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Briol S, Gheysens O, Jamar F, Yildiz H, De Greef J, Cyr Yombi J, Verroken A, Belkhir L. Impact of [ 18F] FDG PET/CT on outcomes in patients with Staphylococcus aureus bacteremia: A retrospective single-center experience. Infect Dis Now 2024:104977. [PMID: 39276874 DOI: 10.1016/j.idnow.2024.104977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 09/06/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE Staphylococcus aureus bacteremia (SAB) is a leading cause of community and hospital-acquired bacteremia with significant morbidity and mortality. Effective management depends on accurate diagnosis, source control and assessment of metastatic infections. [18F] FDG PET/CT has been shown to reduce mortality in high-risk SAB patients. This study aims to evaluate the impact of [18F] FDG PET/CT on outcomes in patients with SAB. METHODS Single-center, retrospective, real-life setting study including all consecutive SAB cases from 2017 to 2019. Medical records were analyzed to collect information. RESULTS Out of the 315 included patients, 132 underwent [18F] FDG PET/CT. In those patients, a clear focus of infection was more frequently identified, leading to better adapted treatments and extended hospital stays. Overall mortality rates at 30 days, 90 days and one year were 25.1 %, 36.8 % and 44.8 % respectively. Mortality was significantly lower in the [18F] FDG PET/CT group (p < 0.0001) and persisted (p < 0.05) after adjusting for imbalances between groups regarding oncologic patients and deaths within 7 days. The difference in mortality remained significant irrespective of prolonged bacteremia but was not significant with regard to hospital-acquired SAB. Supplementary analysis using the Cox proportional hazards model confirmed that [18F] FDG PET/CT was significantly associated with reduced mortality (p < 0.05). CONCLUSION In this real-life cohort, patients with SAB having undergone [18F] FDG PET/CT experienced lower mortality rates, highlighting the additional value of [18F] FDG PET/CT in SAB management. Further research is needed to identify the subpopulations that would benefit most from the integration of [18F] FDG PET/CT in their work-up.
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Affiliation(s)
- Sébastien Briol
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium.
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium
| | - Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium
| | - Julien De Greef
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Alexia Verroken
- Department of Microbiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Leïla Belkhir
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
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Sykora D, Crowley PD, Abu Saleh OM. 79-Year-Old Man With Dysuria, Fever, and Back Pain. Mayo Clin Proc 2024; 99:1482-1487. [PMID: 38912992 DOI: 10.1016/j.mayocp.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 06/25/2024]
Affiliation(s)
- Daniel Sykora
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Patrick D Crowley
- Fellow in Infectious Diseases, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Omar M Abu Saleh
- Advisor to resident and fellow and Consultant in Infectious Diseases, Mayo Clinic, Rochester, MN.
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Fukushima S, Hagiya H, Kuninaga N, Haruki Y, Yamada H, Iwamoto Y, Yoshida M, Sato K, Hanayama Y, Tanaka S, Miyoshi T, Otsuka Y, Ueda K, Otsuka F. Adherence to and clinical utility of "quality indicators" for Staphylococcus aureus bacteremia: a retrospective, multicenter study. Infection 2024; 52:1527-1538. [PMID: 38727926 PMCID: PMC11289132 DOI: 10.1007/s15010-024-02284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND We aimed to improve the prognosis, treatment, and management of Staphylococcus aureus bacteremia (SAB) by evaluating the association between adherence to quality indicators (QIs) and clinical outcomes in patients with their clinical outcomes. METHODS We retrospectively collected clinical and microbiological data on hospitalized patients with SAB from 14 hospitals (three with > 600, two with 401-600, five with 201-400, and four with ≤ 200 beds) in Japan from January to December 2022. The SAB management quality was evaluated using the SAB-QI score (ranging from 0 to 13 points), which consists of 13 QIs (grouped into five categories) based on previous literature. RESULTS Of the 4,448 positive blood culture episodes, 289 patients with SAB (6.5%) were enrolled. The SAB-QI scores ranged from 3 to 13, with a median score of 9 points. The SAB-QI score was highest in middle-sized hospitals with 401-600 beds. Adherence to each of the four QI categories (blood culture, echocardiography, source control, and antibiotic treatment) was significantly higher in survived cases than in fatal cases. Kaplan-Meier curves with log-rank tests demonstrated that higher adherence to SAB-QIs indicated a better prognosis. Logistic regression analysis revealed that age, methicillin resistance, multiple comorbidities (≥ 2), and low SAB-QI score were significantly associated with 30-day mortality in patients with SAB. CONCLUSIONS Our study highlights that greater adherence to the SAB-QIs correlates with improved patient outcomes. Management of patients with SAB should follow these recommended indicators to maintain the quality of care, especially for patients with poor prognosticators.
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Affiliation(s)
- Shinnosuke Fukushima
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Bacteriology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Infectious Diseases, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama, 700-8558, Japan
| | - Hideharu Hagiya
- Department of Infectious Diseases, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama, 700-8558, Japan.
| | - Naoki Kuninaga
- Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Yuto Haruki
- Department of Pharmacy, Tsuyama Chuo Hospital, Okayama, Japan
| | - Haruto Yamada
- Department of General Medicine, Okayama City Hospital, Okayama, Japan
| | - Yoshitaka Iwamoto
- Department of General Medicine, Okayama Medical Center, Okayama, Japan
| | - Masayo Yoshida
- Department of General Medicine, Okayama Kyoritsu Hospital, Okayama, Japan
| | - Kota Sato
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Yoshihisa Hanayama
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shuichi Tanaka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Miyoshi
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keigo Ueda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Beadell B, Yamauchi J, Wong-Beringer A. Comparative in vitro efficacy of antibiotics against the intracellular reservoir of Staphylococcus aureus. J Antimicrob Chemother 2024:dkae241. [PMID: 39073778 DOI: 10.1093/jac/dkae241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Staphylococcus aureus (SA) is a leading cause of bloodstream infection. The liver represents the sentinel immune organ for clearance of bloodstream pathogens and eradication of intracellular SA from liver-resident macrophages (Kupffer cells, KCs) eliminates the likely pathogenic reservoir that contributes to persistent bacteraemia. OBJECTIVES We assessed antimicrobial activity at phagolysosome-mimicking pH, intracellular penetration, and SA eradication within KCs in vitro for clinically prescribed antistaphylococcal agents alone or in combination: vancomycin, daptomycin, ceftaroline, ceftobiprole, oritavancin, oxacillin, cefazolin; rifampin and fosfomycin. METHODS pH-adjusted broth microdilution assays, intracellular bioaccumulation assays, and intracellular killing assays against clinical bloodstream isolates were performed using a murine KC line with study agents. RESULTS Rifampin and β-lactams exhibited enhanced activity [2- to 16-fold minimum inhibitory concentrations (MIC) decrease] at phagolysosomal pH while vancomycin, oritavancin, daptomycin and fosfomycin demonstrated reduced activity (2- to 32-fold MIC increase in order of least to greatest potency reduction). All agents evaluated had poor to modest intracellular to extracellular concentration ratios (0.024-7.8), with exceptions of rifampin and oritavancin (intracellular to extracellular ratios of 17.4 and 78.2, respectively). Finally, we showed that the first-line treatment for SA bacteraemia (SAB), vancomycin, performed worse than all other tested antibiotics in eradicating intracellular SA at human Cmax concentration (0.20 log cfu decrease), while oritavancin performed better than all other agents alone (2.05 versus 1.06-1.36 log cfu decrease). CONCLUSIONS Our findings raise concerns about the efficacy of commonly prescribed antibiotics against intracellular SA reservoirs and emphasize the need to consider targeting pathogen eradication from the liver to achieve early control of SAB.
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Affiliation(s)
- Brent Beadell
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
| | - Joe Yamauchi
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
| | - Annie Wong-Beringer
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
- Department of Pharmacy, Huntington Hospital, Pasadena, CA, USA
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Nappi F. Native Infective Endocarditis: A State-of-the-Art-Review. Microorganisms 2024; 12:1481. [PMID: 39065249 PMCID: PMC11278776 DOI: 10.3390/microorganisms12071481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Native valve infective endocarditis (NVE) is a global phenomenon, defined by infection of a native heart valve and involving the endocardial surface. The causes and epidemiology of the disease have evolved in recent decades, with a doubling of the average patient age. A higher incidence was observed in patients with implanted cardiac devices that can result in right-sided infection of the tricuspid valve. The microbiology of the disease has also changed. Previously, staphylococci, which are most often associated with health-care contact and invasive procedures, were the most common cause of the disease. This has now been superseded by streptococci. While innovative diagnostic and therapeutic strategies have emerged, mortality rates have not improved and remain at 30%, which is higher than that for many cancer diagnoses. The lack of randomized trials and logistical constraints impede clinical management, and long-standing controversies such as the use of antibiotic prophylaxis persist. This state of the art review addresses clinical practice, controversies, and strategies to combat this potentially devastating disease. A multidisciplinary team will be established to provide care for patients with presumptive NVE. The composition of the team will include specialists in cardiology, cardiovascular surgery, and infectious disease. The prompt administration of combination antimicrobial therapy is essential for effective NVE treatment. Additionally, a meticulous evaluation of each patient is necessary in order to identify any indications for immediate valve surgery. With the intention of promoting a more comprehensive understanding of the procedural management of native infective endocarditis and to furnish clinicians with a reference, the current evidence for the utilization of distinct strategies for the diagnosis and treatment of NVE are presented.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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McGuire E, Collin SM, Brown CS, Saito M. Community-Acquired Staphylococcus aureus Bacteremia Among People Who Inject Drugs: A National Cohort Study in England, 2017-2020. Clin Infect Dis 2024; 78:1443-1450. [PMID: 38315893 PMCID: PMC11175704 DOI: 10.1093/cid/ciae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk of community-acquired Staphylococcus aureus bacteremia (CA-SAB), but little is known about clinical outcomes of CA-SAB in PWID compared with the wider population of patients with CA-SAB. METHODS Three national datasets were linked to provide clinical and mortality data on patients hospitalized with CA-SAB in England between 1 January 2017 and 31 December 2020. PWID were identified using the International Classification of Diseases, Tenth Revision code for "mental health and behavioral disorder due to opioid use" (F11). Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for associations of PWID with 30-day all-cause mortality and 90-day hospital readmission. RESULTS In 10 045 cases of CA-SAB, 1612 (16.0%) were PWID. Overall, 796 (7.9%) patients died within 30 days of CA-SAB admission and 1189 (11.8%) patients were readmitted to hospital within 90 days of CA-SAB. In those without infective endocarditis, there was strong evidence of lower odds of mortality among PWID compared with non-PWID (aOR, 0.47 [95% confidence interval {CI}: .33-.68]; P < .001), whereas there was no association in CA-SAB case fatality with endocarditis (aOR, 1.40 [95% CI: .87-2.25]; P = .163). PWID were less likely to be readmitted within 90 days of CA-SAB (aOR, 0.79 [95% CI: .65-.95]; P = .011). CONCLUSIONS In this large cohort study of patients with CA-SAB in England, PWID had lower odds of death in the absence of endocarditis and lower odds of readmission within 90 days compared to non-PWID patients. This study highlights the overrepresentation of PWID among patients with CA-SAB nationally.
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Affiliation(s)
- Emma McGuire
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU), and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon M Collin
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Colin S Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU), and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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Kim T, Lee SR, Park SY, Moon SM, Jung J, Kim MJ, Sung H, Kim MN, Kim SH, Choi SH, Lee SO, Kim YS, Song EH, Chong YP. Validation of a new risk stratification system-based management for methicillin-resistant Staphylococcus aureus bacteraemia: analysis of a multicentre prospective study. Eur J Clin Microbiol Infect Dis 2024; 43:841-851. [PMID: 38411778 DOI: 10.1007/s10096-024-04790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Distinguishing between complicated and uncomplicated Staphylococcus aureus bacteraemia (SAB) is therapeutically essential. However, this distinction has limitations in reflecting the heterogeneity of SAB and encouraging targeted diagnostics. Recently, a new risk stratification system for SAB metastatic infection, involving stepwise approaches to diagnosis and treatment, has been suggested. We assessed its applicability in methicillin-resistant SAB (MRSAB) patients. METHODS We retrospectively analysed data of a 3-year multicentre, prospective cohort of hospitalised patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes. RESULTS Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection. No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 19.6% in the high-risk groups (P < 0.001). After an in-depth diagnostic work-up, patients were finally diagnosed as 'without metastatic infection (6.3%)', 'with metastatic infection (17.4%)', and 'uncertain for metastatic infection (76.3%)'. 30-day mortality increased as the severity of diagnosis shifted from 'without metastatic infection' to 'uncertain for metastatic infection' and 'with metastatic infection' (P = 0.09). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteraemia score ≥ 4, and persistent bacteraemia. CONCLUSIONS The new risk stratification system shows promise in predicting metastatic complications and guiding work-up and management of MRSAB. However, reducing the number of cases labelled as 'high-risk' and 'uncertain for metastatic infection' remains an area for improvement.
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Affiliation(s)
- Taeeun Kim
- Division of Infectious Diseases, Department of Medicine, Nowon Eulji University Hospital, Seoul, Republic of Korea
| | - Sang-Rok Lee
- Division of Infectious Diseases, Department of Internal Medicine, Cheongju St Mary's Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Seong Yeon Park
- Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Song Mi Moon
- Department of Internal Medicine at Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Department of Internal Medicine, Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Eun Hee Song
- Departments of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Republic of Korea.
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
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Słabisz N, Leśnik P, Żybura-Wszoła K, Dudek-Wicher R, Nawrot U, Majda J. Assessing the Interpretation of Molecular Test Results in the Diagnosis of Bloodstream Infections. Diagnostics (Basel) 2024; 14:915. [PMID: 38732329 PMCID: PMC11083173 DOI: 10.3390/diagnostics14090915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
A retrospective study at the 4th Military Clinical Hospital in Wroclaw, Poland, assessed PCR testing alongside blood cultures to guide antimicrobial therapy decisions in hospitalized patients, to determine how much time the results of the molecular tests preceded conventional methods. Among 118 patients, Staphylococcus aureus (37%) and Escherichia coli (21%) were the most common bloodstream infection agents. Blood cultures utilized the BacT/ALERT 3D system, and molecular diagnostics were conducted using the FilmArray platform with the BIOFIRE BCID2 panel. Methicillin susceptibility was observed in 66% of S. aureus strains, while 26% of Gram-negative bacilli exhibited an ESBL phenotype. Therapeutic decisions based on molecular test results were often incorrect for S. aureus infections, particularly MSSA (64.5%), but generally accurate for Gram-negative bacilli. The median times from positive blood culture to BCID2 and pathogen identification/susceptibility were 10 h and 52 h, respectively. Molecular diagnostics facilitated faster initiation of appropriate antibiotic therapy, highlighting the need to educate medical staff on proper interpretation. Consulting within an antimicrobial stewardship program (ASP) could enhance the benefits of implementing molecular methods in bloodstream infection diagnostics.
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Affiliation(s)
- Natalia Słabisz
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
| | - Patrycja Leśnik
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, 50-386 Wroclaw, Poland;
| | - Katarzyna Żybura-Wszoła
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
| | - Ruth Dudek-Wicher
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (R.D.-W.); (U.N.)
| | - Urszula Nawrot
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (R.D.-W.); (U.N.)
| | - Jacek Majda
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
- Department of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and Technology, 58-376 Wroclaw, Poland
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van der Vaart TW, Prins JM, Goorhuis A, Lemkes BA, Sigaloff KCE, Spoorenberg V, Stijnis C, Bonten MJM, van der Meer JTM. The Utility of Risk Factors to Define Complicated Staphylococcus aureus Bacteremia in a Setting With Low Methicillin-Resistant S. aureus Prevalence. Clin Infect Dis 2024; 78:846-854. [PMID: 38157401 PMCID: PMC11006106 DOI: 10.1093/cid/ciad784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Recommended duration of antibiotic treatment of Staphylococcus aureus bacteremia (SAB) is frequently based on distinguishing uncomplicated and complicated SAB, and several risk factors at the onset of infection have been proposed to define complicated SAB. Predictive values of risk factors for complicated SAB have not been validated, and consequences of their use on antibiotic prescriptions are unknown. METHODS In a prospective cohort, patients with SAB were categorized as complicated or uncomplicated through adjudication (reference definition). Associations and predictive values of 9 risk factors were determined, compared with the reference definition, as was accuracy of Infectious Diseases Society of America (IDSA) criteria that include 4 risk factors, and the projected consequences of applying IDSA criteria on antibiotic use. RESULTS Among 490 patients, 296 (60%) had complicated SAB. In multivariable analysis, persistent bacteremia (odds ratio [OR], 6.8; 95% confidence interval [CI], 3.9-12.0), community acquisition of SAB (OR, 2.9; 95% CI, 1.9-4.7) and presence of prosthetic material (OR, 2.3; 95% CI, 1.5-3.6) were associated with complicated SAB. Presence of any of the 4 risk factors in the IDSA definition of complicated SAB had a positive predictive value of 70.9% (95% CI, 65.5-75.9) and a negative predictive value of 57.5% (95% CI, 49.1-64.8). Compared with the reference, IDSA criteria yielded 24 (5%) false-negative and 90 (18%) false-positive classifications of complicated SAB. Median duration of antibiotic treatment of these 90 patients was 16 days (interquartile range, 14-19), all with favorable clinical outcome. CONCLUSIONS Risk factors have low to moderate predictive value to identify complicated SAB and their use may lead to unnecessary prolonged antibiotic use.
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Affiliation(s)
- Thomas W van der Vaart
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bregtje A Lemkes
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kim C E Sigaloff
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Veroniek Spoorenberg
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis Stijnis
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan T M van der Meer
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Zhang M, Liu T, Yang J. Skin neuropathy and immunomodulation in diseases. FUNDAMENTAL RESEARCH 2024; 4:218-225. [PMID: 38933512 PMCID: PMC11197692 DOI: 10.1016/j.fmre.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/14/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Skin is a vital barrier tissue of the body. Immune responses in the skin must be precisely controlled, which would otherwise cause severe disease conditions such as psoriasis, atopic dermatitis, or pathogenic infection. Research evidence has increasingly demonstrated the essential roles of neural innervations, i.e., sensory and sympathetic signals, in modulating skin immunity. Notably, neuropathic changes of such neural structures have been observed in skin disease conditions, implicating their direct involvement in various pathological processes. An in-depth understanding of the mechanism underlying skin neuropathy and its immunomodulatory effects could help reveal novel entry points for therapeutic interventions. Here, we summarize the neuroimmune interactions between neuropathic events and skin immunity, highlighting the current knowledge and future perspectives of this emerging research frontier.
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Affiliation(s)
- Manze Zhang
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Tingting Liu
- Department of Biochemistry, Weill Cornell Medical College, New York, NY 10065, USA
| | - Jing Yang
- IDG/McGovern Institute for Brain Research, Center for Life Sciences, School of Life Sciences, Peking University, Beijing 100871, China
- Peking University Third Hospital Cancer Center, Beijing 100191, China
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11
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Rasmussen M, Gilje P, Fagman E, Berge A. Bacteraemia with gram-positive bacteria-when and how do I need to look for endocarditis? Clin Microbiol Infect 2024; 30:306-311. [PMID: 37659693 DOI: 10.1016/j.cmi.2023.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Patients with bacteraemia caused by gram-positive bacteria are at risk for infective endocarditis (IE). Because IE needs long antibiotic treatment and sometimes heart valve surgery, it is very important to identify patients with IE. OBJECTIVES In this narrative review we present and discuss how to determine which investigations to detect IE that are needed in individual patients with gram-positive bacteraemia. SOURCES Published original studies and previous reviews in English, within the relevant field are used. CONTENT First, the different qualities of the bacteraemia in relation to IE risk are discussed. The risk for IE in bacteraemia is related to the species of the bacterium but also to monomicrobial bacteraemia and the number of positive cultures. Second, patient-related factors for IE risk in bacteraemia are presented. Next, the risk stratification systems to determine the risk for IE in gram-positive bacteraemia caused by Staphylococcus aureus, viridans streptococci, and Enterococcus faecalis are presented and their use is discussed. In the last part of the review, an account for the different modalities of IE-investigations is given. The main focus is on echocardiography, which is the cornerstone of IE-investigations. Furthermore, 18F-fluorodesoxyglucose positron emission tomography/computed tomography and cardiac computed tomography are presented and their use is also discussed. A brief account for investigations used to identify embolic phenomena in IE is also given. Finally, we present a flowchart suggesting which investigations to perform in relation to IE in patients with gram-positive bacteraemia. IMPLICATIONS For the individual patient as well as the healthcare system, it is important both to diagnose IE and to decide when to stop looking for IE. This review might be helpful in finding that balance.
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Affiliation(s)
- Magnus Rasmussen
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden; Department for Infectious Diseases, Skåne University Hospital, Lund, Sweden.
| | - Patrik Gilje
- Department of Cardiology, Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden
| | - Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Berge
- Unit of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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12
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Crozier D, Gray JM, Maltas JA, Bonomo RA, Burke ZDC, Card KJ, Scott JG. The evolution of diverse antimicrobial responses in vancomycin-intermediate Staphylococcus aureus and its therapeutic implications. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.30.569373. [PMID: 38077036 PMCID: PMC10705500 DOI: 10.1101/2023.11.30.569373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Staphylococcus aureus causes endocarditis, osteomyelitis, and bacteremia. Clinicians often prescribe vancomycin as an empiric therapy to account for methicillin-resistant S. aureus (MRSA) and narrow treatment based on culture susceptibility results. However, these results reflect a single time point before empiric treatment and represent a limited subset of the total bacterial population within the patient. Thus, while they may indicate that the infection is susceptible to a particular drug, this recommendation may no longer be accurate during therapy. Here, we addressed how antibiotic susceptibility changes over time by accounting for evolution. We evolved 18 methicillin-susceptible S. aureus (MSSA) populations under increasing vancomycin concentrations until they reached intermediate resistance levels. Sequencing revealed parallel mutations that affect cell membrane stress response and cell-wall biosynthesis. The populations exhibited repeated cross-resistance to daptomycin and varied responses to meropenem, gentamicin, and nafcillin. We accounted for this variability by deriving likelihood estimates that express a population's probability of exhibiting a drug response following vancomycin treatment. Our results suggest antistaphylococcal penicillins are preferable first-line treatments for MSSA infections but also highlight the inherent uncertainty that evolution poses to effective therapies. Infections may take varied evolutionary paths; therefore, considering evolution as a probabilistic process should inform our therapeutic choices.
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13
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Adamu Y, Puig-Asensio M, Dabo B, Schweizer ML. Comparative effectiveness of daptomycin versus vancomycin among patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: A systematic literature review and meta-analysis. PLoS One 2024; 19:e0293423. [PMID: 38381737 PMCID: PMC10881006 DOI: 10.1371/journal.pone.0293423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/12/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND In the treatment of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs), vancomycin stands as the prevalent therapeutic agent. Daptomycin remains an alternative antibiotic to treat MRSA BSIs in cases where vancomycin proves ineffective. However, studies have conflicted on whether daptomycin is more effective than vancomycin among patients with MRSA BSI. OBJECTIVE To compare the effectiveness of daptomycin and vancomycin for the prevention of mortality among adult patients with MRSA BSI. METHODS Systematic searches of databases were performed, including Embase, PubMed, Web of Science, and Cochrane Library. The Newcastle Ottawa Scale (NOS) and Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) were used to assess the quality of individual observational and randomized control studies, respectively. Pooled odd ratios were calculated using random effects models. RESULTS Twenty studies were included based on a priori set inclusion and exclusion criteria. Daptomycin treatment was associated with non-significant lower mortality odds, compared to vancomycin treatment (OR = 0.81; 95% CI, 0.62, 1.06). Sub-analyses based on the time patients were switched from another anti-MRSA treatment to daptomycin demonstrated that switching to daptomycin within 3 or 5 days was significantly associated with 55% and 45% decreased odds of all-cause mortality, respectively. However, switching to daptomycin any time after five days of treatment was not significantly associated with lower odds of mortality. Stratified analysis based on vancomycin minimum inhibitory concentration (MIC) revealed that daptomycin treatment among patients infected with MRSA strains with MIC≥1 mg/L was significantly associated with 40% lower odds of mortality compared to vancomycin treatment. CONCLUSION Compared with vancomycin, an early switch from vancomycin to daptomycin was significantly associated with lower odds of mortality. In contrast, switching to daptomycin at any time only showed a trend towards reduced mortality, with a non-significant association. Therefore, the efficacy of early daptomycin use over vancomycin against mortality among MRSA BSIs patients may add evidence to the existing literature in support of switching to daptomycin early over remaining on vancomycin. More randomized and prospective studies are needed to assess this association.
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Affiliation(s)
- Yau Adamu
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University, Kano, Nigeria
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Bashir Dabo
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Marin L. Schweizer
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States of America
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14
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Sela U, Corrêa da Rosa JM, Fischetti VA, Cohen JE. Quantifying how much host, pathogen, and other factors affect human protective adaptive immune responses. Front Immunol 2024; 15:1330253. [PMID: 38410519 PMCID: PMC10895049 DOI: 10.3389/fimmu.2024.1330253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Recognizing the "essential" factors that contribute to a clinical outcome is critical for designing appropriate therapies and prioritizing limited medical resources. Demonstrating a high correlation between a factor and an outcome does not necessarily imply an essential role of the factor to the outcome. Human protective adaptive immune responses to pathogens vary among (and perhaps within) pathogenic strains, human individual hosts, and in response to other factors. Which of these has an "essential" role? We offer three statistical approaches that predict the presence of newly contributing factor(s) and then quantify the influence of host, pathogen, and the new factors on immune responses. We illustrate these approaches using previous data from the protective adaptive immune response (cellular and humoral) by human hosts to various strains of the same pathogenic bacterial species. Taylor's law predicts the existence of other factors potentially contributing to the human protective adaptive immune response in addition to inter-individual host and intra-bacterial species inter-strain variability. A mixed linear model measures the relative contribution of the known variables, individual human hosts and bacterial strains, and estimates the summed contributions of the newly predicted but unknown factors to the combined adaptive immune response. A principal component analysis predicts the presence of sub-variables (currently not defined) within bacterial strains and individuals that may contribute to the combined immune response. These observations have statistical, biological, clinical, and therapeutic implications.
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Affiliation(s)
- Uri Sela
- Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York, NY, United States
| | - Joel M. Corrêa da Rosa
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Vincent A. Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York, NY, United States
| | - Joel E. Cohen
- Laboratory of Populations, The Rockefeller University, New York, NY, United States
- Department of Statistics, Columbia University, New York, NY, United States
- Department of Statistics, University of Chicago, Chicago, IL, United States
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15
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Nguyen N, Chua HC, Drake T, Jo J, Stramel SA, Vuong NN, Gonzales-Luna AJ, Olson K, On Behalf Of The Houston Infectious Diseases Network. Significant Publications on Infectious Diseases Pharmacotherapy in 2021. J Pharm Pract 2024; 37:198-211. [PMID: 36122416 DOI: 10.1177/08971900221128334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To summarize the most noteworthy infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2021. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were deemed to have significant contributions to ID pharmacotherapy in 2021. These nominations included articles pertaining to both general ID, including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. A total of 35 articles were nominated by HIDN: 30 articles pertaining to general ID pharmacotherapy and 5 articles with HIV/AIDS focus. To select the most influential articles of 2021, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 239 SIDP members who responded to the survey, there were 192 recorded votes for the top 10 general ID pharmacotherapy articles and 47 recorded votes for the top HIV/AIDS article, respectively. The top publications are summarized. Conclusion: Antimicrobial stewardship and the optimal management of infectious disease states continues to be a priority in the midst of the ongoing coronavirus disease 2019 (COVID-19) global pandemic. In light of the sheer volume of ID-related articles published in the past year, this review aims to aid clinicians in remaining up-to-date on key practice-changing ID pharmacotherapy publications from 2021.
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Affiliation(s)
- Nhi Nguyen
- Department of Pharmacy, The University of Texas Medical Branch, Galveston, TX, USA
| | - Hubert C Chua
- Department of Pharmacy, CHI Baylor St Luke's Medical Center, Houston, TX, USA
| | - Ty Drake
- Department of Pharmacy, Houston Methodist Willowbrook Hospital, Houston, TX, USA
| | - Jinhee Jo
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Stefanie Anne Stramel
- Department of Pharmacy, Memorial Hermann Memorial City Medical Center, Houston, TX, USA
| | - Nancy N Vuong
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Kelsey Olson
- Department of Pharmacy, HCA Houston Healthcare Clear Lake, Webster, TX, USA
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16
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Xiao CY, Lan JE, Liu X, Sun ZL, Li XJ, Yin YH, Gibbons S, Mu Q. Acetylenic spiroketal enol ethers from Artemisia rupestris and their synergistic antibacterial effects on methicillin-resistant Staphylococcus aureus. Nat Prod Res 2024; 38:589-593. [PMID: 36855235 DOI: 10.1080/14786419.2023.2183952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
Synergistic bioassay-guided isolation of the extracts of Artemisia rupestris L, which belongs to the family Asteraceae, afforded two acetylenic spiroketal enol ethers, namely rupesdiynes A (1) and B (2). Their structures were determined based on spectroscopic analysis and experimental and calculated ECD investigations. The two compounds exhibited synergistic activity and were able to reduce the minimum inhibitory concentration (MIC) of oxacillin four-fold, with a fractional inhibitory concentration index (FICI) of 0.5 in combination with oxacillin against the oxacillin-resistant EMRSA-16. Biofilm formation inhibitory and Ethidium bromide (EtBr) efflux assay were further employed to verify the possible mechanism of the synergistic antibacterial effect. Additionally, molecular docking studies were conducted to investigate the binding affinities of the two compounds with penicillin-binding protein 2a (PBP2a) of EMRSA-16. Taken together, rupesdiynes A (1) and rupesdiyne B (2) showed moderate synergistic activity against EMRSA-16 with oxacillin via inhibiting biofilm formation and efflux pump activity, respectively.
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Affiliation(s)
| | - Jiang-Er Lan
- School of Pharmacy, Fudan University, Shanghai, China
| | - Xiao Liu
- School of Pharmacy, Fudan University, Shanghai, China
| | - Zhong-Lin Sun
- School of Pharmacy, Fudan University, Shanghai, China
| | - Xiao-Jin Li
- Traditional Chinese Medicine and Ethnomedicine Institute of Xinjiang, Wulumuqi, China
| | - Yi-Han Yin
- School of Pharmacy, Fudan University, Shanghai, China
| | - Simon Gibbons
- Centre for Natural Products Discovery, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Qing Mu
- School of Pharmacy, Fudan University, Shanghai, China
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17
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Hamad Y, Nickel KB, Olsen MA, George IA. Outcomes of Ceftriaxone Compared With Cefazolin or Nafcillin/Oxacillin for Outpatient Therapy for Methicillin-Sensitive Staphylococcus aureus Bloodstream Infections: Results From a Large United States Claims Database. Open Forum Infect Dis 2024; 11:ofad662. [PMID: 38352150 PMCID: PMC10863560 DOI: 10.1093/ofid/ofad662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024] Open
Abstract
Background Ceftriaxone is a convenient option for methicillin-sensitive Staphylococcus aureus (MSSA) outpatient parenteral antimicrobial therapy (OPAT), but population-based studies for its effectiveness are lacking. Methods In this retrospective cohort, a large insurance claims database was queried from 2010 to 2018 for adults with MSSA bloodstream infection (BSI). Patients discharged on OPAT on cefazolin or oxacillin/nafcillin were compared with ceftriaxone with respect to 90-day hospital readmission with the same infection category and 90-day all-cause readmission using logistic regression models. Results Of 1895 patients with MSSA BSI, 1435 (75.7%) patients received cefazolin, oxacillin, or nafcillin and 460 (24.3%) ceftriaxone. Readmission due to the same infection category occurred in 366 (19.3%), and all-cause readmission occurred in 535 (28.3%) within 90 days. Risk factors significantly associated with readmission with the same infection category were the oldest sampled age group (61-64 years: adjusted odds ratio [aOR], 1.47 [95% confidence interval {CI}, 1.01-2.14]), intensive care unit stay during index admission (aOR, 2.33 [95% CI, 1.81-3.01]), prosthetic joint infection (aOR, 1.96 [95% CI, 1.18-2.23]), central line-associated BSI (aOR, 1.72 [95% CI, 1.33-2.94]), and endocarditis (aOR, 1.63 [95% CI, 1.18-2.23]). Ceftriaxone was not associated with increased risk of readmission with the same infection category (aOR, 0.89 [95% CI, .67-1.18]), or 90-day all-cause readmission (aOR, 0.86 [95% CI, .66-1.10]) when compared with oxacillin/nafcillin/cefazolin. Conclusions In this cohort of MSSA BSI patients discharged on OPAT, there were no differences in outcomes of readmission with the same infection and 90-day all-cause readmission in patients treated with ceftriaxone compared to oxacillin/nafcillin or cefazolin. Patients with complicated BSIs such as endocarditis and epidural abscess were more likely to be prescribed cefazolin or oxacillin/nafcillin.
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Affiliation(s)
- Yasir Hamad
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Ige A George
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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18
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Sakoulas G, Nizet V. Measuring beta-lactam minimum inhibitory concentrations in Staphylococcus aureus in the clinical microbiology laboratory: pinning the tail on the donkey. J Clin Microbiol 2024; 62:e0036623. [PMID: 37966224 PMCID: PMC10793257 DOI: 10.1128/jcm.00366-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Significant shortcomings have been identified in standard methods of susceptibility testing in bacteriological media, not only because the media fails to recapitulate the in vivo environment, but susceptibility testing itself fails to capture sub-MIC effects that significantly attenuate bacterial virulence properties. Until susceptibility testing conditions better recapitulate the in vivo environment, attempts to establish the quantitative relevance of beta-lactam MIC using current clinical microbiology standards in Staphylococcus aureus infections will likely prove unsuccessful.
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Affiliation(s)
- George Sakoulas
- Sharp Rees-Stealy Medical Group, San Diego, California, USA
- UCSD School of Medicine, La Jolla, California, USA
| | - Victor Nizet
- UCSD School of Medicine, La Jolla, California, USA
- Skaggs School of Pharmacy, UCSD School of Medicine, La Jolla, California, USA
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19
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Xing A, Ng HM, Jiao H, Li K, Ye Q. The Prevalence, Epidemiological, and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus (MRSA) in Macau (2017-2022). Microorganisms 2024; 12:148. [PMID: 38257975 PMCID: PMC10820975 DOI: 10.3390/microorganisms12010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Macau, recognized as a global tourism hub and the world's most densely populated region, provides a unique environment conducive to methicillin-resistant Staphylococcus aureus (MRSA) transmission in healthcare and community settings, posing a significant public health concern both locally and globally. The epidemiology and molecular characteristics of MRSA in the distinct city of Macau remain largely unelucidated. This five-year longitudinal study (2017-2022) examined the local prevalence and molecular typing of MRSA in Macau, with future MRSA type distribution predicted through ARIMA modeling. We subsequently analyzed the epidemiological characteristics of MRSA, including specimen source, clinical department, collection year, season, patient age, sex, and the annual number of tourists. Comprehensive antibiotic resistance profiles of the strains were also assessed. Of 504 clinically isolated S. aureus strains, 183 (36.3%) were identified as MRSA by the cefoxitin disk diffusion method and validated through multi-locus sequence typing (MLST). The MRSA detection rate showed an upward trend, increasing from 30.1% in 2017 to 45.7% in 2022. SCCmec type IV was predominant (28.9%), followed by types II (25.4%), III (22.1%), and V (22.1%). The primary sources of MRSA isolates were sputum (39.2%) and secretions (25.6%). Older age emerged as a risk factor for MRSA infection, whereas no significant associations were found with seasonal variations, gender, or the annual number of tourists. Despite displaying universal resistance to cefoxitin, oxacillin, and benzylpenicillin, MRSA isolates in Macau remained fully sensitive to vancomycin, tigecycline, quinupristin, nitrofurantoin, and linezolid. Continuous surveillance and analysis of MRSA distribution in Macau could provide invaluable insights for the effective management of MRSA prevention and control measures within healthcare settings.
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Affiliation(s)
- Abao Xing
- Faculty of Applied Sciences, Macao Polytechnic University, Macau; (A.X.); (K.L.)
| | - Hoi Man Ng
- Clinical Laboratory, Kiang Wu Hospital, Macau;
| | - Huining Jiao
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macau;
| | - Kefeng Li
- Faculty of Applied Sciences, Macao Polytechnic University, Macau; (A.X.); (K.L.)
| | - Qianhong Ye
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macau;
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20
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Krsak M, Scherger S, Miller MA, Cobb V, Montague BT, Henao-Martínez AF, Molina KC. Substance use disorder-associated infections' treatment with dalbavancin enabling outpatient transition (SUDDEN OUT) - an investigator-initiated single-arm unblinded prospective cohort study. Ther Adv Infect Dis 2024; 11:20499361231223889. [PMID: 38249543 PMCID: PMC10798100 DOI: 10.1177/20499361231223889] [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: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Background Severe gram-positive infections are frequent in people who inject drugs, and successful completion of treatment presents unique challenges in this population. Objectives We aimed to evaluate the feasibility of a long-acting antibiotic, dalbavancin, as an alternative to standard-of-care antibiotics for severe infections due to vancomycin-susceptible pathogens requiring ⩾2 weeks of therapy. Design We designed an investigator-initiated single-arm unblinded prospective cohort study to evaluate the safety and efficacy of an early switch to dalbavancin in two doses administered 1 week apart. Methods We screened patients admitted with bloodstream infection, osteomyelitis, septic arthritis, infective endocarditis or deep abscesses, and comorbid substance use disorder (SUD) for eligibility. Consenting patients were switched to dalbavancin within 7 days from their index culture. They were monitored in the hospital for efficacy and safety of the treatment until the second dose of dalbavancin 7 days later and then discharged if stable. Study participants were evaluated with a decision support engine for a hypothetical appropriate level of care regarding their SUD after discharge. Their follow-up was planned for 12 months from the index culture, either in-person or via telehealth/telephone. Results The enrollment was terminated early due to significant loss-to-follow-up. In all, 11 patients were enrolled, 4 completed 12 months of follow-up, 2 completed 8 months of follow-up, and 1 was seen once after discharge. The remaining five patients were lost to follow-up immediately after discharge. All 11 patients continued to improve after switching to dalbavancin between the first and second doses. There were two per-protocol failures of treatment. Dalbavancin was well tolerated, though some adverse events were reported. Conclusion Dalbavancin may be a safe and effective alternative for an early switch in treating severe gram-positive infections. Trial registration The trial was registered as NCT04847921 with clinicaltrials.gov.
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Affiliation(s)
- Martin Krsak
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Mail Stop B163, Anschutz Outpatient Pavilion, 1635 Aurora Court, Aurora, CO 80045-2581, USA
| | - Sias Scherger
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Infectious Diseases, University of Nebraska School of Medicine, Omaha, NE, USA
| | - Matthew A. Miller
- Department of Pharmacy, Children’s Hospital Colorado, Aurora, CO, USA
| | - Vincent Cobb
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian T. Montague
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kyle C. Molina
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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21
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Woods EC, Nakasone TSM, Renault CA. Clinical reasoning for performance of transesophageal echocardiography in veterans with Staphylococcus aureus bacteremia. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e221. [PMID: 38156239 PMCID: PMC10753505 DOI: 10.1017/ash.2023.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023]
Abstract
This study examined physicians' reasoning about obtaining transesophageal echocardiography (TEE) in cases of Staphylococcus aureus bacteremia (SAB). In 221 cases of SAB over 5 years, the most common reasons for not performing TEE were clinical response to antibiotics, negative TTE results, and the expectation that TEE would not change management.
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Affiliation(s)
- Emily C. Woods
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Cybele A. Renault
- Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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22
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Nolan J, McCarthy K, Farkas A, Avent ML. Feasibility of individualised patient modelling for continuous vancomycin infusions in outpatient antimicrobial therapy, a retrospective study. Int J Clin Pharm 2023; 45:1444-1451. [PMID: 37532840 DOI: 10.1007/s11096-023-01618-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/24/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio is proposed as a therapeutic drug-monitoring parameter for dosing vancomycin continuous infusion in methicillin-resistant Staphylococcus aureus (MRSA) infection. Individualised pharmacokinetic-pharmacodynamic (PK/PD) calculation of AUC24 may better represent therapeutic dosing than current Therapeutic Drug Monitoring (TDM) practices, targeting a Steady State Concentration of 15-25 mg/L. AIM To compare real world TDM practice to theoretical, individualised, PK/PD target parameters utilising Bayesian predictions to steady state concentrations (Css) for outpatients on continuous vancomycin infusions. METHOD A retrospective single centre study was conducted at a tertiary hospital on adult patients, enrolled in an outpatient parenteral antimicrobial therapy (OPAT) program, receiving vancomycin infusions for MRSA infection. Retrospective Bayesian dosing was modelled to target PK/PD parameters and compared to real world data. RESULTS Fifteen patients were evaluated with 53% (8/15) achieved target CSS during hospitalisation, and 83% (13/15) as outpatient. Median Bayesian AUC/MIC was 613 mg.h/L with CSS 25 mg/L. Patients suffering an Acute Kidney Injury (33%) had higher AUC0-24/MIC values. Retrospective Bayesian modelling demonstrated on median 250 mg/24 h lower doses than that administered was required (R2 = 0.81) which achieved AUC24/MIC median 444.8 (range 405-460) mg.h/L and CSS 18.8 (range 16.8-20.4) mg/L. CONCLUSION Bayesian modelling could assist in obtaining more timely target parameters at lower doses for patients receiving continuous vancomycin infusion as part of an OPAT program, which may beget fewer adverse effects. Utilisation of personalised predictive modelling may optimise vancomycin prescribing, achieving earlier target concentrations as compared to empiric dosing regimens.
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Affiliation(s)
- J Nolan
- The Royal Brisbane and Women's Hospital, Herston, Australia.
- School of Medicine, University of Queensland, 4029, Herston, Australia.
| | - K McCarthy
- The Royal Brisbane and Women's Hospital, Herston, Australia
- School of Medicine, University of Queensland, 4029, Herston, Australia
| | - A Farkas
- Mount Sinai West Hospital, New York, USA
- Optimum Dosing Strategies, Bloomingdale, New York, USA
| | - M L Avent
- The Royal Brisbane and Women's Hospital, Herston, Australia
- Queensland Statewide Antimicrobial Stewardship Program, University of Queensland Centre for Clinical Research, Herston, Australia
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23
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Minter DJ, Appa A, Chambers HF, Doernberg SB. Contemporary Management of Staphylococcus aureus Bacteremia-Controversies in Clinical Practice. Clin Infect Dis 2023; 77:e57-e68. [PMID: 37950887 DOI: 10.1093/cid/ciad500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Indexed: 11/13/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) carries a high risk for excess morbidity and mortality. Despite its prevalence, significant practice variation continues to permeate clinical management of this syndrome. Since the publication of the 2011 Infectious Diseases Society of America (IDSA) guidelines on management of methicillin-resistant Staphylococcus aureus infections, the field of SAB has evolved with the emergence of newer diagnostic strategies and therapeutic options. In this review, we seek to provide a comprehensive overview of the evaluation and management of SAB, with special focus on areas where the highest level of evidence is lacking to inform best practices.
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Affiliation(s)
- Daniel J Minter
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ayesha Appa
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of HIV, Infectious Diseases, and Global Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Henry F Chambers
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of HIV, Infectious Diseases, and Global Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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24
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Moenster RP, Wallace-Lacey A, Western H, Tiefenaur S, Abdulbasir A, Alberts J, Doty J, Abner H, Skouby D, Lorenz M, Fong R, Arora J, Linneman TW. Oritavancin vs Standard of Care for Treatment of Nonendovascular Gram-Positive Bloodstream Infections. Open Forum Infect Dis 2023; 10:ofad411. [PMID: 37937043 PMCID: PMC10627338 DOI: 10.1093/ofid/ofad411] [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: 06/28/2023] [Accepted: 07/28/2023] [Indexed: 11/09/2023] Open
Abstract
Background Data is limited comparing oritavancin (ORT) to the standard-of-care (SOC) for the treatment gram-positive blood stream infections (BSI). Methods This was a retrospective study of all patients in the Veteran's Affairs Health Care System treated with at least 1 dose of oritavancin or at least 5 days of vancomycin, daptomycin, ceftaroline, ampicillin, ampicillin-sulbactam, nafcillin, oxacillin, or cefazolin for a documented gram-positive BSI from 1 January 2015 to 30 June 2021. Patients with polymicrobial blood cultures or positive cultures from other sites were included if the organisms were sensitive to the incident antimicrobial; no concomitant antimicrobials could be used once the incident agent was started. Individuals were also excluded if they were diagnosed with endocarditis, had a neutrophil count 96-hours of treatment before the incident antimicrobial was started.The primary composite outcome was clinical failure, defined as all-cause mortality within 30-days from the end of therapy, or blood cultures positive for the incident organisms ≥72 hours after administration of the first dose and ≤30 days after the administration of the final dose of the study antimicrobial, or any drug or line-related readmissions within 30-days of hospital discharge. Results Two hundred-forty patients were identified for screening with 96 meeting criteria (27 in ORT and 69 in SOC groups). Baseline characteristics were generally balanced between groups except more patients in the ORT group received >96-hours of treatment before the incident antimicrobial was started (70.3% (19/27) vs 13.04% 9/69); P < .001). The pathogen most prevalent was methicillin susceptible Staphylococcus aureus (MSSA) (ORT 33.3% (9/27) vs SOC 46.4% (32/69)). Clinical failure occurred in 7.4% (2/27) in the ORT group and 17.4% (12/69) in SOC (P = .34). No components of the primary outcome were significantly different between groups, but AKI did occur more commonly in the SOC group (27.5% (19/69) vs 3.7% (1/27); P = .01). Conclusions ORT appears to be a safe and effective option when directly compared to the SOC for non-endocarditis BSIs.
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Affiliation(s)
- Ryan P Moenster
- Clinical Pharmacy Services, VA St Louis Health Care System, St. Louis, Missouri, USA
| | | | - Hannah Western
- Department of Pharmacy Practice, St Louis College of Pharmacy at UHSP, St. Louis, Missouri, USA
| | - Seth Tiefenaur
- Department of Pharmacy Practice, St Louis College of Pharmacy at UHSP, St. Louis, Missouri, USA
| | - Anosha Abdulbasir
- Department of Pharmacy Practice, St Louis College of Pharmacy at UHSP, St. Louis, Missouri, USA
| | - Justin Alberts
- Department of Pharmacy Practice, St Louis College of Pharmacy at UHSP, St. Louis, Missouri, USA
| | - Jonathan Doty
- Department of Pharmacy Practice, St Louis College of Pharmacy at UHSP, St. Louis, Missouri, USA
| | - Hartley Abner
- Department of Pharmacy Practice, St Louis College of Pharmacy at UHSP, St. Louis, Missouri, USA
| | - Danielle Skouby
- Clinical Pharmacy Services, VA St Louis Health Care System, St. Louis, Missouri, USA
| | - Michael Lorenz
- Clinical Pharmacy Services, VA St Louis Health Care System, St. Louis, Missouri, USA
| | - Rebecca Fong
- Clinical Pharmacy Services, VA St Louis Health Care System, St. Louis, Missouri, USA
| | - Jyoti Arora
- Division of Biostatistics, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Travis W Linneman
- Clinical Pharmacy Services, VA St Louis Health Care System, St. Louis, Missouri, USA
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25
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Prinsloo C, Smith S, Law M, Hanson J. The Epidemiological, Clinical, and Microbiological Features of Patients with Burkholderia pseudomallei Bacteraemia-Implications for Clinical Management. Trop Med Infect Dis 2023; 8:481. [PMID: 37999600 PMCID: PMC10675116 DOI: 10.3390/tropicalmed8110481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Patients with melioidosis are commonly bacteraemic. However, the epidemiological characteristics, the microbiological findings, and the clinical associations of Burkholderia pseudomallei bacteraemia are incompletely defined. All cases of culture-confirmed melioidosis at Cairns Hospital in tropical Australia between January 1998 and June 2023 were reviewed. The presence of bacteraemia was determined and correlated with patient characteristics and outcomes; 332/477 (70%) individuals in the cohort were bacteraemic. In multivariable analysis, immunosuppression (odds ratio (OR) (95% confidence interval (CI)): (2.76 (1.21-6.27), p = 0.02), a wet season presentation (2.27 (1.44-3.59), p < 0.0001) and male sex (1.69 (1.08-2.63), p = 0.02), increased the likelihood of bacteraemia. Patients with a skin or soft tissue infection (0.32 (0.19-0.57), p < 0.0001) or without predisposing factors for melioidosis (0.53 (0.30-0.93), p = 0.03) were less likely to be bacteraemic. Bacteraemia was associated with intensive care unit admission (OR (95%CI): 4.27 (2.35-7.76), p < 0.0001), and death (2.12 (1.04-4.33), p = 0.04). The median (interquartile range) time to blood culture positivity was 31 (26-39) hours. Patients with positive blood cultures within 24 h were more likely to die than patients whose blood culture flagged positive after this time (OR (95%CI): 11.05 (3.96-30.83), p < 0.0001). Bacteraemia portends a worse outcome in patients with melioidosis. Its presence or absence might be used to help predict outcomes in cases of melioidosis and to inform optimal clinical management.
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Affiliation(s)
- Carmen Prinsloo
- College of Medicine and Dentistry, James Cook University, Cairns Hospital, Cairns, QLD 4870, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia;
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, NSW 2042, Australia;
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia;
- The Kirby Institute, University of New South Wales, Sydney, NSW 2042, Australia;
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
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26
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Harris AD, Souli M, Pettigrew MM. The Next Generation: Mentoring and Diversity in the Antibacterial Resistance Leadership Group. Clin Infect Dis 2023; 77:S331-S335. [PMID: 37843116 PMCID: PMC10578050 DOI: 10.1093/cid/ciad532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
The Antibacterial Resistance Leadership Group (ARLG) Mentoring Program was established to develop and prepare the next generation of clinician-scientists for a career in antibacterial resistance research. The ARLG Diversity, Equity, and Inclusion Working Group partners with the Mentoring Committee to help ensure diversity and excellence in the clinician-scientist workforce of the future. To advance the field of antibacterial research while fostering inclusion and diversity, the Mentoring Program has developed a number of fellowships, awards, and programs, which are described in detail in this article.
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Affiliation(s)
- Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maria Souli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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27
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Holland TL, Cosgrove SE, Doernberg SB, Jenkins TC, Turner NA, Boucher HW, Pavlov O, Titov I, Kosulnykov S, Atanasov B, Poromanski I, Makhviladze M, Anderzhanova A, Stryjewski ME, Assadi Gehr M, Engelhardt M, Hamed K, Ionescu D, Jones M, Saulay M, Smart J, Seifert H, Fowler VG. Ceftobiprole for Treatment of Complicated Staphylococcus aureus Bacteremia. N Engl J Med 2023; 389:1390-1401. [PMID: 37754204 DOI: 10.1056/nejmoa2300220] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Ceftobiprole is a cephalosporin that may be effective for treating complicated Staphylococcus aureus bacteremia, including methicillin-resistant S. aureus. METHODS In this phase 3, double-blind, double-dummy, noninferiority trial, adults with complicated S. aureus bacteremia were randomly assigned in a 1:1 ratio to receive ceftobiprole at a dose of 500 mg intravenously every 6 hours for 8 days and every 8 hours thereafter, or daptomycin at a dose of 6 to 10 mg per kilogram of body weight intravenously every 24 hours plus optional aztreonam (at the discretion of the trial-site investigators). The primary outcome, overall treatment success 70 days after randomization (defined as survival, bacteremia clearance, symptom improvement, no new S. aureus bacteremia-related complications, and no receipt of other potentially effective antibiotics), with a noninferiority margin of 15%, was adjudicated by a data review committee whose members were unaware of the trial-group assignments. Safety was also assessed. RESULTS Of 390 patients who underwent randomization, 387 (189 in the ceftobiprole group and 198 in the daptomycin group) had confirmed S. aureus bacteremia and received ceftobiprole or daptomycin (modified intention-to-treat population). A total of 132 of 189 patients (69.8%) in the ceftobiprole group and 136 of 198 patients (68.7%) in the daptomycin group had overall treatment success (adjusted difference, 2.0 percentage points; 95% confidence interval [CI], -7.1 to 11.1). Findings appeared to be consistent between the ceftobiprole and daptomycin groups in key subgroups and with respect to secondary outcomes, including mortality (9.0% and 9.1%, respectively; 95% CI, -6.2 to 5.2) and the percentage of patients with microbiologic eradication (82.0% and 77.3%; 95% CI, -2.9 to 13.0). Adverse events were reported in 121 of 191 patients (63.4%) who received ceftobiprole and 117 of 198 patients (59.1%) who received daptomycin; serious adverse events were reported in 36 patients (18.8%) and 45 patients (22.7%), respectively. Gastrointestinal adverse events (primarily mild nausea) were more frequent with ceftobiprole. CONCLUSIONS Ceftobiprole was noninferior to daptomycin with respect to overall treatment success in patients with complicated S. aureus bacteremia. (Funded by Basilea Pharmaceutica International and the U.S. Department of Health and Human Services; ERADICATE ClinicalTrials.gov number, NCT03138733.).
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Affiliation(s)
- Thomas L Holland
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Sara E Cosgrove
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Sarah B Doernberg
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Timothy C Jenkins
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Nicholas A Turner
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Helen W Boucher
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Oleksander Pavlov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Ivan Titov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Serhii Kosulnykov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Boyko Atanasov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Ivan Poromanski
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Manana Makhviladze
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Anastasia Anderzhanova
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Martin E Stryjewski
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Maziar Assadi Gehr
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Marc Engelhardt
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Kamal Hamed
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Daniel Ionescu
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Mark Jones
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Mikael Saulay
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Jennifer Smart
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Harald Seifert
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Vance G Fowler
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
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Mok HT, Teng CB, Bergin S, Hon PY, Lye DC, De PP, Vasoo S. Treatment outcomes with benzylpenicillin and non-benzylpenicillin antibiotics, and the performance of the penicillin zone-edge test versus molecular detection of blaZ in penicillin-susceptible Staphylococcus aureus (PSSA) bacteraemia. J Antimicrob Chemother 2023; 78:2515-2523. [PMID: 37596905 DOI: 10.1093/jac/dkad263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023] Open
Abstract
OBJECTIVES The blaZ gene encodes penicillinase, which inactivates penicillin. As there were reports on suboptimal sensitivity for the penicillin zone-edge test, a phenotypic method for blaZ detection, we investigated treatment outcomes in patients with penicillin-susceptible Staphylococcus aureus (PSSA) bacteraemia (phenotypically negative for penicillinase), subjecting isolates to molecular testing for blaZ retrospectively. PATIENTS AND METHODS A retrospective cohort study was conducted on 121 patients with a first episode of PSSA bacteraemia from 1 January 2012 to 31 October 2015 at Tan Tock Seng Hospital (TTSH), Singapore. Patients were grouped into IV benzylpenicillin and non-benzylpenicillin groups. The primary outcome was overall treatment failure, defined as either 30 day all-cause mortality and/or 90 day relapse. The penicillin (P10) zone-edge test was repeated on archived PSSA isolates, concurrently with penicillin MIC determination via gradient diffusion and PCR for blaZ. RESULTS Among 121 patients, 57 patients (47.1%) received IV benzylpenicillin as the predominant antibiotic. There was no significant difference in overall treatment failure between treatment with the benzylpenicillin [7/57 (12.3%)] versus non-benzylpenicillin groups [12/64 (18.8%)] (P = 0.33) or cloxacillin/cefazolin [6/37 (16.2%)] (P = 0.59). For 112 PSSA isolates available for testing, repeat penicillin zone-edge testing was negative for penicillinase production, corroborating previous results. A single PSSA isolate with a negative penicillin zone-edge test was found to be positive for blaZ. CONCLUSIONS We found no differences in overall treatment failure between patients with PSSA bacteraemia treated with benzylpenicillin, anti-staphylococcal β-lactams cefazolin/cloxacillin and other antimicrobials, when using the penicillin zone-edge test as the phenotypic method for blaZ screening.
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Affiliation(s)
- Hoi Tong Mok
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Christine B Teng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Pharmacy, The National University of Singapore, Singapore, Singapore
| | - Sarah Bergin
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Microbiology, Tallaght University Hospital, Dublin, Ireland
| | - Pei Yun Hon
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, Singapore, Singapore
| | - David C Lye
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Partha P De
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shawn Vasoo
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Zhang G, Zhang N, Xu J, Yang T, Yin H, Cai Y. Efficacy and safety of vancomycin for the treatment of Staphylococcus aureus bacteraemia: a systematic review and meta-analysis. Int J Antimicrob Agents 2023; 62:106946. [PMID: 37543121 DOI: 10.1016/j.ijantimicag.2023.106946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/11/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of vancomycin with the other anti-Gram-positive bacteria antibiotics in the treatment of Staphylococcus aureus bacteraemia. METHODS We searched the PubMed, MEDLINE, Embase and Cochrane Library databases until August 2022 for studies that compared vancomycin with other antibiotic regimens for treating Staphylococcus aureus bacteraemia. Clinical and microbiological responses, adverse events, relapse rate and mortality were considered. RESULTS Fifteen randomized controlled trials and nine retrospective studies were included. The efficacy and safety data of vancomycin differed from those of the comparators group. After subgroup analysis, the differences came mainly from the trials compared with daptomycin. Compared to daptomycin, vancomycin showed a lower microbiological cure rate (OR = 0.58, 95% CI = 0.41∼0.82, I2 = 0%, P = 0.002) and clinical cure rate (OR = 0.53, 95% CI = 0.42∼0.68, I2 = 3%, P < 0.00001), as well as more adverse events (OR = 3.21, 95% CI = 1.43∼7.19, I2 = 59%, P = 0.005). CONCLUSION The efficacy of vancomycin in treating Staphylococcus aureus bacteraemia is still excellent but slightly inferior in adverse events. However, this does not affect its use as a first-line drug. Daptomycin is expected to be a better antimicrobial drug.
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Affiliation(s)
- Guanxuanzi Zhang
- Medical School of Chinese PLA, Graduate School of Chinese PLA General Hospital, Beijing, China; Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, Beijing, China
| | - Na Zhang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, Beijing, China
| | - Juan Xu
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, Beijing, China
| | - Tianli Yang
- Medical School of Chinese PLA, Graduate School of Chinese PLA General Hospital, Beijing, China; Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, Beijing, China
| | - Hong Yin
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, Beijing, China.
| | - Yun Cai
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, Beijing, China.
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Ioannou P, Zacharioudaki M, Spentzouri D, Koutoulakou A, Kitsos-Kalyvianakis K, Chontos C, Karakonstantis S, Maraki S, Samonis G, Kofteridis DP. A Retrospective Study of Staphylococcus aureus Bacteremia in a Tertiary Hospital and Factors Associated with Mortality. Diagnostics (Basel) 2023; 13:diagnostics13111975. [PMID: 37296829 DOI: 10.3390/diagnostics13111975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is a severe infection frequently associated with significant morbidity and mortality. Recent studies have shown that SAB mortality has decreased during the last decades. However, about 25% of patients suffering from the disease will ultimately die. Hence, there is an urgent need for more timely and efficient treatment of patients with SAB. The aim of the present study was to retrospectively evaluate a cohort of SAB patients hospitalized in a tertiary hospital and to identify factors independently associated with mortality. All 256 SAB patients hospitalized from January 2005 to December 2021 in the University Hospital of Heraklion, Greece, were evaluated. Their median age was 72 years, while 101 (39.5%) were female. Most SAB patients were cared for in medical wards (80.5%). The infection was community-acquired in 49.5%. Among all strains 37.9% were methicillin-resistant S. aureus (MRSA), however, definite treatment with an antistaphylococcal penicillin was given only in 22% of patients. Only 14.4% of patients had a repeat blood culture after the initiation of antimicrobial treatment. Infective endocarditis was present in 8%. In-hospital mortality has reached 15.9%. Female gender, older age, higher McCabe score, previous antimicrobial use, presence of a central venous catheter, neutropenia, severe sepsis, septic shock, and MRSA SAB were positively associated with in-hospital mortality, while monomicrobial bacteremia was negatively associated. The multivariate logistic regression model identified only severe sepsis (p = 0.05, odds ratio = 12.294) and septic shock (p = 0.007, odds ratio 57.18) to be independently positively associated with in-hospital mortality. The evaluation revealed high rates of inappropriate empirical antimicrobial treatment and non-adherence to guidelines, as shown, by the lack of repeat blood cultures. These data underline the urgent need for interventions with antimicrobial stewardship, increased involvement of infectious diseases physicians, educational sessions, and creation and implementation of local guidelines for improvement of the necessary steps for timely and efficient SAB treatment. Optimization of diagnostic techniques is needed to overcome challenges such as heteroresistance that may affect treatment. Clinicians should be aware of the factors associated with mortality in patients with SAB to identify those who are at a higher risk and optimize medical management.
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Affiliation(s)
- Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Maria Zacharioudaki
- Pediatrics Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Despoina Spentzouri
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | | | - Christoforos Chontos
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - George Samonis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Diamantis P Kofteridis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
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Koshovyi O, Heinämäki J, Raal A, Laidmäe I, Topelius NS, Komisarenko M, Komissarenko A. PHARMACEUTICAL 3D-PRINTING OF NANOEMULSIFIED EUCALYPT EXTRACTS AND THEIR ANTIMICROBIAL ACTIVITY. Eur J Pharm Sci 2023:106487. [PMID: 37277046 DOI: 10.1016/j.ejps.2023.106487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/02/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023]
Abstract
Overcoming the health threatening consequences of staphylococcal infections and their negative socio-economic effects have become a priority in the medical, pharmaceutical, food and many other sectors globally. Staphylococcal infections are a big challenge for a global health care, since they are difficult to be diagnosed and treated. Therefore, the development of new medicinal products of plant-origin is timely and important, because bacteria have a limited ability to develop resistance to such products. In the present study, a modified eucalypt (Eucalyptus viminalis L.) extract was prepared and further enhanced by using different excipients (surface active agents) to obtain a water-miscible 3D-printable extract (nanoemulsified aqueous eucalypt extract). Phytochemical and antibacterial studies of the eucalypt leaves extracts were conducted as a preliminary investigation for 3D-printing experiments of the extracts. The nanoemulsified aqueous eucalypt extract was mixed with polyethylene oxide (PEO) to form a gel applicable for semi-solid extrusion (SSE) 3D printing. The key process parameters in a 3D-printing process were identified and verified. The printing quality of the 3D-lattice type eucalypt extract preparations was very good, demonstrating the feasibility of using an aqueous gel in SSE 3D printing also exhibiting compatibility of the carrier polymer (PEO) with the plant extract. The SSE 3D-printed eucalypt extract preparations presented a rapid dissolution in water within 10-15 minutes, suggesting the applicability of these preparations e.g., in oral immediate-release applications.
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Affiliation(s)
- Oleh Koshovyi
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, Nooruse 1, 50411 Tartu, Estonia; The National University of Pharmacy, 53 Pushkinska st, 61002 Kharkiv, Ukraine.
| | - Jyrki Heinämäki
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, Nooruse 1, 50411 Tartu, Estonia.
| | - Ain Raal
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, Nooruse 1, 50411 Tartu, Estonia.
| | - Ivo Laidmäe
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, Nooruse 1, 50411 Tartu, Estonia.
| | | | - Mykola Komisarenko
- The National University of Pharmacy, 53 Pushkinska st, 61002 Kharkiv, Ukraine.
| | - Andrey Komissarenko
- The National University of Pharmacy, 53 Pushkinska st, 61002 Kharkiv, Ukraine.
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Böing CW, Froböse NJ, Schaumburg F, Kampmeier S. Impact of the COVID-19 Pandemic on the Management of Staphylococcus aureus Bloodstream Infections in a Tertiary Care Hospital. Pathogens 2023; 12:pathogens12040611. [PMID: 37111497 PMCID: PMC10143185 DOI: 10.3390/pathogens12040611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is associated with a high mortality rate. The clinical outcome of SAB patients highly depends on early diagnosis, adequate antibiotic therapy and source control. In the context of the COVID-19 pandemic, the health care system faced additional organizational challenges and the question arose whether structured screening and triaging for COVID-19 and shifting resources influence the management of SAB. Patients (n = 115) with SAB were enrolled in a retrospective comparative study with historical controls (March 2019-February 2021). The quality of SAB therapy was assessed with a point score, which included correct choice of antibiotic, adequate dosage of antibiotic, sufficient duration of therapy, early start of therapy after receipt of findings, focus search and taking control blood cultures 3-4 days after starting adequate antibiotic therapy. The quality of treatment before and after the onset of the COVID-19 pandemic were compared. No significant differences in the total score points were found between the pre-COVID-19 and COVID-19 cohort. All quality indicators, except the correct duration of antibiotic therapy, showed no significant differences in both cohorts. Furthermore, there were no significant differences in the outcome between both cohorts. The treatment quality of SAB therapy was comparable before and during the COVID-19 pandemic.
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Affiliation(s)
- Christian W Böing
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany
| | - Neele J Froböse
- Institute of Medical Microbiology, Domagkstraße 10, 48149 Münster, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, Domagkstraße 10, 48149 Münster, Germany
| | - Stefanie Kampmeier
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany
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White BP, Barber KE, Chastain DB. Variation Among Infectious Diseases Pharmacists for the Treatment of Staphylococcus aureus Bacteremia. J Pharm Pract 2023; 36:295-302. [PMID: 34399064 DOI: 10.1177/08971900211038864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Staphylococcus aureus bacteremia (SAB) remains complex, in that optimal treatment for patients, including complicated or persistent infection, remains unclear. Two recent surveys have demonstrated practice variations in SAB among infectious diseases (ID) physicians. Objectives: The purpose of this survey was to examine practice variations in SAB among ID pharmacists. Methods: A thirty-five-question survey was electronically distributed to the American College of Clinical Pharmacy (ACCP) Infectious Diseases Practice and Research Network (IDPRN) in Fall 2019 to determine differences in SAB management. Data were analyzed utilizing Pearson's Chi-Square or Fisher's Exact Test. Results: A total of 106 ID pharmacists responded. Only 28% of pharmacists practiced at hospitals with mandatory ID consultation for SAB. A majority (75%) had rapid diagnostic technology (RDT) for identifying SABSI, but 32% of those facilities with RDT did not notify pharmacy with results. Anti-staphylococcal penicillins were preferred for MSSA blood stream infections (BSI) in patients with central nervous system infection and endocarditis, whereas cefazolin was favored for other MSSA BSI. For persistent MRSA BSI, 34% selected daptomycin alone while 38% elected to combine daptomycin and ceftaroline. Pharmacists at hospitals less than 500 beds were more likely to use daptomycin, while those at larger hospitals were more likely to use daptomycin and ceftaroline for persistent MRSA BSI (P < .05). Conclusions: A survey of ID pharmacists showed variation in the management of SABs, as well as the definition and treatment of persistent SAB. Mandatory ID consultation and RDT use to improve SAB management have not been optimized.
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Affiliation(s)
- Bryan P White
- Department of Pharmacy, 6195OU Medical Center, Oklahoma City, OK, USA
- College of Medicine, Infectious Diseases Section, 12308University of Oklahoma, Oklahoma City, OK, USA
| | - Katie E Barber
- College of Pharmacy, 15516University of Mississippi, Jackson, MS, USA
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Khan ZA, Warden AR, Jiang H, Abdullah A, Ahmad M, Jiang L, Ding X. Time-lapse proteomics unveil constant high exposure of non-antibiotic drug induces synthetic susceptibility towards regular antibiotics. Microbiol Res 2023; 269:127320. [PMID: 36764262 DOI: 10.1016/j.micres.2023.127320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/10/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Antibiotic resistance is a significant threat to the human race, as regular consumption of antibiotics may lead to antibiotic-resistant bacterial strains. Non-antibiotic drugs also have an extensive impact on bacterial strains, where persistent uptake alters the survival mechanisms of bacteria that could lead to cross-resistance towards other antibiotics. Here, we use time-lapse proteomics shift assays to examine Gram-negative (E. coli. O157:H7 and P. aeruginosa) and Gram-positive (E. faecalis and S. aureus) strains of bacteria for short and continuous exposure to the non-antibiotic drug Hydroxychloroquine (HCQ). Proteomic transitions from wild type to HCQ-exposed strains revealed bacterial transitions and their survival adaptabilities, which were different across all strains. In addition to their structural differences, some shared pathways were enriched among Gram-negative and positive strains. We also validated the cross-resistance and sensitivity towards 24 regularly prescribed antibiotics, indicating that long-term exposure to non-antibiotic drugs may induce general proteomics alterations in the bacterial strains, promoting antibiotic resistance. We validated that HCQ exposure renders Gram-negative strains resistant to Β-lactam and susceptible to macrolides and folic acid. In contrast, Gram-positive strains become susceptible to Β-lactam and resistant to aminoglycosides. Exposure to non-antibiotic drugs causes resistance or susceptibility toward other antibiotics, providing clinicians a reason to overcome antibiotic resistance.
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Affiliation(s)
- Zara Ahmad Khan
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, School of Medicine and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Antony R Warden
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Jiang
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Aynur Abdullah
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, School of Medicine and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mashaal Ahmad
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
| | - Lai Jiang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, School of Medicine and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Xianting Ding
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, School of Medicine and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Yanık-Yalçın T, Erol Ç, Demirkaya MH, Durukan E, Kurt-Azap Ö. Evaluation of Clinical Approach and Outcomes Staphylococcus aureus Bacteremia. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:31-39. [PMID: 38633900 PMCID: PMC10986690 DOI: 10.36519/idcm.2023.191] [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] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 04/19/2024]
Abstract
Objective Despite appropriate treatment and early diagnosis methods, Staphylococcus aureus bacteremia (SAB) is still associated with a high mortality rate. This study aims to evaluate the clinical features and approaches to SAB and to analyze the parameters that may affect 7-day and 30-day mortality. Materials and Methods Adult patients with SAB data between 2011 and 2018 were evaluated retrospectively. Clinical data, patient demographics, and 7-day and 30-day mortality rates were obtained from their medical records. Results In total, 144 patients were included in the study; 57.6% (83/144) of patients were men, and the mean age was 65.2±16.5 years. The most common source of infection was the central-line catheter (38.9%), followed by intra-abdominal (21%), respiratory (16.7), infective endocarditis (5.6%), and osteoarticular foci (2.1%). Fifteen percent (15%) of the strains were methicillin resistant. Transthoracic echocardiography (TTE) was performed for 80.6% (116/144) patients. Infectious diseases specialist consultation within 96 hours from blood culture signal was requested in 79.9%. Overall, 7-day mortality was 11.8%, and 30-day mortality was 21.5%. Staying in intensive care units (ICU) increased the risk of 30-day mortality by 1.1 times, and respiratory-focused SAB increased the risk by 4.3 times. Conclusion SAB is still a big threat. Staphylococcal pneumonia remains a severe infection. Several prognostic factors influence mortality. Identifying the source, ensuring source control, and appropriate initial therapy as soon as possible are critical for reducing mortality and morbidity in SAB.
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Affiliation(s)
- Tuğba Yanık-Yalçın
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Çiğdem Erol
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Melike Hamiyet Demirkaya
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Elif Durukan
- Department of Public Health, Başkent University School of Medicine, Ankara, Turkey
| | - Özlem Kurt-Azap
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
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Ledger EVK, Edwards AM. Growth Arrest of Staphylococcus aureus Induces Daptomycin Tolerance via Cell Wall Remodelling. mBio 2023; 14:e0355822. [PMID: 36722949 PMCID: PMC9973334 DOI: 10.1128/mbio.03558-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 02/02/2023] Open
Abstract
Almost all bactericidal drugs require bacterial replication and/or metabolic activity for their killing activity. When these processes are inhibited by bacteriostatic antibiotics, bacterial killing is significantly reduced. One notable exception is the lipopeptide antibiotic daptomycin, which has been reported to efficiently kill growth-arrested bacteria. However, these studies employed only short periods of growth arrest (<1 h), which may not fully represent the duration of growth arrest that can occur in vivo. We found that a growth inhibitory concentration of the protein synthesis inhibitor tetracycline led to a time-dependent induction of daptomycin tolerance in S. aureus, with an approximately 100,000-fold increase in survival after 16 h of growth arrest, relative to exponential-phase bacteria. Daptomycin tolerance required glucose and was associated with increased production of the cell wall polymers peptidoglycan and wall-teichoic acids. However, while the accumulation of peptidoglycan was required for daptomycin tolerance, only a low abundance of wall teichoic acid was necessary. Therefore, whereas tolerance to most antibiotics occurs passively due to a lack of metabolic activity and/or replication, daptomycin tolerance arises via active cell wall remodelling. IMPORTANCE Understanding why antibiotics sometimes fail to cure infections is fundamental to improving treatment outcomes. This is a major challenge when it comes to Staphylococcus aureus because this pathogen causes several different chronic or recurrent infections. Previous work has shown that a lack of replication, as often occurs during infection, makes bacteria tolerant of most bactericidal antibiotics. However, one antibiotic that has been reported to kill nonreplicating bacteria is daptomycin. In this work, we show that the growth arrest of S. aureus does in fact lead to daptomycin tolerance, but it requires time, nutrients, and biosynthetic pathways, making it distinct from other types of antibiotic tolerance that occur in nonreplicating bacteria.
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Affiliation(s)
- Elizabeth V. K. Ledger
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, United Kingdom
| | - Andrew M. Edwards
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, United Kingdom
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Parsons JB, Westgeest AC, Conlon BP, Fowler VG. Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia: Host, Pathogen, and Treatment. Antibiotics (Basel) 2023; 12:455. [PMID: 36978320 PMCID: PMC10044482 DOI: 10.3390/antibiotics12030455] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a devastating pathogen responsible for a variety of life-threatening infections. A distinctive characteristic of this pathogen is its ability to persist in the bloodstream for several days despite seemingly appropriate antibiotics. Persistent MRSA bacteremia is common and is associated with poor clinical outcomes. The etiology of persistent MRSA bacteremia is a result of the complex interplay between the host, the pathogen, and the antibiotic used to treat the infection. In this review, we explore the factors related to each component of the host-pathogen interaction and discuss the clinical relevance of each element. Next, we discuss the treatment options and diagnostic approaches for the management of persistent MRSA bacteremia.
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Affiliation(s)
- Joshua B. Parsons
- Department of Medicine, Division of Infectious Disease, Duke University Medical Center, Durham, NC 27710, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Annette C. Westgeest
- Department of Medicine, Division of Infectious Disease, Duke University Medical Center, Durham, NC 27710, USA
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Brian P. Conlon
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Vance G. Fowler
- Department of Medicine, Division of Infectious Disease, Duke University Medical Center, Durham, NC 27710, USA
- Duke Clinical Research Institute, Durham, NC 27710, USA
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Gentry CA, Whitman CM, Kliewer BS, Williams RJ, Thind SK. Propensity-matched analysis of the protective effect of ticagrelor versus clopidogrel on the risk of developing Staphylococcus aureus bacteremia. Int J Antimicrob Agents 2023; 61:106752. [PMID: 36773940 DOI: 10.1016/j.ijantimicag.2023.106752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/24/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Recent data indicate that ticagrelor, used in acute coronary syndromes (ACS), has antibacterial effects against Staphylococcus sp. and other effects that may help management of infection. The primary objective of this study was to evaluate the protective effect of ticagrelor in patients who have had an ACS event and the risk of developing Staphylococcus aureus bacteremia (SAB) compared to a propensity-matched cohort receiving clopidogrel. METHODS This study was a retrospective, nationwide analysis of all patients presenting to any percutaneous coronary intervention-performing Veterans Affairs Medical Center with an ACS episode and resultant prescription for clopidogrel or ticagrelor. The primary outcome was the comparative rate of SAB in patients receiving ticagrelor vs. clopidogrel. RESULTS Analysis involved 24 456 patients on ticagrelor and 277 277 patients on clopidogrel. There was a statistically significant difference in the number of patients developing SAB between the propensity-matched groups (32 [0.13%] of 24 456 for ticagrelor vs. 71 [0.29%] of 24 456 for clopidogrel; odds ratio (OR), 0.43; 95% confidence interval (CI), 0.28-0.65; P<0.0001). Multivariate logistic regression showed that receipt of clopidogrel, comorbid dermatologic condition, comorbid hematologic condition, and baseline anemia were independently associated with the development of SAB. CONCLUSIONS The study findings align with recent reports that ticagrelor may have a beneficial role in the prevention of SAB.
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Affiliation(s)
- Chris A Gentry
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA.
| | - Charles M Whitman
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA
| | - Brian S Kliewer
- Section of Internal Medicine, Medical Service, Oklahoma City Veterans Affairs Health Care System, and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Riley J Williams
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA
| | - Sharanjeet K Thind
- Section of Infectious Diseases, Medical Service, Oklahoma City Veterans Affairs Health Care System, and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Sequential oral antibiotic in uncomplicated Staphylococcus aureus bacteraemia: a propensity-matched cohort analysis. Clin Microbiol Infect 2023:S1198-743X(23)00054-X. [PMID: 36773773 DOI: 10.1016/j.cmi.2023.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES We aimed to analyse the efficacy and safety of oral sequential therapy (OST) in uncomplicated Staphylococcus aureus bacteraemia (SAB). METHODS Single-centre observational cohort at a tertiary hospital in Spain, including all patients with the first SAB episode from January 2015 to December 2020. We excluded patients with complicated SAB and those who died during the first week. Patients were classified into the OST group (patients who received oral therapy after initial intravenous antibiotic therapy [IVT]), and IVT group (patients who received exclusively IVT). We performed a propensity-score matching to balance baseline differences. The primary composite endpoint was 90-day mortality or microbiological failure. Secondary endpoints included 90-day SAB relapse. RESULTS Out of 407 SAB first episodes, 230 (56.5%) were included. Of these, 112 (n = 48.7%) received OST and 118 (51.3%) IVT exclusively. Transition to oral therapy was performed after 7 days (interquartile range, 4-11). The primary endpoint occurred in 10.7% (11/112) in OST vs. 30.5% (36/118) in IVT (p < 0.001). SAB relapses occurred in 3.6% (4/112) vs. 1.7% (2/118) (p 0.436). None of the deaths in OST were related to SAB or its complications. After propensity-score matching, the primary endpoint was not more frequent in the OST group (relative risk, 0.42; 95% CI, 0.22-0.79). Ninety-day relapses occurred similarly in both groups (relative risk, 1.35; 95% CI, 0.75-2.39). DISCUSSION After an initial intravenous antibiotic, patients with uncomplicated SAB can safely be switched to oral antibiotics without apparent adverse outcomes. This strategy could save costs and complications of prolonged hospital stays. Prospective randomized studies are needed.
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Gentry CA, Williams RJ, Whitman CM, Thind SK, Kliewer BS. Staphylococcus aureus bacteraemia treatment outcomes in patients receiving ticagrelor vs a propensity-matched cohort receiving clopidogrel. Int J Antimicrob Agents 2023; 61:106743. [PMID: 36736927 DOI: 10.1016/j.ijantimicag.2023.106743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Ticagrelor may improve the outcomes in Staphylococcus aureus bacteraemia (SAB). However, treatment outcome data for these patients remain limited. The primary objective of this study was to characterize the outcomes of patients with SAB who received ticagrelor compared with a cohort who received clopidogrel. METHODS This was a retrospective, nationwide propensity-matched analysis of patients with SAB who were prescribed ticagrelor or clopidogrel concomitantly with antistaphylococcal therapy. The primary outcome was the comparative all-cause 30-day mortality rate between propensity-matched groups. RESULTS In total, 1509 patients were prescribed concomitantly with ticagrelor or clopidogrel during treatment of S. aureus bacteraemia; of these, 194 patients were excluded from this study due to an inadequate number of antiplatelet doses within the first week of therapy (n=171) or non-admission to hospital (n=23). Of the remaining 1315 patients, 74 patients received ticagrelor and 1241 patients received clopidogrel. There was no significant difference in all-cause 30-day mortality between the groups [6/74 (8.1%) in the ticagrelor group vs 10/74 (13.5%) in the clopidogrel group; P=0.29]. Multi-variate logistic regression demonstrated that elevated aspartate aminotransferase, systolic blood pressure <90 mmHg, elevated serum creatinine and neurological comorbidity were independently associated with all-cause 30-day mortality. CONCLUSIONS This study found no difference in all-cause 30-day mortality between the two groups, although overall mortality appeared to be lower compared with other reports. Randomized controlled trials of P2Y12 inhibitors as adjunctive agents to antibiotic therapy for the treatment of serious S. aureus infections are warranted.
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Affiliation(s)
- Chris A Gentry
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA.
| | - Riley J Williams
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA
| | - Charles M Whitman
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA
| | - Sharanjeet K Thind
- Section of Infectious Diseases, Medical Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA; Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Brian S Kliewer
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Internal Medicine, Medical Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA
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Bici A, Pianko MJ, Nachar VR. Incidence and risk factors for bacterial infection using bortezomib, lenalidomide, and dexamethasone (RVd) in newly diagnosed multiple myeloma. Leuk Lymphoma 2023; 64:407-414. [PMID: 36308285 PMCID: PMC9993956 DOI: 10.1080/10428194.2022.2138380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 02/17/2023]
Abstract
Infections are an important cause of morbidity and mortality in newly diagnosed multiple myeloma (NDMM), but the real-world risk using modern induction regimens such as bortezomib, lenalidomide, and dexamethasone (RVd) is not well described. We performed a retrospective single-center cohort study to identify infections and risk factors in patients treated with first-line RVd from January 2014 to January 2020 and collected demographic and clinical data. Of 144 patients treated with RVd for NDMM, 21 patients (14.5%) experienced a bacterial infection during induction, of which 8 (5.5%) were grade 3 infections despite a low rate of antibiotic prophylaxis use (12%). Grade 3 neutropenia occurred in 11% of patients, 2% had febrile neutropenia and there were no deaths from infection. On multivariable analysis, age, smoking history, diabetes, antibiotic use in the 60 days preceding the start of RVd, and high-risk cytogenetics were associated with higher risk of bacterial infection.
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Affiliation(s)
- Anisa Bici
- Department of Pharmacy Services, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, MI, United States
| | - Matthew J. Pianko
- Division of Hematology and Oncology, Department of Internal Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Victoria R Nachar
- Department of Pharmacy Services, University of Michigan Rogel Cancer Center, Ann Arbor, MI, United States
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42
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Li W, Wang J, Li C, Zong Z, Zhao J, Gao H, Liu D. Achieving Ultrasensitive Chromogenic Probes for Rapid, Direct Detection of Carbapenemase-Producing Bacteria in Sputum. JACS AU 2023; 3:227-238. [PMID: 36711106 PMCID: PMC9875220 DOI: 10.1021/jacsau.2c00607] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 06/18/2023]
Abstract
Carbapenemase-producing bacteria (CPB) stand as the most dangerous "superbugs" in the clinic. Rapid point-of-care (POC) detection of CPB in clinical samples is key to timely and effective infection management. We herein report the first ultrasensitive chromogenic probe that allows direct POC detection of CPB in clinical sputum samples at a sample-to-result time of less than 15 min. This chromogenic probe is modularly designed by conjugating the carbapenem core with a benzene derivative bearing an electronegativity-tunable substituent. Unexpectedly high sensitivity was achieved simply by choosing strong electron-withdrawing substituents, such as -N+(CH3)3, without resorting to complex molecular design. Through integrating the probes with a portable paper chip, 24 out of 80 clinical sputum samples from sepsis patients with lung infections were quickly diagnosed as CPB-positive, exhibiting 100% clinical sensitivity and specificity. This low-cost paper chip assay can be readily performed on-site, breaking through the dilemma of rapid CPB detection, especially in resource-limited settings.
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Affiliation(s)
- Wenshuai Li
- State
Key Laboratory of Medicinal Chemical Biology, Research Center for
Analytical Sciences, and Tianjin Key Laboratory of Molecular Recognition
and Biosensing, Frontiers Science Center for New Organic Matter, College
of Chemistry, Nankai University, Tianjin300071, China
| | - Jingjing Wang
- Department
of Intensive Care Unit, Key Laboratory for Critical Care Medicine
of the Ministry of Health, Emergency Medicine Research Institute,
Tianjin First Center Hospital, School of Medicine, Nankai University, Tianjin300071, China
| | - Chen Li
- College
of Arts and Sciences, Shanxi Agricultural
University, Taigu030801, China
| | - Zhiyou Zong
- State
Key Laboratory of Medicinal Chemical Biology, Research Center for
Analytical Sciences, and Tianjin Key Laboratory of Molecular Recognition
and Biosensing, Frontiers Science Center for New Organic Matter, College
of Chemistry, Nankai University, Tianjin300071, China
| | - Jinzhong Zhao
- College
of Arts and Sciences, Shanxi Agricultural
University, Taigu030801, China
| | - Hongmei Gao
- Department
of Intensive Care Unit, Key Laboratory for Critical Care Medicine
of the Ministry of Health, Emergency Medicine Research Institute,
Tianjin First Center Hospital, School of Medicine, Nankai University, Tianjin300071, China
| | - Dingbin Liu
- State
Key Laboratory of Medicinal Chemical Biology, Research Center for
Analytical Sciences, and Tianjin Key Laboratory of Molecular Recognition
and Biosensing, Frontiers Science Center for New Organic Matter, College
of Chemistry, Nankai University, Tianjin300071, China
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43
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Hadano Y, Hijikata T. A fatal case of persistent bacteremia and acute cholecystitis caused by Staphylococcus aureus: A case report. IDCases 2023; 31:e01695. [PMID: 36704024 PMCID: PMC9871290 DOI: 10.1016/j.idcr.2023.e01695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
Biliary tract infections caused by Staphylococcus aureus are rare. Here, we describe a case of fatal acute cholecystitis and persistent bacteremia caused by S. aureus in a patient with newly diagnosed diabetes mellitus. Staphylococcus aureus can cause bacteremic biliary tract infections, which are associated with higher mortality rates compared to biliary Klebsiella pneumoniae bacteremia. Early aggressive treatment and consultations with infectious disease specialists are recommended when biliary S. aureus bacteremia is clinically suspected.
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Affiliation(s)
- Yoshiro Hadano
- Division of Infection Control and Prevention, Shimane University Hospital, Izumo, Shimane, Japan,Antimicrobial stewardship team, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan,Correspondence to: Division of Infection Control and Prevention, Shimane University Hospital, 89–1 Enyacho, Izumo, Shimane 693–8501, Japan.
| | - Toshiyuki Hijikata
- Hino-minnano-clinic, Hino, Tokyo, Japan,Department of Emergency Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan,Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Kanagawa, Japan
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44
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Kouijzer IJE, Fowler VG, Ten Oever J. Redefining Staphylococcus aureus bacteremia: A structured approach guiding diagnostic and therapeutic management. J Infect 2023; 86:9-13. [PMID: 36370898 PMCID: PMC11105116 DOI: 10.1016/j.jinf.2022.10.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/20/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
The current duration of therapy in patients with Staphylococcus aureus bacteremia (SAB) is based on differentiating complicated from uncomplicated disease. While this approach allows clinicians and investigators to group SAB patients into broadly similar clinical categories, it fails to account for the intrinsic heterogeneity of SAB. This is due in part to the fact that risk factors for metastatic infection and confirmed metastatic infection are considered as equivalent in most scoring systems. In this viewpoint, we propose a two-step system of categorizing patients with SAB. Initially, patients with SAB would be categorized as 'high risk' or 'low risk' for metastatic infection based upon an initial set of diagnostic procedures. In the second step, patients identified as 'high-risk' would undergo additional diagnostic evaluation. The results of this stepwise diagnostic evaluation would define a 'final clinical diagnosis' to inform an individualized final treatment plan.
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Affiliation(s)
- Ilse J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Vance G Fowler
- Department of Medicine, Duke University, Durham North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jaap Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands.
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45
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Reece ST, Kaufmann SH. Host Defenses to Intracellular Bacteria. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Impact of specialty on the self-reported practice of using oral antibiotic therapy for definitive treatment of bloodstream infections. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2023; 3:e48. [PMID: 36970426 PMCID: PMC10031584 DOI: 10.1017/ash.2023.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/11/2023]
Abstract
Abstract
Background:
No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat bloodstream infections (BSIs), and practices may vary depending on clinician specialty and experience.
Objective:
To assess practice patterns regarding oral antibiotic use for treatment of bacteremia in infectious diseases clinicians (IDCs, including physicians and pharmacists and trainees in these groups) and non–infectious diseases clinicians (NIDCs).
Design:
Open-access survey.
Participants:
Clinicians caring for hospitalized patients receiving antibiotics.
Methods:
An open-access, web-based survey was distributed to clinicians at a Midwestern academic medical center using e-mail and to clinicians outside the medical center using social media. Respondents answered questions regarding confidence prescribing OAT for BSI in different scenarios. We used χ2 analysis for categorical data evaluated association between responses and demographic groups.
Results:
Of 282 survey responses, 82.6% of respondents were physicians, 17.4% pharmacists, and IDCs represented 69.2% of all respondents. IDCs were more likely to select routine use of OAT for BSI due to gram-negative anaerobes (84.6% vs 59.8%; P < .0001), Klebsiella spp (84.5% vs 69.0%; P < .009), Proteus spp (83.6% vs 71.3%; P < .027), and other Enterobacterales (79.5% vs 60.9%; P < .004). Our survey results revealed significant differences in selected treatment of Staphylococcus aureus syndromes. Fewer IDCs than NIDCs selected OAT to complete treatment for methicillin-resistant S. aureus (MRSA) BSI due to gluteal abscess (11.9% vs 25.6%; P = .012) and methicillin-susceptible S. aureus (MSSA) BSI due to septic arthritis (13.9% vs 20.9%; P = .219).
Conclusions:
Practice variation and discordance with evidence for the use of OAT for BSIs exists among IDCs versus NIDCs, highlighting opportunities for education in both clinician groups.
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Chen Y, Chen D, Liu H, Zhang CG, Song LL. Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis: A case report. World J Clin Cases 2022; 10:13418-13425. [PMID: 36683620 PMCID: PMC9850991 DOI: 10.12998/wjcc.v10.i36.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteraemia (SAB) is among the leading causes of bacteraemia and infectious endocarditis. The frequency of infectious endocarditis (IE) among SAB patients ranges from 5% to 10%-12%. In adults, the characteristics of epidermolytic hyperkeratosis (EHK) include hyperkeratosis, erosions, and blisters. Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cell-mediated immunity.
CASE SUMMARY We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases. After genetic tests, the skin disease was diagnosed as EHK.
CONCLUSION A breached skin barrier secondary to EHK, coupled with inadequate sanitation, likely provided the opportunity for bacterial seeding, leading to IE and deep-seated abscess or organ abscess. EHK may be associated with skin infection and multiple risk factors for extracutaneous infections. Patients with EHK should be treated early to minimize their consequences. If patients with EHK present with prolonged fever of unknown origin, IE and organ abscesses should be ruled out, including metastatic spreads.
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Affiliation(s)
- Yu Chen
- Department of Emergency, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Dian Chen
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Hao Liu
- Department of Pathology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Chen-Guang Zhang
- Department of Emergency, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Lin-Lin Song
- Department of Emergency, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
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Genomic and Epidemiological Features of Two Dominant Methicillin-Susceptible Staphylococcus aureus Clones from a Neonatal Intensive Care Unit Surveillance Effort. mSphere 2022; 7:e0040922. [PMID: 36218345 PMCID: PMC9769867 DOI: 10.1128/msphere.00409-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Methicillin-susceptible Staphylococcus aureus (MSSA) is a more prevalent neonatal intensive care unit (NICU) pathogen than methicillin-resistant S. aureus (MRSA). However, the introduction and spread of MSSA, the role of systematic decolonization, and optimal infection prevention and control strategies remain incompletely understood. We previously screened infants hospitalized in a university-affiliated level III to IV NICU twice monthly over 18 months for S. aureus colonization and identified several prevalent staphylococcal protein A (spa) types. Here, we performed whole-genome sequencing (WGS) and phylogenetic comparisons of 140 isolates from predominant spa types t279, t1451, and t571 to examine possible transmission routes and identify genomic and epidemiologic features associated with the spread of dominant clones. We identified two major MSSA clones: sequence type 398 (ST398), common in the local community, and ST1898, not previously encountered in the region. ST398 NICU isolates formed distinct clusters with closely related community isolates from previously published data sets, suggesting multiple sources of acquisition, such as family members or staff, including residents of the local community. In contrast, ST1898 isolates were nearly identical, pointing to clonal expansion within the NICU. Almost all ST1898 isolates harbored plasmids encoding mupirocin resistance (mupA), suggesting an association between the proliferation of this clone and decolonization efforts with mupirocin. Comparative genomics indicated genotype-specific pathways of introduction and spread of MSSA via community-associated (ST398) or health care-associated (ST1898) sources and the potential role of mupirocin resistance in dissemination of ST1898. Future surveillance efforts could benefit from routine genotyping to inform clone-specific infection prevention strategies. IMPORTANCE Methicillin-susceptible Staphylococcus aureus (MSSA) is a significant pathogen in neonates. However, surveillance efforts in neonatal intensive care units (NICUs) have focused primarily on methicillin-resistant S. aureus (MRSA), limiting our understanding of colonizing and infectious MSSA clones which are prevalent in the NICU. Here, we identify two dominant colonizing MSSA clones during an 18-month surveillance effort in a level III to IV NICU, ST398 and ST1898. Using genomic surveillance and phylogenetic analysis, coupled with epidemiological investigation, we found that these two sequence types had distinct modes of spread, namely the suggested exchange with community reservoirs for ST398 and the contribution of antibiotic resistance to dissemination of ST1898 in the health care setting. This study highlights the additional benefits of whole-genome surveillance for colonizing pathogens, beyond routine species identification and genotyping, to inform targeted infection prevention strategies.
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Satishkumar N, Lai LY, Mukkayyan N, Vogel BE, Chatterjee SS. A Nonclassical Mechanism of β-Lactam Resistance in Methicillin-Resistant Staphylococcus aureus and Its Effect on Virulence. Microbiol Spectr 2022; 10:e0228422. [PMID: 36314912 PMCID: PMC9769611 DOI: 10.1128/spectrum.02284-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a group of pathogenic bacteria that are infamously resistant to β-lactam antibiotics, a property attributed to the mecA gene. Recent studies have reported that mutations associated with the promoter region of pbp4 demonstrated high levels of β-lactam resistance, suggesting the role of PBP4 as an important non-mecA mediator of β-lactam resistance. The pbp4-promoter-associated mutations have been detected in strains with or without mecA. Our previous studies that were carried out in strains devoid of mecA described that pbp4-promoter-associated mutations lead to PBP4 overexpression and β-lactam resistance. In this study, by introducing various pbp4-promoter-associated mutations in the genome of a MRSA strain, we demonstrate that PBP4 overexpression can supplement mecA-associated resistance in S. aureus and can lead to increased β-lactam resistance. The promoter and regulatory region of pbp4 is shared with a divergently transcribed gene, abcA, which encodes a multidrug exporter. We demonstrate that the promoter mutations caused an upregulation of pbp4 and downregulation of abcA, confirming that the resistant phenotype is associated with PBP4 overexpression. PBP4 has also been associated with staphylococcal pathogenesis, however, its exact role remains unclear. Using a Caenorhabditis elegans model, we demonstrate that strains having increased PBP4 expression are less virulent than wild-type strains, suggesting that β-lactam resistance mediated via PBP4 likely comes at the cost of virulence. IMPORTANCE Our study demonstrates the ability of PBP4 to be an important mediator of β-lactam resistance in not only methicillin-susceptible Staphylococcus aureus (MSSA) background strains as previously demonstrated but also in MRSA strains. When present together, PBP2a and PBP4 overexpression can produce increased levels of β-lactam resistance, causing complications in treatment. Thus, this study suggests the importance of monitoring PBP4-associated resistance in clinical settings, as well as understanding the mechanistic basis of associated resistance, so that treatments targeting PBP4 may be developed. This study also demonstrates that S. aureus strains with increased PBP4 expression are less pathogenic, providing important hints about the role of PBP4 in S. aureus resistance and pathogenesis.
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Affiliation(s)
- Nidhi Satishkumar
- Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
- Institute of Marine and Environmental Technology (IMET), Baltimore, Maryland, USA
| | - Li-Yin Lai
- Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
- Institute of Marine and Environmental Technology (IMET), Baltimore, Maryland, USA
| | - Nagaraja Mukkayyan
- Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
- Institute of Marine and Environmental Technology (IMET), Baltimore, Maryland, USA
| | - Bruce E. Vogel
- Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Som S. Chatterjee
- Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
- Institute of Marine and Environmental Technology (IMET), Baltimore, Maryland, USA
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Maione A, Pietra AL, Salvatore MM, Guida M, Galdiero E, de Alteriis E. Undesired Effect of Vancomycin Prolonged Treatment: Enhanced Biofilm Production of the Nosocomial Pathogen Candida auris. Antibiotics (Basel) 2022; 11:antibiotics11121771. [PMID: 36551428 PMCID: PMC9774269 DOI: 10.3390/antibiotics11121771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Fungal infections are often consequent to prolonged antibiotic treatments. Vancomycin (Van) is the first-choice antibiotic in the treatment of Staphylococcus aureus infections associated with colonization of catheter surfaces. We demonstrate the direct effect of Van in promoting the formation of the biofilm of the emergent yeast pathogen Candida auris, developed in the conventional polystyrene microwell plate model, as well as on silicone surfaces (22 and 28% increase in total biomass, respectively) and on an S. aures biofilm, residual after vancomycin treatment, where C. auris achieved 99% of the mixed biofilm population. The effect of Van was assessed also in vivo, in the Galleria mellonella infection model, which showed higher mortality when infected with the yeast pathogen in the presence of the antibiotic. This evidence enhances awareness of the potential risk associated with prolonged antibiotic use in promoting fungal infections.
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Affiliation(s)
- Angela Maione
- Department of Biology, University of Naples Federico II, 80126 Naples, Italy
| | | | - Maria Michela Salvatore
- Department of Chemical Sciences, University of Naples Federico II, 80126 Naples, Italy
- Institute for Sustainable Plant Protection, National Research Council, 80055 Portici, Italy
| | - Marco Guida
- Department of Biology, University of Naples Federico II, 80126 Naples, Italy
- BAT Center-Interuniversity Center for Studies on Bioinspired Agro-Environmental Technology, University of Naples Federico II, 80055 Portici, Italy
| | - Emilia Galdiero
- Department of Biology, University of Naples Federico II, 80126 Naples, Italy
- Correspondence: ; Tel.: +39-081-679182
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