infections are not uncommon as achieving adequate source control is often not feasible before heart transplantation. Evidence suggest that cefazolin plus ertapenem is effective in refractory methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, but this approach has not been described in LVAD recipients. In this article, we report two cases of refractory MSSA bacteremia in LVAD recipients that were successfully treated with salvage therapy with cefazolin plus ertapenem and subsequent heart transplantation. This treatment strategy should be considered in patients with refractory LVAD-associated infection due to MSSA that are not responding to standard treatment.
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Affiliation(s)
- Jorge L Cardenas-Alvarez
- Department of Medicine, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Jose Suarez
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Gabriel Motoa
- Department of Medicine, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Shweta Anjan
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Yoichiro Natori
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Matthias Loebe
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Joao R Breda
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Nina Thakkar-Rivera
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Anita Phancao
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Ali Ghodsizad
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Joseph E Bauerlein
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Mrudula R Munagala
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Jacques Simkins
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
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188
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Staphylococcus aureus Bacteremia in Hospitalized Patients and Associated Factors: A Cross-sectional Study from Mashhad, Iran. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.116313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Staphylococcus aureus is an important cause of resistant infection with high mortality and morbidity. Objectives: We aimed to evaluate the clinical characteristics and comorbidities of patients with S. aureus infection to define the predictors of adverse outcomes. Methods: In this cross-sectional study, patients (aged ≥ 15 years) with positive S. aureus blood cultures were included. Their demographic and clinical characteristics were recorded, and their association with the main adverse outcomes (methicillin-resistant S. aureus [MRSA], infective endocarditis, source of infection, and the final outcome were analyzed using SPSS software version 16. Results: The male-to-female ratio was 54/51. The mean age was 55.13 years (women: 58.45 ± 20.4 and men: 53.6 ± 17.6). Of 105 cases analyzed, 40% had hospital-, 25.7% community-, and 34.3% healthcare-associated bacteremia. The median duration of hospital admission was 13 days. Thirty-two percent had MRSA, differently based on the source of infection (P = 0.029). Twenty-eight patients had infective endocarditis, differently based on the source of infection, prosthetics, considerable foci of infection, and receipt of blood and its derivatives (P < 0.05). Most patients with neurological and end-stage renal disease (both P = 0.001) did not have infective endocarditis. Finally, 61.9% of the patients were discharged with good condition, 38.1% died, and 9% left the hospital before diagnosis of the foci. Conclusions: Vascular catheters and cardiovascular diseases, including hypertension, are among the most common factors associated with S. aureus bacteremia, and it is necessary to carefully examine the presence of these factors, as well as infective endocarditis in these patients.
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189
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Artim CM, Kunala M, O'Leary MK, Alabi CA. PEGylated Oligothioetheramide Prodrugs Activated by Host Serum Proteases. Chembiochem 2021; 22:2697-2702. [PMID: 34227209 PMCID: PMC8497000 DOI: 10.1002/cbic.202100146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/03/2021] [Indexed: 11/08/2022]
Abstract
Due to the increasing prominence of antibiotic resistance, novel drug discovery and delivery approaches targeting bacteria are essential. In this work we evaluate a prodrug design to improve the cytotoxic profile of polycationic oligothioetheramides (oligoTEAs), which are promising antimicrobials. Herein we chemically modify the oligoTEA, PDT-4G, with a polyethylene glycol (PEG) and show that 1, 2, and 5 kDa PEGs mitigate cytotoxicity. As PEGylation reduces antibacterial activity, we evaluate two peptide linkers which, unlike oligoTEAs, are susceptible to proteolytic cleavage in serum. To gain insight into the prodrug reactivation, two linkers were tested, the 5-residue peptide sequence LMPTG, and the dipeptide sequence VC-PABC. In the presence of 20 % serum, prodrugs made with the VC-PABC linker successfully inhibited bacterial growth. Overall, we observed reactivation of oligoTEAs facilitated by serum protease cleavage of the peptide linkers. This work opens the door to the future design of antimicrobial prodrugs with tunable release profiles.
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Affiliation(s)
- Christine M Artim
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, NY 14853, USA
| | - Manisha Kunala
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, NY 14853, USA
| | - Meghan K O'Leary
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, NY 14853, USA
| | - Christopher A Alabi
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, NY 14853, USA
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190
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Exploring healthcare worker attitudes to peripheral vascular catheter management to facilitate policy implementation. J Hosp Infect 2021; 116:99-100. [PMID: 34418525 DOI: 10.1016/j.jhin.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 11/21/2022]
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191
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Daptomycin versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection with or without Endocarditis: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10081014. [PMID: 34439067 PMCID: PMC8389004 DOI: 10.3390/antibiotics10081014] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/05/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of invasive infections, mainly bloodstream infections (BSI) with or without endocarditis. The purpose of this meta-analysis was to compare vancomycin, the mainstay treatment, with daptomycin as therapeutic options in this context. Materials: PubMed, Embase and the Cochrane Database were searched from their inception to 15 February 2020. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, persistence of infection, length-of-stay, antibiotic discontinuation due to adverse events (AEs) and 30-day re-admission. This study was registered with PROSPERO, CRD42020169413. Results: Eight studies (1226 patients, 554 vs. 672 in daptomycin vs. vancomycin, respectively) were included. No significant difference in terms of overall mortality was observed [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.40–1.33, I2 = 67%]. Daptomycin was associated with a significantly reduced risk of clinical failure (OR 0.58, 95% CI 0.38–0.89, I2 = 60%), as confirmed by pooling adjusted effect sizes (adjusted OR against the use of vancomycin 1.94, 95%CI 1.33–1.82, I2 = 41%), and was linked with fewer treatment-limiting AEs (OR 0.15, 95%CI 0.06–0.36, I2 = 19%). No difference emerged between the two treatments as secondary outcomes. Results were not robust to unmeasured confounding (E-value lower than 95% CI 1.00 for all-cause mortality). Conclusions: Against MRSA BSI, with or without endocarditis, daptomycin seems to be associated with a lower risk of clinical failure and treatment-limiting AEs compared with vancomycin. Further studies are needed to better characterize the differences between the two drugs.
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192
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Impact of agr Functionality on the Outcome of Patients with Methicillin-Susceptible Staphylococcus aureus Bacteremia. Microbiol Spectr 2021; 9:e0011621. [PMID: 34378959 PMCID: PMC8552762 DOI: 10.1128/spectrum.00116-21] [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] [Indexed: 12/17/2022] Open
Abstract
Dysfunctional accessory gene regulator (agr) is associated with unfavorable outcomes in invasive methicillin-resistant Staphylococcus aureus infections. However, it is unknown whether this association persists in methicillin-susceptible Staphylococcus aureus bacteremia (MSSA-B). This study evaluated the association between agr dysfunction and mortality in patients with MSSA-B. This retrospective cohort study included MSSA-B patients (≥15 years) enrolled from June 2014 to June 2019 and retrospectively collected their demographic and clinical information. Stored causative strains were measured for agr functionality by δ-hemolysin production assays. Among 244 MSSA-B patients, 91 (37.3%) and 153 (62.7%) had dysfunctional and functional agr MSSA-B, respectively. Ninety-day mortality occurred in 18.7% and 17.6% dysfunctional and functional groups, respectively (P = 0.97). Kaplan-Meier analysis showed that mortality due to dysfunctional agr MSSA-B was not significantly higher (P = 0.82). Age, sites, the severity of infection, and comorbidity adjusted hazard ratio (aHR) of the dysfunctional group for 90-day mortality was 1.303 (95% confidence interval [CI], 0.698 to 2.436, P = 0.41). Mortality due to MSSA-B with sequential organ failure assessment (SOFA) scores of 2 to 5 was significantly higher in the dysfunctional group (P = 0.03), and the dysfunctional agr aHR for 90-day mortality was 3.260 (95% CI, 1.050 to 10.118, P = 0.04). The agr dysfunction of causative organisms can have a significant effect on the outcomes of MSSA-B in patients with moderate severity (SOFA scores 2 to 5). IMPORTANCE Few studies have examined the association between methicillin-susceptible Staphylococcus aureus (MSSA) infection and accessory gene regulator (agr) functionality. We evaluated the association between agr dysfunction and mortality in patients with MSSA bacteremia. Dysfunctional agr is associated with lower survival in MSSA bacteremia patients with moderately severe sequential organ failure assessment (SOFA) scores of 2 to 5. We found that the agr functionality of causative organisms may have an effect on patients’ outcomes in MSSA like in methicillin-resistant S. aureus.
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193
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Kolben Y, Ishay Y, Azmanov H, Rokney A, Baum M, Amit S, Nir-Paz R. Right-sided endocarditis caused by polyclonal Staphylococcus aureus infection. Eur J Med Res 2021; 26:91. [PMID: 34380556 PMCID: PMC8356449 DOI: 10.1186/s40001-021-00549-z] [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: 05/17/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
We present a case of bacterial endocarditis with both methicillin-sensitive and methicillin-resistant Staphylococcus aureus, which based on typing, originated from two distinct clones. Such a case may be misinterpreted by microbiology lab automation to be a monoclonal multi-drug resistant Staphylococcus aureus, while simple microbiology techniques will instantly reveal distinct clonality.
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Affiliation(s)
- Yotam Kolben
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Yuval Ishay
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Henny Azmanov
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Assaf Rokney
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Moti Baum
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Sharon Amit
- Department of Microbiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Microbiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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194
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Chen K, Malik AA, Sheng YJ, Ahmed S, Sun C, Deng CL, Ojha SC. Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis. Front Pediatr 2021; 9:713447. [PMID: 34422731 PMCID: PMC8374148 DOI: 10.3389/fped.2021.713447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Treatment of bloodstream staphylococcal infections (BSI) necessitates the prompt initiation of appropriate antimicrobial agents and the rapid de-escalation of excessive broad-spectrum coverage to reduce the risk of mortality. We, therefore, aimed to demonstrate the diagnostic accuracy of nucleic acid amplification tests (NAAT) for the identification of methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in clinically suspected patients. Methods: Until November 23, 2020, databases including PubMed, Scopus, Embase, and Web of Science were scanned for eligible studies. A bivariate random-effects model was used for meta-analysis of the 33 included studies obtained from 1606 citations, and pooled summary estimates with 95% confidence intervals (CI) were generated. Results: Twenty-three studies (n = 8,547) assessed NAAT accuracy for MSSA detection, while three studies (n = 479) evaluated MRSA detection in adults. The pooled NAAT sensitivity and specificity for MRSA in adults was higher [sensitivity: 0.83 (95% CI 0.59-0.96), specificity: 0.99 (95% CI 0.98-1.0)] as compared to MSSA [sensitivity: 0.76 (95% CI 0.69-0.82), specificity: 0.98 (95% CI 0.98-0.99)]. Similarly, eight studies (n = 4,089) investigating MSSA in pediatric population reported higher NAAT accuracy [sensitivity: 0.89 (95% CI 0.76-0.96), specificity: 0.98 (95% CI 0.97-0.98)] compared to adults. Among NAA tests, SeptiFast (real-time PCR, commercial) was frequently applied, and its diagnostic accuracy corresponded well to the overall summary estimates. A meta-regression and subgroup analysis of study design, sample condition, and patient selection method could not explain the heterogeneity (P > 0.05) in the diagnostic efficiency. Conclusions: NAAT could be applied as the preferred initial tests for timely diagnosis and BSI management.
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Affiliation(s)
- Ke Chen
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Southwest Medical University, Luzhou, China
| | - Aijaz Ahmad Malik
- Faculty of Medical Technology, Center of Data Mining and Biomedical Informatics, Mahidol University, Bangkok, Thailand
| | - Yun-Jian Sheng
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Southwest Medical University, Luzhou, China
| | - Sarfraz Ahmed
- Department of Basic Sciences, University of Veterinary and Animal Sciences Lahore, Narowal, Pakistan
| | - Changfeng Sun
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Southwest Medical University, Luzhou, China
| | - Cun-Liang Deng
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Suvash Chandra Ojha
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Southwest Medical University, Luzhou, China
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Grillo S, Cuervo G, Carratala J, San-Juan R, Aguado JM, Morata L, Gomez-Zorrilla S, López-Contreras J, Gasch O, Gomila-Grange A, Iftimie S, Garcia-Pardo G, Calbo E, Boix-Palop L, Oriol I, Jover-Sáenz A, López-Cortés LE, Euba G, Aguirregabiria M, Garcia-Pais MJ, Gioia F, Paño JR, Pedro-Botet ML, Benítez RM, Pérez-Rodríguez MT, Meije Y, Loeches-Yagüe MB, Horna G, Berbel D, Domínguez MÁ, Padullés A, Cobo S, Hereu P, Videla S, Tebe C, Pallarés N, Miro JM, Pujol M. Multicentre, randomised, open-label, phase IV-III study to evaluate the efficacy of cloxacillin plus fosfomycin versus cloxacillin alone in adult patients with methicillin-susceptible Staphylococcus aureus bacteraemia: study protocol for the SAFO trial. BMJ Open 2021; 11:e051208. [PMID: 34353808 PMCID: PMC8344278 DOI: 10.1136/bmjopen-2021-051208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a frequent condition, with high mortality rates. There is a growing interest in identifying new therapeutic regimens able to reduce therapeutic failure and mortality observed with the standard of care of beta-lactam monotherapy. In vitro and small-scale studies have found synergy between cloxacillin and fosfomycin against S. aureus. Our aim is to test the hypothesis that cloxacillin plus fosfomycin achieves higher treatment success than cloxacillin alone in patients with MSSA bacteraemia. METHODS We will perform a superiority, randomised, open-label, phase IV-III, two-armed parallel group (1:1) clinical trial at 20 Spanish tertiary hospitals. Adults (≥18 years) with isolation of MSSA from at least one blood culture ≤72 hours before inclusion with evidence of infection, will be randomly allocated to receive either cloxacillin 2 g/4-hour intravenous plus fosfomycin 3 g/6-hour intravenous or cloxacillin 2 g/4-hour intravenous alone for 7 days. After the first week, sequential treatment and total duration of antibiotic therapy will be determined according to clinical criteria by the attending physician.Primary endpoints: (1) Treatment success at day 7, a composite endpoint comprising all the following criteria: patient alive, stable or with improved quick-Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA at day 7. (2) Treatment success at test of cure (TOC) visit: patient alive and no isolation of MSSA in blood culture or at another sterile site from day 8 until TOC (12 weeks after randomisation).We assume a rate of treatment success of 74% in the cloxacillin group. Accepting alpha risk of 0.05 and beta risk of 0.2 in a two-sided test, 183 subjects will be required in each of the control and experimental groups to obtain statistically significant difference of 12% (considered clinically significant). ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Bellvitge University Hospital (AC069/18) and from the Spanish Medicines and Healthcare Product Regulatory Agency (AEMPS, AC069/18), and is valid for all participating centres under existing Spanish legislation. The results will be presented at international meetings and will be made available to patients and funders. TRIAL REGISTRATION NUMBER The protocol has been approved by AEMPS with the Trial Registration Number EudraCT 2018-001207-37. ClinicalTrials.gov Identifier: NCT03959345; Pre-results.
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Affiliation(s)
- Sara Grillo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Jordi Carratala
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- University of Barcelona, Barcelona, Spain
| | - Rafael San-Juan
- Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Jose M Aguado
- Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Silvia Gomez-Zorrilla
- Department of Infectious Diseases, Consorci Parc de Salut MAR de Barcelona, Barcelona, Spain
- Institut de Recerca Hospital del Mar, IMIM, Barcelona, Spain
| | - Joaquín López-Contreras
- Department of Infectious diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
| | - Oriol Gasch
- Infectious Diseases Department, Consorcio Corporacion Sanitaria Parc Tauli, Sabadell, Spain
- Institut d'Investigació i Innovació Parc Taulí, I3PT, Sabadell, Spain
| | - Aina Gomila-Grange
- Institut d'Investigació i Innovació Parc Taulí, I3PT, Sabadell, Spain
- Consorcio Corporación Sanitaria Parc Taulí, Sabadell, Spain
| | - Simona Iftimie
- Department of Infection and Immunity, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Graciano Garcia-Pardo
- Departament of Preventive Medicine, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Esther Calbo
- Infectious Diseases Unit, Hospital Universitari MutuaTerrassa, Terrassa, Spain
- Fundació per la Docència i Recerca MútuaTerrassa, Terrassa, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Unit, Hospital Universitari MutuaTerrassa, Terrassa, Spain
- Fundació per la Docència i Recerca MútuaTerrassa, Terrassa, Spain
| | - Isabel Oriol
- Department of Internal Medicine, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
| | - Alfredo Jover-Sáenz
- Territorial Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, IRBLLEIDA, Lleida, Spain
| | - Luis Eduardo López-Cortés
- Department of Infectious diseases, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Gorane Euba
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Malen Aguirregabiria
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Microbiology Department, Hospital Universitario Cruces, Barakaldo, Spain
| | - Maria Jose Garcia-Pais
- Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francesca Gioia
- Department of Infectious diseases, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Jose Ramón Paño
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Maria Luisa Pedro-Botet
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Rosa Maria Benítez
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | | | - Yolanda Meije
- Hospital de Barcelona, Barcelona, Spain
- Societat Cooperativa d'Instal·lacions Assistencials Sanitàries, Barcelona, Spain
| | | | - Gertrudis Horna
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Damaris Berbel
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Microbiology and Parassitology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria Ángeles Domínguez
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Microbiology and Parassitology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Ariadna Padullés
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Pharmacy Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sara Cobo
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Pharmacy Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Pilar Hereu
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sebastian Videla
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Cristian Tebe
- University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Natàlia Pallarés
- University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep M Miro
- Department of Infectious Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
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Deodatus JAA, Paas SFE, Wagenvoort GHJ, de Kubber MM. Case report: appendicitis induced Staphylococcus aureus and Klebsiella pneumoniae bacteremia in a young healthy male. Int J Emerg Med 2021; 14:36. [PMID: 34281508 PMCID: PMC8287795 DOI: 10.1186/s12245-021-00358-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Appendicitis is one of the most frequently encountered conditions at the emergency department. Distinction is made between complicated and uncomplicated appendicitis. Complicated appendicitis may cause serious intra-abdominal infection, bacteremia, or sepsis. Emergency health providers should be highly alert to any early signs indicating such complications. Case presentation We present the case of a healthy young male with a gangrenous appendicitis, who received antibiotics and underwent appendectomy. Blood cultures showed unequivocal Staphylococcus aureus and concomitant Klebsiella pneumoniae bacteremia requiring prolonged antibiotic treatment and further diagnostic evaluation. Conclusions Although rare, appendicitis can cause Staphylococcus aureus and Klebsiella pneumoniae bacteremia with extensive implications for workup and antibiotic management. Our case stresses the importance of obtaining cultures in patients with suspicion of bacteremia given its consequences for clinical management.
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Telles JP, Leme RCP, Campos ML, Ito C, Bail L, Nogueira KDS, Tuon FF. Ceftriaxone and methicillin-susceptible staphylococcus aureus: a perspective from pharmacokinetics/pharmacodynamics studies. Expert Opin Drug Metab Toxicol 2021; 17:1039-1048. [PMID: 34225556 DOI: 10.1080/17425255.2021.1951221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION : Usage of ceftriaxone-based therapy to treat Methicillin-Susceptible Staphylococcus aureus (MSSA) infections is a controversial issue, from in vitro to clinical studies. AREA COVERED : We conducted a literature review using PubMed of articles with ceftriaxone pharmacokinetics parameters and built a probability of target attainment (PTA) based on PK values from stable conditions (non-critically-ill patients) with goals of fT>55%, fT>75%, and fT>100%. Ceftriaxone's minimal inhibitory concentration from 31 MSSA strains (0.25-64mg/L) was used to build the cumulative fraction response (CFR). The isolates were clinically relevant from blood, bronchoalveolar lavage, and soft tissue biopsy. EXPERT OPINION The results from controversies about using ceftriaxone for MSSA infections have been commonly addressed in the literature. However, variables such as (i) pharmacokinetic profile, (ii) pharmacodynamic target, (iii) site of infection, and (iv) MIC distributions may influence divergences. From this pharmacokinetics-pharmacodynamics perspective, ceftriaxone may be a reasonable option for MSSA infections when the MIC50 and MIC90 were 4mg/L and 8mg/L. CFR analysis demonstrated that ceftriaxone 1g q24h could be used if bacteriostasis is the aim (fT>55%), while 1g q12h should be used for bactericidal effects (fT>75% or fT>100%). Since there is a lack of data from clinical trials, the findings should be interpreted cautiously.
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Affiliation(s)
- Joao Paulo Telles
- AC Camargo Cancer Center, Department of Infectious Diseases, São Paulo - SP, Brazil.,Hospital Universitário Evangélico Mackenzie, Curitiba - PR, Brazil
| | | | - Michel Leandro Campos
- Federal University of Mato Grosso, Health Sciences Institute, Sinop, Mato Grosso, Brazil
| | - Carmen Ito
- Division of Microbiology, Universidade Estadual de Ponta Grossa, Ponta Grossa - PR, Brazil.,Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba - PR, Brazil
| | - Larissa Bail
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba - PR, Brazil
| | - Keite da Silva Nogueira
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba - PR, Brazil.,Basic Pathology Department, Universidade Federal do Paraná, Curitiba - PR, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba - PR, Brazil
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Daptomycin Pharmacokinetics and Pharmacodynamics in Patients on Methadone Substitution Therapy. Eur J Drug Metab Pharmacokinet 2021; 46:547-554. [PMID: 34231117 DOI: 10.1007/s13318-021-00690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE When administered for severe infections in intravenous drug users (IDUs) at a daily dose of 6 mg/kg, daptomycin displayed abnormal pharmacokinetic parameters compared with those seen in healthy volunteers; specifically, decreased trough and maximum concentrations (Ctrough; Cmax) and increased clearance (CL). The objective of this study was to evaluate the pharmacokinetics and pharmacodynamics of daptomycin administered at a daily dosage of 12 mg/kg for Staphylococcus aureus infective endocarditis (IE) in patients concomitantly treated with methadone, and to compare the results with those published in the literature for healthy controls treated with the same daily dose. METHODS Antibiotic treatment included daptomycin (12 mg/kg daily) in combination with an antistaphylococcal β-lactam (cefazolin 2 g three times a day). The minimum inhibitory concentration (MIC) of Staphylococcus aureus isolated through blood cultures was used to calculate pharmacokinetic and pharmacodynamic parameters such as the ratio of the area under the concentration-time curve over 24 h to the MIC (AUC0-24/MIC) and Cmax/MIC. RESULTS Five IDUs hospitalized for IE were enrolled. The mean measured daptomycin Cmax and Ctrough were 54.1 μg/mL (CV: 0.32) and 8.7 μg/mL (CV: 0.59), respectively; the mean calculated AUC0-24 was 742.7 μg × h/mL (CV: 0.31). The estimated average volume of distribution at the steady state (Vd,ss) and the half-life (t1/2) were 316.5 mL/kg (CV: 0.53) and 14.4 h (CV: 0.30), respectively. The mean daptomycin clearance from plasma normalized for body weight (CLwp) was 17.3 mL/(h × kg) (CV: 0.33). The calculated average Cmax and AUC0-24 (183.7 µg/mL and 1277.4 µg × h/mL, respectively) were lower than and statistically significantly different from (p < 0.001 and p = 0.001, respectively) those expected for healthy volunteers. CONCLUSIONS Treatment of Staphylococcus aureus IE in IDUs on methadone treatment requires the use of high daptomycin daily doses in order to achieve satisfactory pharmacodynamic parameters. Close monitoring of the daptomycin plasma concentration is suggested.
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199
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Curating and comparing 114 strain-specific genome-scale metabolic models of Staphylococcus aureus. NPJ Syst Biol Appl 2021; 7:30. [PMID: 34188046 PMCID: PMC8241996 DOI: 10.1038/s41540-021-00188-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/25/2021] [Indexed: 12/19/2022] Open
Abstract
Staphylococcus aureus is a high-priority pathogen causing severe infections with high morbidity and mortality worldwide. Many S. aureus strains are methicillin-resistant (MRSA) or even multi-drug resistant. It is one of the most successful and prominent modern pathogens. An effective fight against S. aureus infections requires novel targets for antimicrobial and antistaphylococcal therapies. Recent advances in whole-genome sequencing and high-throughput techniques facilitate the generation of genome-scale metabolic models (GEMs). Among the multiple applications of GEMs is drug-targeting in pathogens. Hence, comprehensive and predictive metabolic reconstructions of S. aureus could facilitate the identification of novel targets for antimicrobial therapies. This review aims at giving an overview of all available GEMs of multiple S. aureus strains. We downloaded all 114 available GEMs of S. aureus for further analysis. The scope of each model was evaluated, including the number of reactions, metabolites, and genes. Furthermore, all models were quality-controlled using MEMOTE, an open-source application with standardized metabolic tests. Growth capabilities and model similarities were examined. This review should lead as a guide for choosing the appropriate GEM for a given research question. With the information about the availability, the format, and the strengths and potentials of each model, one can either choose an existing model or combine several models to create models with even higher predictive values. This facilitates model-driven discoveries of novel antimicrobial targets to fight multi-drug resistant S. aureus strains.
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Rieg S, Ernst A, Peyerl-Hoffmann G, Joost I, Camp J, Hellmich M, Kern WV, Kaasch AJ, Seifert H. Combination therapy with rifampicin or fosfomycin in patients with Staphylococcus aureus bloodstream infection at high risk for complications or relapse: results of a large prospective observational cohort. J Antimicrob Chemother 2021; 75:2282-2290. [PMID: 32355950 DOI: 10.1093/jac/dkaa144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To investigate whether Staphylococcus aureus bloodstream infection (SAB) patients at high risk for complications or relapse benefit from combination therapy with adjunctive rifampicin or fosfomycin. METHODS In this post hoc analysis, SAB patients with native valve infective endocarditis, osteoarticular infections or implanted foreign devices were included. The co-primary endpoints were all-cause 90 day mortality and death or SAB-related late complications within 180 days. To overcome treatment selection bias and account for its time dependence, inverse probability of treatment weights were calculated and included in marginal structural Cox proportional hazard models (MSCMs). RESULTS A total of 578 patients were included in the analysis, of which 313 (54%) received combination therapy with either rifampicin (n = 242) or fosfomycin (n = 58). In the multivariable MSCM, combination therapy was associated with a better outcome, that is, a lower rate of death or SAB-related late complications within 180 days (HR 0.65, 95% CI 0.46-0.92). This beneficial effect was primarily seen in patients with implanted foreign devices, in which combination therapy was associated with a lower rate of death or SAB-related late complications within 180 days (HR 0.53, 95% CI 0.35-0.79) and a lower 90 day mortality (HR 0.57, 95% CI 0.36-0.91). Upon agent-specific stratification, we found no significant differences in outcomes between combination therapy containing rifampicin and fosfomycin; however, the number of patients in most subgroups was not large enough to draw firm conclusions. CONCLUSIONS In patients with implanted foreign devices, combination therapy was associated with a better long-term outcome. Larger prospective studies are needed to validate these findings.
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, 50924 Cologne, Germany
| | - Gabriele Peyerl-Hoffmann
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Insa Joost
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, 50924 Cologne, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, 50937 Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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