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Gangar T, Patra S. Antibiotic persistence and its impact on the environment. 3 Biotech 2023; 13:401. [PMID: 37982084 PMCID: PMC10654327 DOI: 10.1007/s13205-023-03806-6] [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: 05/23/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
From boon molecules to molecules contributing to rising concern has been the sojourn of antibiotics. The problem of antibiotic contamination has gotten worse due to antibiotics' pervasive use in every aspect of the environment. One such consequence of pollution is the increase in infections with antibiotic resistance. All known antimicrobials being used for human benefit lead to their repetitive and routine release into the environment. The misuse of antibiotics has aggravated the situation to a level that we are short of antibiotics to treat infections as organisms have developed resistance against them. Overconsumption is not just limited to human health care, but also occurs in other areas such as aquaculture, livestock, and veterinary applications for the purpose of improving feed and meat products. Due to their harmful effects on non-target species, the trace level of antibiotics in the aquatic ecosystem presents a significant problem. Since the introduction of antibiotics into the environment is more than their removal, they have been given the status of persistent pollutants. The buildup of antibiotics in the environment threatens aquatic life and may lead to bacterial strains developing resistance. As newer organisms are becoming resistant, there exists a shortage of antibiotics to treat infections. This has presented a very critical problem for the health-care community. Another rising concern is that the development of newer drug molecules as antibiotics is minimal. This review article critically explains the cause and nature of the pollution and the effects of this emerging trend. Also, in the latter sections, why we need newer antibiotics is questioned and discussed.
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Affiliation(s)
- Tarun Gangar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, North Guwahati, Assam 781039 India
| | - Sanjukta Patra
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, North Guwahati, Assam 781039 India
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Fever of Unknown Origin and Multidrug Resistant Organism Colonization in AML Patients. Mediterr J Hematol Infect Dis 2023; 15:e2023013. [PMID: 36660358 PMCID: PMC9833311 DOI: 10.4084/mjhid.2023.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023] Open
Abstract
Background Colonization by multidrug-resistant organisms (MDRO) is a frequent complication in hematologic departments, which puts patients at risk of life-threatening bacterial sepsis. Fever of unknown origin (FUO) is a condition related to the delivery of chemotherapy in hematologic malignancies, in which the use of antibiotics is debated. The incidence, risk factors, and influence on the outcome of these conditions in patients with acute myeloid leukemia (AML) are not clearly defined. Methods We retrospectively analyzed 132 consecutive admissions of non-promyelocytic AML patients at the Hematology Unit of the University Tor Vergata in Rome between June 2019 and February 2022. MDRO swab-based screening was performed in all patients on the day of admission and once weekly after that. FUO was defined as fever with no evidence of infection. Results Of 132 consecutive hospitalizations (69 AML patients), MDRO colonization was observed in 35 cases (26%) and resulted independently related to a previous MDRO colonization (p=0.001) and length of hospitalization (p=0.03). The colonization persistence rate in subsequent admissions was 64%. MDRO-related bloodstream infection was observed in 8 patients (23%) and correlated with grade III/IV mucositis (p=0.008) and length of hospitalization (p=0.02). FUO occurred in 68 cases (51%) and correlated with an absolute neutrophilic count <500μ/L at admission (0.04). Conclusion In our experience, MDRO colonization is a frequent and difficult-to-eradicate condition that can arise at all stages of treatment. Prompt discharge of patients as soon as clinical conditions allow could limit the spread of MDRO. In addition, the appropriate use of antibiotics, especially in the case of FUO, and the contraction of hospitalization length, when feasible, are measures to tackle the further spread of MDRO.
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Damji S, Perrott J, Shajari S, Grant J, Wong T, Harbin M. Pattern of acquisition of hospital-associated pathogens in the ICU of an academic tertiary care hospital. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:108-116. [PMID: 36337356 PMCID: PMC9608111 DOI: 10.3138/jammi-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Among hospitalized patients, a 48-hour window from time of hospitalization defines nosocomial infections and guides empiric antibiotic selection. This time frame may lead to overuse of broad-spectrum antibiotics. Our primary objective was to determine the earliest and median time since hospital admission to acquire antibiotic-resistant pathogens among patients admitted to the intensive care unit (ICU) of an academic, tertiary care hospital. METHODS Retrospective chart review was conducted for adult patients admitted to the ICU from home or another hospital within the same health authority in 2018, to identify the time to acquisition of hospital-associated pathogens: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, non-ESBL ceftriaxone-resistant Enterobacterales, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Patients transferred from hospitals outside the health authority, admitted to ICU after 14 days of hospitalization, who were solid organ or bone marrow transplant recipients, or who were otherwise immunocompromised were excluded. RESULTS In 2018, 1,343 patients were admitted to this ICU; 820 met the inclusion criteria. Of these, 121 (14.76%) acquired a hospital-associated pathogen in the ICU. The probability of isolating a hospital-associated pathogen by 48 hours of hospital admission was 3%. The earliest time to isolate any of these pathogens was 29 hours, and the median was 9 days (interquartile range [IQR] 3.8-15.6 days). CONCLUSIONS Most patients (85.3%) in this ICU never acquired a hospital-associated pathogen. The median time to acquire a hospital-associated pathogen among the remaining patients suggests that initiating empiric broad-spectrum antibiotics on the basis of a 48-hour threshold may be premature.
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Affiliation(s)
- Shazia Damji
- Department of Pharmacy, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jerrold Perrott
- Department of Pharmacy, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Salomeh Shajari
- Department of Pharmacy, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Grant
- Department of Pharmacy, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Titus Wong
- Department of Pharmacy, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Megan Harbin
- Department of Pharmacy, Royal Inland Hospital, Kamloops, British Columbia, Canada
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Seabra G, Ventura Mendes RF, Dos Santos Amorim LFV, Peregrino IV, Branquinha MH, Dos Santos ALS, Nunes APF. Azithromycin Use in COVID-19 Patients: Implications on the Antimicrobial Resistance. Curr Top Med Chem 2021; 21:677-683. [PMID: 34028347 DOI: 10.2174/156802662108210319145317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gabriela Seabra
- Laboratorio de Resistencia Bacteriana (RESBAC), Departamento de Microbiologia, Centro de Ciencias da Saude (CCS), Universidade Federal do Espirito Santo (UFES), Vitoria, Brazil
| | - Roberta Ferreira Ventura Mendes
- Laboratorio de Resistencia Bacteriana (RESBAC), Departamento de Microbiologia, Centro de Ciencias da Saude (CCS), Universidade Federal do Espirito Santo (UFES), Vitoria, Brazil
| | - Luiz Felipe Vieira Dos Santos Amorim
- Laboratorio de Resistencia Bacteriana (RESBAC), Departamento de Microbiologia, Centro de Ciencias da Saude (CCS), Universidade Federal do Espirito Santo (UFES), Vitoria, Brazil
| | - Ingrid Vianez Peregrino
- Laboratorio de Resistencia Bacteriana (RESBAC), Departamento de Microbiologia, Centro de Ciencias da Saude (CCS), Universidade Federal do Espirito Santo (UFES), Vitoria, Brazil
| | - Marta Helena Branquinha
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - André Luis Souza Dos Santos
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Ana Paula Ferreira Nunes
- Laboratorio de Resistencia Bacteriana (RESBAC), Departamento de Microbiologia, Centro de Ciencias da Saude (CCS), Universidade Federal do Espirito Santo (UFES), Vitoria, Brazil
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Jaggi P, Hamdy RF, Lee B, Hersh AL, Gerber JS, Sharland M, Terrill C, Newland JG. Use of Antimicrobial Agents in Hospitalized Children for Noninfectious Indications. J Pediatric Infect Dis Soc 2020; 9:490-493. [PMID: 32677678 DOI: 10.1093/jpids/piz053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/03/2019] [Indexed: 12/24/2022]
Abstract
In this point-prevalence study of 32 US children's hospitals, we determined that 1.7% of hospitalized children received at least 1 antimicrobial agent for a non-infection-related reason; macrolides were used most commonly. Antimicrobial stewardship efforts to understand and affect use for these reasons is an unmet need; additional research considering the individual and societal effects of these antimicrobial-prescribing practices should be undertaken.
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Affiliation(s)
- Preeti Jaggi
- Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Rana F Hamdy
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Division of Infectious Diseases, Children's National Medical Center, Washington, DC
| | - Brian Lee
- Department of Pediatrics, School of Medicine, Children's Mercy, Kansas City, Missouri
| | - Adam L Hersh
- Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, United Kingdom
| | - Mike Sharland
- Institute of Infection and Immunity, St George's University of London, United Kingdom
| | - Cindy Terrill
- Division of Infectious Diseases, Department of Pediatrics, Washington University St Louis, Missouri
| | - Jason G Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University St Louis, Missouri
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Tsai WC, Shen CF, Lin YL, Shen FC, Tsai PJ, Wang SY, Lin YS, Wu JJ, Chi CY, Liu CC. Emergence of macrolide-resistant Streptococcus pyogenes emm12 in southern Taiwan from 2000 to 2019. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:1086-1093. [PMID: 32994137 DOI: 10.1016/j.jmii.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Group A Streptococcus (GAS) is an important pathogen causing morbidity and mortality worldwide. Surveillance of resistance and emm type has important implication to provide helpful information on the changing GAS epidemiology and empirical treatment. METHODS To study the emergence of resistant GAS in children with upper respiratory tract infection (URTI), a retrospective study was conducted from 2000 to 2019 in southern Taiwan. Microbiological studies, including antibiotic susceptibility, were performed. GAS emm types and sequences were determined by molecular methods. The population was divided into two separate decades to analyze potential changes over time. The 1st decade was 2000-2009; the 2nd decade was 2010-2019. Multivariate analyses were performed to identify independent risk factors associated with macrolide resistance between these periods. RESULTS A total of 320 GAS from 339 children were enrolled. Most of the children (75%) were under 9 years of age. The most common diagnosis was scarlet fever (225, 66.4%), and the frequency increased from 54.8% in the 1st to 77.9% in the 2nd decade (p < 0.0001). There was a significant increase in resistance to erythromycin and azithromycin from 18.1%, 19.3% in the 1st to 58.4%, 61.0% in the 2nd decade (p < 0.0001). This was associated with clonal expansion of the GAS emm12-ST36 which carrying erm(B) and tet(M) from 3.0% in the 1st to 53.2% in the 2nd decade (p < 0.0001). CONCLUSIONS Significant emergence of macrolide-resistant GAS emm12-ST36 in children supports the need for continuing surveillance and investigation for the clonal virulence.
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Affiliation(s)
- Wei-Chun Tsai
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ya-Lan Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Fan-Ching Shen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
| | - Pei-Jane Tsai
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan
| | - Shu-Ying Wang
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yee-Shin Lin
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Jiunn-Jong Wu
- Department of Biotechnology and Laboratory Science in Medicine, School of Biomedical Science and Engineering, National Yang Ming University, Taipei, Taiwan
| | - Chia-Yu Chi
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan; Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan.
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Jung J, Seo E, Yoo RN, Sung H, Lee J. Clinical significance of viral-bacterial codetection among young children with respiratory tract infections: Findings of RSV, influenza, adenoviral infections. Medicine (Baltimore) 2020; 99:e18504. [PMID: 31914021 PMCID: PMC6959858 DOI: 10.1097/md.0000000000018504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral-bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07-0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13-0.98), respectively.We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral-bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.
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Affiliation(s)
- Jiwon Jung
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Euri Seo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
- Department of Pediatrics, Dongkuk University Ilsan Hospital, Ilsan
| | - Ree Nar Yoo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hungseop Sung
- Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jina Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Schroeder MR, Lohsen S, Chancey ST, Stephens DS. High-Level Macrolide Resistance Due to the Mega Element [ mef(E)/ mel] in Streptococcus pneumoniae. Front Microbiol 2019; 10:868. [PMID: 31105666 PMCID: PMC6491947 DOI: 10.3389/fmicb.2019.00868] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 01/06/2023] Open
Abstract
Transferable genetic elements conferring macrolide resistance in Streptococcus pneumoniae can encode the efflux pump and ribosomal protection protein, mef(E)/mel, in an operon of the macrolide efflux genetic assembly (Mega) element- or induce ribosomal methylation through a methyltransferase encoded by erm(B). During the past 30 years, strains that contain Mega or erm(B) or both elements on Tn2010 and other Tn916-like composite mobile genetic elements have emerged and expanded globally. In this study, we identify and define pneumococcal isolates with unusually high-level macrolide resistance (MICs > 16 μg/ml) due to the presence of the Mega element [mef(E)/mel] alone. High-level resistance due to mef(E)/mel was associated with at least two specific genomic insertions of the Mega element, designated Mega-2.IVa and Mega-2.IVc. Genome analyses revealed that these strains do not possess erm(B) or known ribosomal mutations. Deletion of mef(E)/mel in these isolates eliminated macrolide resistance. We also found that Mef(E) and Mel of Tn2010-containing pneumococci were functional but the high-level of macrolide resistance was due to Erm(B). Using in vitro competition experiments in the presence of macrolides, high-level macrolide-resistant S. pneumoniae conferred by either Mega-2.IVa or erm(B), had a growth fitness advantage over the lower-level, mef(E)/mel-mediated macrolide-resistant S. pneumoniae phenotypes. These data indicate the ability of S. pneumoniae to generate high-level macrolide resistance by macrolide efflux/ribosomal protection [Mef(E)/Mel] and that high-level resistance regardless of mechanism provides a fitness advantage in the presence of macrolides.
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Affiliation(s)
- Max R Schroeder
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Laboratories of Microbial Pathogenesis, Department of Veterans Affairs Medical Center, Atlanta, GA, United States
| | - Sarah Lohsen
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Scott T Chancey
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Laboratories of Microbial Pathogenesis, Department of Veterans Affairs Medical Center, Atlanta, GA, United States
| | - David S Stephens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Laboratories of Microbial Pathogenesis, Department of Veterans Affairs Medical Center, Atlanta, GA, United States
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Davidson RJ. In vitro activity and pharmacodynamic/pharmacokinetic parameters of clarithromycin and azithromycin: why they matter in the treatment of respiratory tract infections. Infect Drug Resist 2019; 12:585-596. [PMID: 30881064 PMCID: PMC6413744 DOI: 10.2147/idr.s187226] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Clarithromycin and azithromycin are second-generation macrolides established and widely used for treating a range of upper and lower respiratory tract infections. Extensive clinical trials data indicate that these drugs are highly effective in these applications and broadly comparable in their clinical and microbiological effectiveness. However, consideration of pharmacokinetic, metabolic, and tissue-penetration data, including the significant antibacterial activity of the metabolite 14-hydroxy-clarithromycin, plus the findings of pharmacodynamic modeling, provide evidence that the long half-life and lower potency of azithromycin predispose this agent to select for resistant isolates. Comparison of the “mutant-prevention concentrations” of clarithromycin and azithromycin, and examination of large-scale epidemiological data from Canada, also support the view that these drugs differ materially in their propensity to promote resistance among bacterial strains implicated in common respiratory infections, and that clarithromycin may offer important advantages over azithromycin that should be considered when choosing a macrolide to treat these conditions.
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Affiliation(s)
- Ross J Davidson
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada, .,Department of Medicine, .,Department of Pathology, .,Department of Microbiology & Immunology, Dalhousie University, Halifax, NS, Canada,
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10
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Yan Z, Huang X, Xie Y, Song M, Zhu K, Ding S. Macrolides induce severe cardiotoxicity and developmental toxicity in zebrafish embryos. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 649:1414-1421. [PMID: 30308910 DOI: 10.1016/j.scitotenv.2018.07.432] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 04/15/2023]
Abstract
Macrolide antibiotics (MALs) are widely used for both human and animal health. Most MALs and their metabolites transfer into aquatic organisms and environment resulting in violent consequences. Previous studies show that MALs cause cardiotoxicity in humans and mammals. However, the potential risk of these chemicals in aquatic organisms remains unclear. Here, we used zebrafish embryos as a model to evaluate the toxicity of MALs. Zebrafish embryos were exposed to four typical MALs including azithromycin (AZM), clarithromycin (CLR), tilmicosin (TMS) and tylosin (TYL) to study their cardiotoxicity. The heart rate of zebrafish embryos showed similar biphasic distribution in the presence of four MALs at 2 days post-fertilization (dpf). The heart rate increased significantly at low levels of MALs while decreased obviously at high levels. Subsequently, TMS was chose to study its acute toxicity and developmental toxicity, which caused pericardial edema and spinal curvature in zebrafish embryos at 4 dpf. Furthermore, we found that TMS triggered oxidative stress, with decreased SOD activities and increased MDA contents. Lastly, apoptosis was observed in zebrafish embryos under TMS treatment, with up-regulation of apoptosis associated genes such as p53, bcl 2, bax, caspase 3 and caspase 9, confirmed by increased protein expression based on Western blot analysis. Taken together, these data indicate that MALs can cause serious toxicity in the development of zebrafish. Great caution should be taken due to the huge consumption of MALs for food animal production and treatments with TMS for infections in aquaculture.
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Affiliation(s)
- Zhaoyang Yan
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China; National Center for Veterinary Drug Safety Evaluation, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Xiaoyong Huang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Yangzhouyun Xie
- National Center for NanoScience and Technology, Beijing 100190, China
| | - Meirong Song
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Kui Zhu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China; National Center for Veterinary Drug Safety Evaluation, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China; Beijing Key Laboratory of Detection Technology for Animal-Derived Food Safety and Beijing Laboratory for Food Quality and Safety, Beijing 100193, China.
| | - Shuangyang Ding
- National Center for Veterinary Drug Safety Evaluation, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China; Beijing Key Laboratory of Detection Technology for Animal-Derived Food Safety and Beijing Laboratory for Food Quality and Safety, Beijing 100193, China.
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11
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Stress Suppressor Screening Leads to Detection of Regulation of Cyclic di-AMP Homeostasis by a Trk Family Effector Protein in Streptococcus pneumoniae. J Bacteriol 2018; 200:JB.00045-18. [PMID: 29483167 DOI: 10.1128/jb.00045-18] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/21/2018] [Indexed: 02/07/2023] Open
Abstract
Cyclic di-AMP (c-di-AMP) is a newly discovered bacterial second messenger. However, regulation of c-di-AMP homeostasis is poorly understood. In Streptococcus pneumoniae, a sole diadenylate cyclase, CdaA, produces c-di-AMP and two phosphodiesterases, Pde1 and Pde2, cleave the signaling dinucleotide. To expand our knowledge of the pneumococcal c-di-AMP signaling network, we performed whole-genome sequencing of Δpde1 Δpde2 heat shock suppressors. In addition to their effects on surviving heat shock, these suppressor mutations restored general stress resistance and improved growth in rich medium. Mutations in CdaA or in the potassium transporter TrkH paired with an insertion leading to a frameshift at the C terminus of CdaA significantly reduced c-di-AMP levels. These observations indicate that the elevated c-di-AMP levels in the Δpde1 Δpde2 mutant enhance susceptibility of S. pneumoniae to the stress conditions. Interestingly, we have previously shown that TrkH complexes with a Trk family c-di-AMP-binding protein, CabP, to mediate potassium uptake. In this study, we found that deletion of cabP significantly reduced pneumococcal c-di-AMP levels. This is the first observation that a c-di-AMP effector protein modulates bacterial c-di-AMP homeostasis.IMPORTANCE Second messengers, including c-di-AMP, are prevalent among bacterial species. In S. pneumoniae, c-di-AMP phosphodiesterase-encoding gene null mutants are attenuated during mouse models of infection, but the role of c-di-AMP signaling in pneumococcal pathogenesis is enigmatic. In this work, we found that heat shock suppressor mutations converge on undermining c-di-AMP toxicity by changing intracellular c-di-AMP concentrations. These mutations improve the growth and restore the stress response generally in c-di-AMP phosphodiesterase-deficient pneumococci, thereby demonstrating the essentiality for tight regulation of c-di-AMP homeostasis in order to respond to stress. Likewise, this work demonstrates that a c-di-AMP effector protein, CabP, affects c-di-AMP homeostasis, which provides new perception into c-di-AMP regulation. This study has implications for c-di-AMP-producing bacteria since many species contain CabP homologs.
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12
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Donà D, Zingarella S, Gastaldi A, Lundin R, Perilongo G, Frigo AC, Hamdy RF, Zaoutis T, Da Dalt L, Giaquinto C. Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia. PLoS One 2018; 13:e0193581. [PMID: 29489898 PMCID: PMC5831636 DOI: 10.1371/journal.pone.0193581] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/14/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Italian pediatric antimicrobial prescription rates are among the highest in Europe. As a first step in an Antimicrobial Stewardship Program, we implemented a Clinical Pathway (CP) for Community Acquired Pneumonia with the aim of decreasing overall prescription of antibiotics, especially broad-spectrum. MATERIALS AND METHODS The CP was implemented on 10/01/2015. We collected antibiotic prescribing and outcomes data from children aged 3 months-15 years diagnosed with CAP from 10/15/2014 to 04/15/2015 (pre-intervention period) and from 10/15/2015 to 04/15/2016 (post-intervention period). We assessed antibiotic prescription differences pre- and post-CP, including rates, breadth of spectrum, and duration of therapy. We also compared length of hospital stay for inpatients and treatment failure for inpatients and outpatients. Chi-square and Fisher's exact test were used to compare categorical variables and Wilcoxon rank sum test was used to compare quantitative outcomes. RESULTS 120 pre- and 86 post-intervention clinic visits were identified with a diagnosis of CAP. In outpatients, we observed a decrease in broad-spectrum regimens (50% pre-CP vs. 26.8% post-CP, p = 0.02), in particular macrolides, and an increase in narrow-spectrum (amoxicillin) post-CP. Post-CP children received fewer antibiotic courses (median DOT from 10 pre-CP to 8 post-CP, p<0.0001) for fewer days (median LOT from 10 pre-CP to 8 post-CP, p<0.0001) than their pre-CP counterparts. Physicians prescribed narrow-spectrum monotherapy more frequently than broad-spectrum combination therapy (DOT/LOT ratio 1.157 pre-CP vs. 1.065 post-CP). No difference in treatment failure was reported before and after implementation (2.3% pre-CP vs. 11.8% post-CP, p = 0.29). Among inpatients we also noted a decrease in broad-spectrum regimens (100% pre-CP vs. 66.7% post-CP, p = 0.02) and the introduction of narrow-spectrum regimens (0% pre-CP vs. 33.3% post-CP, p = 0.02) post-CP. Hospitalized patients received fewer antibiotic courses post-CP (median DOT from 18.5 pre-CP to 10 post-CP, p = 0.004), while there was no statistical difference in length of therapy (median LOT from 11 pre-CP to 10 post-CP, p = 0.06). Days of broad spectrum therapy were notably lower post-CP (median bsDOT from 17 pre-CP to 4.5 post-CP, p <0.0001). No difference in treatment failure was reported before and after CP implementation (16.7% pre-CP vs. 15.4% post-CP, p = 1). CONCLUSIONS Introduction of a CP for CAP in a Pediatric Emergency Department led to reduction of broad-spectrum antibiotic prescriptions, of combination therapy and of duration of treatment both for outpatients and inpatients.
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Affiliation(s)
- Daniele Donà
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
- PENTA Foundation, Padua, Italy
| | - Silvia Zingarella
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Andrea Gastaldi
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | | | - Giorgio Perilongo
- Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Rana F. Hamdy
- Department of Pediatrics, Children's National Health System, Washington DC, United States of America
| | - Theoklis Zaoutis
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
- PENTA Foundation, Padua, Italy
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14
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Wang J, Liu F, Ao P, Li X, Zheng H, Wu D, Zhang N, Yu J, Yuan J, Wu X. Detection of Serotype Distribution and Drug Resistance ofStreptococcus PneumoniaeIsolated From Pediatric Patients. Lab Med 2016; 48:39-45. [DOI: 10.1093/labmed/lmw059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mohareb AM, Dugas AF, Hsieh YH. Changing epidemiology and management of infectious diseases in US EDs. Am J Emerg Med 2016; 34:1059-65. [PMID: 27041249 DOI: 10.1016/j.ajem.2016.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The rise of antibiotic-resistant pathogens is believed to have influenced the emergency department (ED) epidemiology and management of infectious diseases (IDs) since 2000. METHODS Data from the National Hospital Ambulatory Medical Care Survey from 2000 to 2010 were used to examine temporal trends in the incidence of IDs presenting to EDs. Outcome measures included national visit rates, visit proportions, and antimicrobial prescriptions for all ID primary diagnoses, as well as for specific organ systems of interest (respiratory tract, skin/soft tissue, and urinary tract). RESULTS An ID-related primary diagnosis was given in 18.3% (95% confidence interval, 17.9%-18.8%) of all ED visits during the study period. The hospitalization rate for these conditions is 7.8% (95% confidence interval, 7.3%-8.3%). The share of macrolide prescriptions for upper respiratory tract infections and lower respiratory tract infections increased by 34% and 46%, respectively, and that of quinolone prescription for lower respiratory tract infections doubled from 9% to 18.4% during the study period. Management of skin and soft tissue infections shifted from predominant use of cephalosporins to sulfonamides. For UTIs, quinolones were most commonly prescribed, with an increasing use of third-generation cephalosporins. Antibiotics were more frequently prescribed to patients who are white compared with (white: 60%, black: 57%, other races: 52%, P < .05). CONCLUSION The changing epidemiology of IDs diagnosed in US EDs reflects national trends in emerging pathogens and drug resistance. Broad-spectrum antibiotics are being prescribed at increasing rates. There are significant demographic disparities in nationwide antibiotic prescription practices.
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Affiliation(s)
- Amir M Mohareb
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Andrea F Dugas
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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Pan F, Han L, Huang W, Tang J, Xiao S, Wang C, Qin H, Zhang H. Serotype Distribution, Antimicrobial Susceptibility, and Molecular Epidemiology of Streptococcus pneumoniae Isolated from Children in Shanghai, China. PLoS One 2015; 10:e0142892. [PMID: 26571373 PMCID: PMC4646667 DOI: 10.1371/journal.pone.0142892] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 10/28/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Streptococcus pneumoniae is a common pathogenic cause of pediatric infections. This study investigated the serotype distribution, antimicrobial susceptibility, and molecular epidemiology of pneumococci before the introduction of conjugate vaccines in Shanghai, China. METHODS A total of 284 clinical pneumococcal isolates (270, 5, 4,3, and 2 of which were isolated from sputum, bronchoalveolar lavage fluid, blood, cerebral spinal fluid, and ear secretions, respectively) from children less than 14 years of age who had not been vaccinated with a conjugate vaccine, were collected between January and December in 2013. All isolates were serotyped by multiplex polymerase chain reaction or quellung reactions and antimicrobial susceptibility testing was performed using the broth microdilution method. The molecular epidemiology of S.pneumoniae was analyzed by multilocus sequence typing (MLST). RESULTS Among the 284 pneumococcal isolates, 19F (33.5%), 19A (14.1%), 23F (12.0%), and 6A (8.8%) were the most common serotypes and the coverage rates of the 7-, 10-, and 13-valent pneumococcal conjugate vaccines (PCV7, PCV10, and PCV13) were 58.6%, 59.4% and 85.1%, respectively. Antimicrobial susceptibility showed that the prevalence rates of S.pneumoniae resistance to penicillin were 11.3% (32/284). Approximately 88.0% (250/284) of the isolates exhibited multi-drug resistance. MLST analysis revealed a high level of diversity, with 65 sequence types (STs) among 267 isolates. Specifically, the four predominant STs were ST271 (24.3%, 65/267), ST320 (11.2%, 30/267), ST81 (9.7%, 26/267), and ST3173 (5.2%, 14/267), which were mainly associated with serotypes 19F, 19A, 23F, and 6A, respectively. CONCLUSIONS The prevalent serotypes among clinical isolates from children were 19F, 19A, 23F, and 6A and these isolates showed high resistance rates to β-lactams and macrolides. The Taiwan19F-14 clone played a predominant role in the dissemination of pneumococcal isolates in Shanghai, China. Therefore, continued and regional surveillance on pneumococcal isolates may be necessary.
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Affiliation(s)
- Fen Pan
- Department of Clinical Laboratory, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lizhong Han
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weichun Huang
- Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jin Tang
- Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shuzhen Xiao
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chun Wang
- Department of Clinical Laboratory, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Huihong Qin
- Department of Clinical Laboratory, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hong Zhang
- Department of Clinical Laboratory, Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai, China
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Abstract
Macrolide antimicrobials are commonly prescribed, specifically for the treatment of respiratory tract infections. Although still effective, the development of widespread macrolide resistance has limited their use. Aside from their antimicrobial effects, macrolides are also known to possess immune-modulatory properties which may confer a survival benefit in both acute and chronic inflammatory states. This review discusses the efficacy, potential mechanisms, and adverse effects of macrolide therapy specifically in community-acquired pneumonia in outpatients, hospitalized ward patients, and those requiring intensive care unit admission. Challenges for ongoing research in this field are discussed and treatment recommendations offered.
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Dayie NTKD, Arhin RE, Newman MJ, Dalsgaard A, Bisgaard M, Frimodt-Møller N, Slotved HC. Multidrug-Resistant Streptococcus pneumoniae Isolates from Healthy Ghanaian Preschool Children. Microb Drug Resist 2015; 21:636-42. [PMID: 26172078 DOI: 10.1089/mdr.2014.0314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Streptococcus pneumoniae is the cause of high mortality among children worldwide. Antimicrobial treatment and vaccination are used to control pneumococcal infections. In Ghana, data on antimicrobial resistance and the prevalence of multidrug-resistant pneumococcal clones are scarce; hence, the aim of this study was to determine the antibiogram of S. pneumoniae recovered from Ghanaian children younger than six years of age and to what extent resistances were due to the spread of certain sero- and multilocus sequence typing (MLST) types. The susceptibility of 115 pneumococcal isolates, recovered in a previous study, to six antimicrobials was determined by disk diffusion test. Overall, 90.4% of isolates were intermediate penicillin resistant, 99.1% were trimethoprim resistant, 73.0% were tetracycline resistant, and 33.9% were sulfamethoxazole resistant. Low resistance was recorded for erythromycin (2.6%) and cefotaxime (5.2%). Overall, 72.2% of isolates were resistant to penicillin (I or R) and at least two other antimicrobials. MLST of 20 isolates showing resistance to at least four antimicrobials revealed a high diversity documented by 16 different clones, none of which had previously been associated with multidrug resistance. The resistances found may have emerged due to nonprudent antimicrobial use practices and there is a need to monitor and promote prudent antimicrobial usage in Ghana.
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Affiliation(s)
- Nicholas T K D Dayie
- 1 Department of Medical Microbiology, University of Ghana Medical School , Accra, Ghana .,2 Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen, Denmark
| | - Reuben E Arhin
- 1 Department of Medical Microbiology, University of Ghana Medical School , Accra, Ghana
| | - Mercy J Newman
- 1 Department of Medical Microbiology, University of Ghana Medical School , Accra, Ghana
| | - Anders Dalsgaard
- 2 Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen, Denmark
| | - Magne Bisgaard
- 2 Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen, Denmark
| | - Niels Frimodt-Møller
- 3 Department of Clinical Microbiology, University Hospital , Rigshospitalet, Copenhagen, Denmark
| | - Hans-Christian Slotved
- 4 Department of Microbiology and Infection Control, Statens Serum Institut , Copenhagen, Denmark
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20
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The impact of heptavalent pneumococcal conjugate vaccine on the incidence of childhood community-acquired pneumonia and bacteriologically confirmed pneumococcal pneumonia in Japan. Epidemiol Infect 2015; 144:494-506. [PMID: 26122538 DOI: 10.1017/s0950268815001272] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Heptavalent pneumococcal conjugate vaccine (PCV7) was introduced to Japan in 2010. We investigated the impact of PCV7 on childhood community-acquired pneumonia (CAP) and pneumococcal pneumonia (PP). Children aged <5 years living in Chiba city, Japan, who were admitted to hospitals were enrolled to estimate the incidence of CAP based on the mid-year population. PP was determined by the presence of Streptococcus pneumoniae in cultured blood and/or sputum samples of CAP patients. The incidence of CAP and S. pneumoniae isolated from PP patients was compared before (April 2008-March 2009) and after (April 2012-March 2013) the introduction of PCV7 immunization. The annual incidence of CAP was reduced [incidence rate ratio 0·81, 95% confidence interval (CI) 0·73-0·90]. When comparing post-vaccine with pre-vaccine periods, the odds ratio for PP incidence was 0·60 (95% CI 0·39-0·93, P = 0·024). PCV7-covered serotypes markedly decreased (66·6% in pre-vaccine vs. 15·6% in post-vaccine, P < 0·01), and serotypes 6C, 15A, 15C and 19A increased. Multidrug-resistant international clones in the pre-vaccine period (Spain6B-2/ST90, Taiwan19F-14/ST236) decreased, while Sweden15A-25/ST63 was the dominant clone in the post-vaccine period. A significant reduction in the incidence of both CAP hospitalizations and culture-confirmed PP of vaccine serotypes was observed at 2 years after PCV7 vaccination.
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Hawkins PA, Chochua S, Jackson D, Beall B, McGee L. Mobile elements and chromosomal changes associated with MLS resistance phenotypes of invasive pneumococci recovered in the United States. Microb Drug Resist 2014; 21:121-9. [PMID: 25115711 DOI: 10.1089/mdr.2014.0086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pneumococcal macrolide resistance is usually expressed as one of two phenotypes: the M phenotype conferred by the mef gene or the MLSB phenotype caused by modification of ribosomal targets, most commonly mediated by an erm methylase. Target-site modification leading to antibiotic resistance can also occur due to sequence mutations within the 23S rRNA or the L4 and L22 riboproteins. We screened 4,535 invasive isolates resistant to erythromycin and 18 invasive isolates nonsusceptible to quinupristin-dalfopristin (Q-D) to deduce the potential mechanisms involved. Of 4,535 erythromycin-resistant isolates, 66.2% were polymerase chain reaction (PCR)-positive for mef alone, 17.8% for ermB alone, and 15.1% for both mef and ermB. Thirty-seven isolates (0.9%) were PCR negative for both determinants. Of these, 3 were positive for ermA (subclass ermTR) and 25 had chromosomal mutations. No chromosomal mutations (in 23S rRNA, rplD, or rplV) nor any of the macrolides/lincosamides/streptogramin (MLS) resistance genes screened for (ermT, ermA, cfr, lsaC, and vgaA) were found in the remaining nine isolates. Of 18 Q-D nonsusceptible isolates, 14 had chromosomal mutations and one carried both mef and ermB; no chromosomal mutations or other resistance genes were found in 3 isolates. Overall, we found 28 mutations, 13 of which have not been previously described in Streptococcus pneumoniae. The role of these mutations remains to be confirmed by transformation assays.
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Affiliation(s)
- Paulina A Hawkins
- 1 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia
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Parameswaran GI, Sethi S. Long-term macrolide therapy in chronic obstructive pulmonary disease. CMAJ 2014; 186:1148-52. [PMID: 25096664 DOI: 10.1503/cmaj.121573] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ganapathi Iyer Parameswaran
- Division of Infectious Diseases (Parameswaran) and Division of Pulmonary, Critical Care and Sleep Medicine (Sethi), Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY; Veterans Affairs Western New York Healthcare System (Parameswaran, Sethi), Buffalo, NY
| | - Sanjay Sethi
- Division of Infectious Diseases (Parameswaran) and Division of Pulmonary, Critical Care and Sleep Medicine (Sethi), Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY; Veterans Affairs Western New York Healthcare System (Parameswaran, Sethi), Buffalo, NY.
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Abstract
Telithromycin (Ketek), Aventis Pharma), a ketolide, belongs to a new class of antibiotics that was developed for the treatment of upper and lower respiratory tract infections. The prevalence of penicillin and macrolide resistance among respiratory pathogens is increasing in the USA. Telithromycin is highly active against beta-lactam, macrolide and fluoroquinolone reduced-susceptibility pathogens. Its efficacy has been shown to be equal or superior to comparator agents in numerous studies. It has a broad in vitro spectrum versus usual respiratory pathogens and oral once-daily dosing that increases patient compliance. Telithromycin penetrates rapidly into neutrophils in bronchopulmonary tissue, with peak levels obtained in 1 to 2 h. Results of clinical trials show clinical-esponse rates similar to comparator agents. The most frequent adverse events involve the gastrointestinal system, with mild to moderate diarrhea and nausea. A low rate of discontinuation was observed in the studies. Telithromycin is an effective first-line treatment for mild to moderate respiratory infections in adults.
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Affiliation(s)
- Karen M Spiers
- Division of Infectious Diseases, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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24
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Link-Gelles R, Thomas A, Lynfield R, Petit S, Schaffner W, Harrison L, Farley MM, Aragon D, Nicols M, Kirley PD, Zansky S, Jorgensen J, Juni BA, Jackson D, Moore MR, Lipsitch M. Geographic and temporal trends in antimicrobial nonsusceptibility in Streptococcus pneumoniae in the post-vaccine era in the United States. J Infect Dis 2013; 208:1266-73. [PMID: 23852588 DOI: 10.1093/infdis/jit315] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We examined whether observed increases in antibiotic nonsusceptible nonvaccine serotypes after introduction of pneumococcal conjugate vaccine in the United States in 2000 were driven primarily by vaccine or antibiotic use. METHODS Using active surveillance data, we evaluated geographic and temporal differences in serotype distribution and within-serotype differences during 2000-2009. We compared nonsusceptibility to penicillin and erythromycin by geography after standardizing differences across time, place, and serotype by regressing standardized versus crude proportions. A regression slope (RS) approaching zero indicates greater importance of the standardizing factor. RESULTS Through 2000-2006, geographic differences in nonsusceptibility were better explained by within-serotype prevalence of nonsusceptibility (RS 0.32, 95% confidence interval [CI], .08-.55 for penicillin) than by geographic differences in serotype distribution (RS 0.71, 95% CI, .44-.97). From 2007-2009, serotype distribution differences became more important for penicillin (within-serotype RS 0.52, 95% CI, .11-.93; serotype distribution RS 0.57, 95% CI, .14-1.0). CONCLUSIONS Differential nonsusceptibility, within individual serotypes, accounts for most geographic variation in nonsusceptibility, suggesting selective pressure from antibiotic use, rather than differences in serotype distribution, mainly determines nonsusceptibility patterns. Recent trends suggest geographic differences in serotype distribution may be affecting the prevalence of nonsusceptibility, possibly due to decreases in the number of nonsusceptible serotypes.
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Affiliation(s)
- Ruth Link-Gelles
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
Pneumococcus is one of the most common bacterial pathogens encountered in medicine. This article summarizes the risk factors, pathogenesis, treatment, and prevention of the spectrum of disease caused by pneumococcus with particular emphasis on antibiotic resistance as well as immunization. This information is useful for physicians caring for patients both as inpatients and outpatients as well as for those concerned with public health and disease prevention.
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Affiliation(s)
- Samuel Y Ash
- Department of Medicine, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356421, Seattle, WA 98195, USA.
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Croucher NJ, Finkelstein JA, Pelton SI, Mitchell PK, Lee GM, Parkhill J, Bentley SD, Hanage WP, Lipsitch M. Population genomics of post-vaccine changes in pneumococcal epidemiology. Nat Genet 2013; 45:656-63. [PMID: 23644493 PMCID: PMC3725542 DOI: 10.1038/ng.2625] [Citation(s) in RCA: 268] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/05/2013] [Indexed: 11/09/2022]
Abstract
Whole genome sequencing of 616 asymptomatically carried pneumococci was used to study the impact of the 7-valent pneumococcal conjugate vaccine. Comparison of closely related isolates revealed the role of transformation in facilitating capsule switching to non-vaccine serotypes and the emergence of drug resistance. However, such recombination was found to occur at significantly different rates across the species, and the evolution of the population was primarily driven by changes in the frequency of distinct genotypes extant pre-vaccine. These alterations resulted in little overall effect on accessory genome composition at the population level, contrasting with the fall in pneumococcal disease rates after the vaccine’s introduction.
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Affiliation(s)
- Nicholas J Croucher
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
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Serisier DJ. Risks of population antimicrobial resistance associated with chronic macrolide use for inflammatory airway diseases. THE LANCET RESPIRATORY MEDICINE 2013; 1:262-74. [PMID: 24429132 DOI: 10.1016/s2213-2600(13)70038-9] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Macrolide antibiotics have established efficacy in the management of cystic fibrosis and diffuse panbronchiolitis-uncommon lung diseases with substantial morbidity and the potential for rapid progression to death. Emerging evidence suggests benefits of maintenance macrolide treatment in more indolent respiratory diseases including chronic obstructive pulmonary disease and non-cystic fibrosis bronchiectasis. In view of the greater patient population affected by these disorders (and potential for macrolide use to spread to disorders such as chronic cough), widespread use of macrolides, particularly azithromycin, has the potential to substantially influence antimicrobial resistance rates of a range of respiratory microbes. In this Personal View, I explore theories around population (rather than patient) macrolide resistance, appraise evidence linking macrolide use with development of resistance, and highlight the risks posed by injudicious broadening of their use, particularly of azithromycin. These risks are weighed against the potential benefits of macrolides in less aggressive inflammatory airway disorders. A far-sighted approach to maintenance macrolide use in non-cystic fibrosis inflammatory airway diseases is needed, which minimises risks of adversely affecting community macrolide resistance: combining preferential use of erythromycin and restriction of macrolide use to those patients at greatest risk represents an appropriately cautious management approach.
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Affiliation(s)
- David J Serisier
- Department of Respiratory Medicine, Mater Adult Hospital, South Brisbane, QLD, Australia; University of Queensland and Mater Medical Research Institute, Mater Health Services, South Brisbane, QLD, Australia.
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Malhotra-Kumar S, Goossens H. Mass azithromycin distribution and emerging resistance: taking a minimum harms approach. Clin Infect Dis 2013; 56:1527-9. [PMID: 23487372 DOI: 10.1093/cid/cit139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pinto LA, Pitrez PM, Luisi F, de Mello PP, Gerhardt M, Ferlini R, Barbosa DC, Daros I, Jones MH, Stein RT, Marostica PJ. Azithromycin therapy in hospitalized infants with acute bronchiolitis is not associated with better clinical outcomes: a randomized, double-blinded, and placebo-controlled clinical trial. J Pediatr 2012; 161:1104-8. [PMID: 22748516 DOI: 10.1016/j.jpeds.2012.05.053] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/22/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To test the hypothesis that azithromycin reduces the length of hospitalization and oxygen requirement in infants with acute viral bronchiolitis (AB). STUDY DESIGN We performed a randomized, double-blinded, placebo-controlled trial in southern Brazil, from 2009 to 2011. Infants (<12 months of age) hospitalized with AB were recruited in 2 hospitals. Patients were randomized to receive either azithromycin or placebo, administered orally, for 7 days. At enrollment, clinical data were recorded and nasopharyngeal samples were collected for viral identification through immunofluorescence. Main outcomes were duration of oxygen requirement and length of hospitalization. RESULTS One hundred eighty-four patients were included in the study (azithromycin 88 subjects, placebo 96 subjects). Baseline clinical characteristics and viral identification were not different between the groups studied. A virus was detected in 112 (63%) patients, and of those, 92% were positive for respiratory syncytial virus. The use of azithromycin did not reduce the median number of days of either hospitalization (P = .28) or oxygen requirement (P = .47). CONCLUSIONS Azithromycin did not improve major clinical outcomes in a large sample of hospitalized infants with AB, even when restricting the findings to those with positive respiratory syncytial virus samples. Azithromycin therapy should not be given for AB because it provides no benefit and overuse increases overall antibiotic resistance.
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Affiliation(s)
- Leonardo A Pinto
- Department of Pediatrics, Hospital São Lucas and Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
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Valery PC, Morris PS, Grimwood K, Torzillo PJ, Byrnes CA, Masters IB, Bauert PA, McCallum GB, Mobberly C, Chang AB. Azithromycin for Indigenous children with bronchiectasis: study protocol for a multi-centre randomized controlled trial. BMC Pediatr 2012; 12:122. [PMID: 22891748 PMCID: PMC3445847 DOI: 10.1186/1471-2431-12-122] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/30/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The prevalence of chronic suppurative lung disease (CSLD) and bronchiectasis unrelated to cystic fibrosis (CF) among Indigenous children in Australia, New Zealand and Alaska is very high. Antibiotics are a major component of treatment and are used both on a short or long-term basis. One aim of long-term or maintenance antibiotics is to reduce the frequency of acute pulmonary exacerbations and symptoms. However, there are few studies investigating the efficacy of long-term antibiotic use for CSLD and non-CF bronchiectasis among children. This study tests the hypothesis that azithromycin administered once a week as maintenance antibiotic treatment will reduce the rate of pulmonary exacerbations in Indigenous children with bronchiectasis. METHODS/DESIGN We are conducting a multicentre, randomised, double-blind, placebo controlled clinical trial in Australia and New Zealand. Inclusion criteria are: Aboriginal, Torres Strait Islander, Maori or Pacific Island children aged 1 to 8 years, diagnosed with bronchiectasis (or probable bronchiectasis) with no underlying disease identified (such as CF or primary immunodeficiency), and having had at least one episode of pulmonary exacerbation in the last 12 months. After informed consent, children are randomised to receive either azithromycin (30 mg/kg once a week) or placebo (once a week) for 12-24 months from study entry. Primary outcomes are the rate of pulmonary exacerbations and time to pulmonary exacerbation determined by review of patient medical records. Secondary outcomes include length and severity of pulmonary exacerbation episodes, changes in growth, school loss, respiratory symptoms, forced expiratory volume in 1-second (FEV(1); for children ≥6 years), and sputum characteristics. Safety endpoints include serious adverse events. Antibiotic resistance in respiratory bacterial pathogens colonising the nasopharynx is monitored. Data derived from medical records and clinical assessments every 3 to 4 months for up to 24 months from study entry are recorded on standardised forms. DISCUSSION Should this trial demonstrate that azithromycin is efficacious in reducing the number of pulmonary exacerbations, it will provide a much-needed rationale for the use of long-term antibiotics in the medical management of bronchiectasis in Indigenous children. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12610000383066.
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Affiliation(s)
- Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Darwin, NT, Australia
| | - Keith Grimwood
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Infectious Diseases Laboratory, Royal Children’s Hospital, Brisbane, QLD, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, and University of Sydney, Sydney, Australia
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
- Paediatric Respiratory Medicine, Starship Children’s Health, Auckland, New Zealand
| | - I Brent Masters
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
| | - Paul A Bauert
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Darwin, NT, Australia
| | - Gabrielle B McCallum
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Charmaine Mobberly
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
- Paediatric Respiratory Medicine, Starship Children’s Health, Auckland, New Zealand
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
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Li B, Magee TV, Buzon RA, Widlicka DW, Bill DR, Brandt T, Cao X, Coutant M, Dou H, Granskog K, Flanagan ME, Hayward CM, Li B, Liu F, Liu W, Nguyen TT, Raggon JW, Rose P, Rainville J, Reilly UD, Shen Y, Sun J, Wilcox GE. Process Development of a Novel Azetidinyl Ketolide Antibiotic. Org Process Res Dev 2012. [DOI: 10.1021/op300064b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Bryan Li
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Thomas V. Magee
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Richard A. Buzon
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Daniel W. Widlicka
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Dave R. Bill
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Thomas Brandt
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Xiaoping Cao
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Michael Coutant
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Haijian Dou
- Shanghai ChemPartner Co. Ltd., 720 Cailun Road, Zhangjiang Hi-Tech Park,
Shanghai, China
| | - Karl Granskog
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Mark E. Flanagan
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Cheryl M. Hayward
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Bin Li
- Shanghai ChemPartner Co. Ltd., 720 Cailun Road, Zhangjiang Hi-Tech Park,
Shanghai, China
| | - Fengwei Liu
- Shanghai ChemPartner Co. Ltd., 720 Cailun Road, Zhangjiang Hi-Tech Park,
Shanghai, China
| | - Wei Liu
- Asymchem Life Science Co. Ltd., No. 71, 7th Street, TEDA, Tianjin, China
| | - Thuy-Trinh Nguyen
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Jeffrey W. Raggon
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Peter Rose
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Joseph Rainville
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Usa Datta Reilly
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Yue Shen
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Jianmin Sun
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
| | - Glenn E. Wilcox
- Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut
06340, United States
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Hicks LA, Chien YW, Taylor TH, Haber M, Klugman KP. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996-2003. Clin Infect Dis 2011; 53:631-9. [PMID: 21890767 DOI: 10.1093/cid/cir443] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae infections have become increasingly complicated and costly to treat with the spread of antibiotic resistance. We evaluated the relationship between antibiotic prescribing and nonsusceptibility among invasive pneumococcal disease (IPD) isolates. METHODS Outpatient antibiotic prescription data for penicillins, cephalosporins, macrolides, and trimethoprim-sulfamethoxazole were abstracted from the IMS Health Xponent database to calculate the annual number of prescriptions per capita. We analyzed IPD data from 7 of the Centers for Disease Control and Prevention's Active Bacterial Core surveillance sites (population, 18.6 million) for which data were available for the entire time period under study (1996-2003). Logistic regression models were used to assess whether sites with high antibiotic prescribing rates had a high proportion of nonsusceptible and serotype 19A IPD. RESULTS Yearly prescribing rates during the period 1996-2003 for children <5 years of age decreased by 37%, from 4.23 to 2.68 prescriptions per capita per year (P < .001), and those for persons ≥5 years of age decreased by 42%, from 0.98 to 0.57 prescriptions per capita per year (P < .001); increases in azithromycin prescribing were noted for both groups. Sites with high rates of antibiotic prescribing had a higher proportion of IPD nonsusceptibility than did low-prescribing sites (P = .003 for penicillin, P < .001 for every other antibiotic class). Cephalosporin and macrolide prescribing were associated with penicillin and multidrug nonsusceptibility and serotype 19A IPD (P < .001). CONCLUSIONS In sites where antibiotic prescribing is high, the proportion of nonsusceptible IPD is also high, suggesting that local prescribing practices contribute to local resistance patterns. Cephalosporins and macrolides seem to be selecting for penicillin- and multidrug-resistant pneumococci, as well as serotype 19A IPD. Antibiotic use is a major factor contributing to the spread of antibiotic resistance; strategies to reduce antibiotic resistance should continue to include judicious use of antibiotics.
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Affiliation(s)
- Lauri A Hicks
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Serotype emergence and genotype distribution among macrolide-resistant invasive Streptococcus pneumoniae isolates in the postconjugate vaccine (PCV-7) era. Antimicrob Agents Chemother 2011; 56:743-50. [PMID: 22123697 DOI: 10.1128/aac.05122-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We conducted population-based surveillance for pneumococcal bacteremia within a 5-county region surrounding Philadelphia from October 2001 through September 2008, the period following introduction of the seven-valent pneumococcal conjugate vaccine. Erythromycin resistance increased from 14.7% in 2001-2002 to 20.3% in 2007-2008, while the resistance rate to penicillin (MIC, ≥2 μg/ml) decreased from 7.2% to 4.2% during the same period. The most predominant serotypes associated with erythromycin resistance in 2007-2008 included 19A (29.7%), 15A (29.2%), 6C (10.1%), 3 (5.6%), and 6A (4.5%). The molecular mechanisms for the increasing erythromycin resistance were mainly due to the growing presence of mef(A) negative erm(B)(+) and mef(A)(+) erm(B)(+) genotypes, which increased from 20.0% to 46.1% and from 1.8% to 19.1%, respectively, from 2001-2002 to 2007-2008. However, mef(A)-mediated erythromycin resistance decreased from 72.7% in 2001-2002 to 34.8% in 2007-2008. Serotypes related to the erm(B) gene were 15A (45.6%), 19A (20.9%), 3 (10.1%), and 6B (6.3%); serotypes related to the mef(A) gene were 6A (18.6%), 19A (15.0%), 6C (9.3%), and 14(8.4%); serotypes associated with the presence of both erm(B) and mef(A) were 19A (81.5%), 15A (7.7%), and 19F (6.2%). Pulsed-field gel electrophoresis analysis demonstrated that erythromycin-resistant isolates within the 19A serotype were genetically diverse and related to several circulating international clones. In contrast, erythromycin-resistant isolates within the 15A serotype consisted of clonally identical or closely related isolates.
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Achermann R, Suter K, Kronenberg A, Gyger P, Mühlemann K, Zimmerli W, Bucher H. Antibiotic use in adult outpatients in Switzerland in relation to regions, seasonality and point of care tests. Clin Microbiol Infect 2011; 17:855-61. [DOI: 10.1111/j.1469-0691.2010.03348.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Falcó V, Sánchez A, Pahissa A, Rello J. Emerging drugs for pneumococcal pneumonia. Expert Opin Emerg Drugs 2011; 16:459-77. [DOI: 10.1517/14728214.2011.576669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lin YC, Lin HC, Lin HC. Doctor characteristics and prescribing antibiotics for urinary tract infections: the experience of an Asian country. J Eval Clin Pract 2010; 16:1221-6. [PMID: 20722886 DOI: 10.1111/j.1365-2753.2009.01299.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES This study aims to explore the relationship between doctor characteristics and prescribing behaviour for patients with urinary tract infections (UTIs) using a 2-year population-based data set in Taiwan. METHODS This study used data from the Taiwan National Health Insurance Research Database. Our study sample consists of first-time ambulatory care visits for treatment of UTIs among female patients between 2005 and 2006 (n=45,934). The primary outcome studied was 'whether a broad-spectrum antibiotic was prescribed', and the key independent variables were 'doctor characteristics'. Doctor characteristics included gender, age (<41, 41-50, >50), specialty, type (hospital-based vs. office-based) and practice location. Multivariate logistic regression analysis using generalized estimated equations was performed to assess the adjusted odds ratio of the doctors using broad-spectrum antibiotics. RESULTS Among the sampled patients, 13.5% were prescribed broad-spectrum antibiotics at their first visit for treatment of UTIs. The adjusted odds of prescribing second-line antibiotics for doctors aged between 41-50 years and >50 years were 0.80 (P<0.001) and 0.90 (P=0.007) times, respectively, that of doctors aged <41 years. Doctors specializing in family medicine were 1.10 (P=0.006) times more likely than doctors specializing in obstetrics and gynaecology to prescribe broad-spectrum, and office-based doctors were 1.41 (P<0.001) times more likely than hospital-based doctors to do so. CONCLUSIONS We conclude that there is variation in doctor prescribing behaviour of antimicrobial therapy for UTIs, after adjusting for possible confounding factors. Continuing medical education and intervention should be designed for doctor groups with undesirable performance in prescribing antibiotics.
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Affiliation(s)
- Yi-Chun Lin
- Section of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital and Lecturer, School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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Sutherland ER, King TS, Icitovic N, Ameredes BT, Bleecker E, Boushey HA, Calhoun WJ, Castro M, Cherniack RM, Chinchilli VM, Craig TJ, Denlinger L, DiMango EA, Fahy JV, Israel E, Jarjour N, Kraft M, Lazarus SC, Lemanske RF, Peters SP, Ramsdell J, Sorkness CA, Szefler SJ, Walter MJ, Wasserman SI, Wechsler ME, Chu HW, Martin RJ. A trial of clarithromycin for the treatment of suboptimally controlled asthma. J Allergy Clin Immunol 2010; 126:747-53. [PMID: 20920764 PMCID: PMC2950827 DOI: 10.1016/j.jaci.2010.07.024] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 06/23/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND PCR studies have demonstrated evidence of Mycoplasma pneumoniae and Chlamydophila pneumoniae in the lower airways of patients with asthma. OBJECTIVE To test the hypothesis that clarithromycin would improve asthma control in individuals with mild-to-moderate persistent asthma that was not well controlled despite treatment with low-dose inhaled corticosteroids. METHODS Adults with an Asthma Control Questionnaire score ≥1.5 after a 4-week period of treatment with fluticasone propionate were entered into a PCR-stratified randomized, controlled trial to evaluate the effect of 16 weeks of either clarithromycin or placebo, added to fluticasone, on asthma control in individuals with or without lower airway PCR evidence of M pneumoniae or C pneumoniae. RESULTS A total of 92 participants were randomized. Twelve (13%) subjects demonstrated PCR evidence of M pneumoniae or C pneumoniae in endobronchial biopsies; 80 were PCR-negative for both organisms. In PCR-positive participants, clarithromycin yielded a 0.4 ± 0.4 unit improvement in the Asthma Control Questionnaire score, with a 0.1 ± 0.3 unit improvement in those allocated to placebo. This between-group difference of 0.3 ± 0.5 (P = .6) was neither clinically nor statistically significant. In PCR-negative participants, a nonsignificant between-group difference of 0.2 ± 0.2 units (P = .3) was observed. Clarithromycin did not improve lung function or airway inflammation but did improve airway hyperresponsiveness, increasing the methacholine PC(20) by 1.2 ± 0.5 doubling doses (P = .02) in the study population. CONCLUSION Adding clarithromycin to fluticasone in adults with mild-to-moderate persistent asthma that was suboptimally controlled by low-dose inhaled corticosteroids alone did not further improve asthma control. Although there was an improvement in airway hyperresponsiveness with clarithromycin, this benefit was not accompanied by improvements in other secondary outcomes.
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Harvey RJ, Wallwork BD, Lund VJ. Anti-inflammatory effects of macrolides: applications in chronic rhinosinusitis. Immunol Allergy Clin North Am 2010; 29:689-703. [PMID: 19879444 DOI: 10.1016/j.iac.2009.07.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The anti-inflammatory effects of macrolides are significant. The clinical impact on diffuse panbronchiolitis (DPB) has improved 10-year survival from 12% to more than 90% for these patients. The immunomodulatory activity of macrolides has been a source of mechanistic research as well as clinical research in non-DPB inflammatory airway disease. Suppression of neutrophilic inflammation of the airways has been demonstrated as the most robust immunomodulatory response from 14- and 15-membered ring macrolides. The inhibition of transcription factors, mainly nuclear factor-kB and activator protein 1, from alterations in intracellular cell signaling drives this mechanism. The suppression of interleukin-8 to a range of endogenous and exogenous challenges characterizes the alterations to cytokine production. The inflammatory mechanisms of chronic rhinosinusitis (CRS) have been a major non-DPB focus. Macrolides have been trialed in more than 14 prospective trials and are the focus of numerous research projects. Evidence for a strong clinical effect in CRS is mounting, but results may be tempered by researchers' inability to characterize the disease process. Eosinophilic dominated CRS is unlikely to respond, based on current research understanding and data from clinical trials. This article discusses the current concepts of macrolides and their application in the management of CRS.
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Affiliation(s)
- Richard J Harvey
- Department of Otolaryngology, Skull Base Surgery, St. Vincent's Hospital, Sydney, NSW 2010, Australia.
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Abstract
Trachoma is a significant public health problem that is endemic in 57 countries, affecting 40.6 million people and contributing to 4% of the global burden of blindness. Repeated episodes of infection from Chlamydia trachomatis lead to long-term inflammation, scarring of the tarsal conjunctiva and distortion of the upper eyelid with in-turning of eyelashes that abrade the surface of the globe. This constant abrasion, in turn, can cause irreversible corneal opacity and blindness. The Alliance for the Global Elimination of Trachoma by 2020 (GET2020) has adopted the SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) strategy as the main action against trachoma. Trichiasis surgery reduces the risk of blindness by reversing the in-turning of eyelashes and also improves the quality of life from non-visual symptoms. However, future efforts need to aim at increasing accessibility to surgery and improving acceptance. Antibacterials are required to reduce the burden of infection. Oral azithromycin is as close to the perfect antibacterial as we will get for mass distribution: it is safe, requires only a single oral dose, treatment is usually repeated every 6-12 months, resistance is not seen as a problem, and cost is not a limiting factor with a large donation programme and newer generic versions of the drug. Future focus should be on the details of antibacterial distribution such as coverage, frequency of distribution and target population. The promotion of facial cleanliness through education may be the key to trachoma elimination as it will stop the frequent exchange of infected ocular secretions and thus reduce the transmission of infection. However, innovative methods are required to translate health education and promotion activities into sustainable changes in hygiene behaviour. Environmental improvements should focus on the barriers to achieving facial cleanliness and cost-effective means need to be identified. There are a number of countries already eligible for certification of trachoma elimination and if current momentum continues, blinding trachoma can be eliminated by the year 2020.
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Affiliation(s)
- Anu A Mathew
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
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Magee TV, Ripp SL, Li B, Buzon RA, Chupak L, Dougherty TJ, Finegan SM, Girard D, Hagen AE, Falcone MJ, Farley KA, Granskog K, Hardink JR, Huband MD, Kamicker BJ, Kaneko T, Knickerbocker MJ, Liras JL, Marra A, Medina I, Nguyen TT, Noe MC, Obach RS, O’Donnell JP, Penzien JB, Reilly UD, Schafer JR, Shen Y, Stone GG, Strelevitz TJ, Sun J, Tait-Kamradt A, Vaz ADN, Whipple DA, Widlicka DW, Wishka DG, Wolkowski JP, Flanagan ME. Discovery of Azetidinyl Ketolides for the Treatment of Susceptible and Multidrug Resistant Community-Acquired Respiratory Tract Infections. J Med Chem 2009; 52:7446-57. [DOI: 10.1021/jm900729s] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas V. Magee
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Sharon L. Ripp
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Bryan Li
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Richard A. Buzon
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Lou Chupak
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Thomas J. Dougherty
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Steven M. Finegan
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Dennis Girard
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Anne E. Hagen
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Michael J. Falcone
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Kathleen A. Farley
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Karl Granskog
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Joel R. Hardink
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Michael D. Huband
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Barbara J. Kamicker
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Takushi Kaneko
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | | | - Jennifer L. Liras
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Andrea Marra
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Ivy Medina
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Thuy-Trinh Nguyen
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Mark C. Noe
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - R. Scott Obach
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - John P. O’Donnell
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Joseph B. Penzien
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Usa Datta Reilly
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - John R. Schafer
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Yue Shen
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Gregory G. Stone
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | | | - Jianmin Sun
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Amelia Tait-Kamradt
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Alfin D. N. Vaz
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - David A. Whipple
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Daniel W. Widlicka
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Donn G. Wishka
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Joanna P. Wolkowski
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
| | - Mark E. Flanagan
- Pfizer Global Research & Development, Pfizer, Inc., Groton, Connecticut 06340
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Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 2009; 302:758-66. [PMID: 19690308 PMCID: PMC4818952 DOI: 10.1001/jama.2009.1163] [Citation(s) in RCA: 379] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT During the 1990s, antibiotic prescriptions for acute respiratory tract infection (ARTI) decreased in the United States. The sustainability of those changes is unknown. OBJECTIVE To assess trends in antibiotic prescriptions for ARTI. DESIGN, SETTING, AND PARTICIPANTS The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (1995-2006) were used to examine trends in antibiotic prescription rates by antibiotic indication and class. Annual survey data and census denominators were combined in 2-year intervals for rate calculations. MAIN OUTCOME MEASURES National annual visit rates and antibiotic prescription rates for ARTI, including otitis media (OM) and non-ARTI. RESULTS Among children younger than 5 years, annual ARTI visit rates decreased by 17% (95% confidence interval [CI], 9%-24%), from 1883 per 1000 population in 1995-1996 to 1560 per 1000 population in 2005-2006, primarily due to a 33% (95% CI, 22%-43%) decrease in OM visit rates (950 to 634 per 1000 population, respectively). This decrease was accompanied by a 36% (95% CI, 26%-45%) decrease in ARTI-associated antibiotic prescriptions (1216 to 779 per 1000 population). Among persons aged 5 years or older, ARTI visit rates remained stable but associated antibiotic prescription rates decreased by 18% (95% CI, 6%-29%), from 178 to 146 per 1000 population. Antibiotic prescription rates for non-OM ARTI for which antibiotics are rarely indicated decreased by 41% (95% CI, 22%-55%) and 24% (95% CI, 10%-37%) among persons younger than 5 years and 5 years or older, respectively. Overall, ARTI-associated prescription rates for penicillin, cephalosporin, and sulfonamide/tetracycline decreased. Prescription rates for azithromycin increased and it became the most commonly prescribed macrolide for ARTI and OM (10% of OM visits). Among adults, quinolone prescriptions increased. CONCLUSIONS Overall antibiotic prescription rates for ARTI decreased, associated with fewer OM visits in children younger than 5 years and with fewer prescriptions for ARTI for which antibiotics are rarely indicated. However, prescription rates for broad-spectrum antibiotics increased significantly.
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Affiliation(s)
- Carlos G Grijalva
- Department of Preventive Medicine, Vanderbilt University School of Medicine, 1500 21st Ave, Ste 2600, The Village at Vanderbilt, Nashville, TN 37232-2637, USA.
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Karlowsky JA, Lagacé-Wiens PRS, Low DE, Zhanel GG. Annual macrolide prescription rates and the emergence of macrolide resistance among Streptococcus pneumoniae in Canada from 1995 to 2005. Int J Antimicrob Agents 2009; 34:375-9. [PMID: 19560902 DOI: 10.1016/j.ijantimicag.2009.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 05/13/2009] [Accepted: 05/14/2009] [Indexed: 10/20/2022]
Abstract
Over the last 20 years, Canadian pneumococcal surveillance studies have documented a steady rise in macrolide resistance. In the current study, we probed the nature of associations between the emergence of macrolide-resistant Streptococcus pneumoniae in Canada and changes in macrolide (azithromycin, clarithromycin and erythromycin) prescription rates. Macrolide susceptibility testing data for respiratory tract isolates of S. pneumoniae (n=15109) were acquired from two published national Canadian surveillance databases, and dispensed outpatient macrolide prescription data were acquired from the proprietary Intercontinental Medical Statistics (IMS) Health Canada CompuScript database. Nationally, macrolide resistance increased from 3.7% in 1995 to 19.0% in 2005 (P=0.003) as the annual macrolide prescription rate increased from 106.7 to 123.2 prescriptions/1000 persons per year (P=0.003). From 1995 to 2005, azithromycin and clarithromycin prescriptions increased from 4.8 to 52.5 prescriptions/1000 persons per year (P<0.0001) and from 24.7 to 58.4 prescriptions/1000 persons per year (P=0.005), respectively, whilst erythromycin prescriptions decreased from 77.2 to 12.3 prescriptions/1000 persons per year (P<0.0001). By univariate regression analysis, increasing rates of azithromycin (R(2)=0.931; P<0.0001) and clarithromycin (R(2)=0.725; P=0.0009) prescriptions and a decreasing rate of erythromycin prescriptions (R(2)=-0.963; P<0.0001) were all associated with increasing macrolide resistance from 1995 to 2005. Multivariate regression analysis showed that a model including all three macrolide prescription rates provided the best fit to the trend of increasing macrolide resistance. When the data were analysed by provincial origin, no statistically significant associations were found between prescription rates of any macrolide and macrolide resistance rates by univariate and multivariate regression analyses. We conclude that increasing macrolide resistance among respiratory isolates of pneumococci in Canada from 1995 to 2005 was associated both with decreasing prescriptions for erythromycin and concurrent increases in prescriptions for azithromycin and clarithromycin (azithromycin>clarithromycin by univariate regression analysis). Resistance development is complex and factors other than macrolide use may also be associated with observed increases in macrolide resistance in Canada from 1995 to 2005.
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Affiliation(s)
- James A Karlowsky
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
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Coco AS, Horst MA, Gambler AS. Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998-2004. BMC Pediatr 2009; 9:41. [PMID: 19552819 PMCID: PMC2711950 DOI: 10.1186/1471-2431-9-41] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 06/24/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Overuse of broad-spectrum antibiotics is associated with antibiotic resistance. Acute otitis media (AOM) is responsible for a large proportion of antibiotics prescribed for US children. Rates of broad-spectrum antibiotic prescribing for AOM are unknown. METHODS Analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1998 to 2004 (N = 6,878). Setting is office-based physicians, hospital outpatient departments, and emergency departments. Patients are children aged 12 years and younger prescribed antibiotics for acute otitis media. Main outcome measure is percentage of broad-spectrum antibiotics, defined as amoxicillin/clavulanate, macrolides, cephalosporins and quinolones. RESULTS Broad-spectrum prescribing for acute otitis media increased from 34% of visits in 1998 to 45% of visits in 2004 (P < .001 for trend). The trend was primarily attributable to an increase in prescribing of amoxicillin/clavulanate (8% to 15%; P < .001 for trend) and macrolides (9% to 15%; P < .001 for trend). Prescribing remained stable for amoxicillin and cephalosporins while decreasing for narrow-spectrum agents (12% to 3%; P < .001 for trend) over the study period. Independent predictors of broad-spectrum antibiotic prescribing were ear pain, non-white race, public and other insurance (compared to private), hospital outpatient department setting, emergency department setting, and West region (compared to South and Midwest regions), each of which was associated with lower rates of broad-spectrum prescribing. Age and fever were not associated with prescribing choice. CONCLUSION Prescribing of broad-spectrum antibiotics for acute otitis media has steadily increased from 1998 to 2004. Associations with non-clinical factors suggest potential for improvement in prescribing practice.
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Affiliation(s)
- Andrew S Coco
- Research Institute & Department of Family Medicine, Lancaster General Hospital, North Duke Street, Lancaster, PA 17604-3555, USA
| | - Michael A Horst
- Research Institute & Department of Family Medicine, Lancaster General Hospital, North Duke Street, Lancaster, PA 17604-3555, USA
| | - Angela S Gambler
- Research Institute & Department of Family Medicine, Lancaster General Hospital, North Duke Street, Lancaster, PA 17604-3555, USA
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National paediatric immunization program of high risk groups: no effect on the incidence of invasive pneumococcal diseases. Vaccine 2009; 27:3963-8. [PMID: 19393711 DOI: 10.1016/j.vaccine.2009.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 04/08/2009] [Accepted: 04/15/2009] [Indexed: 11/22/2022]
Abstract
This study monitors the epidemiology of invasive pneumococcal diseases (IPD) in hospitalized children up to 60 months of age before (February 2001-October 2004) and after (November 2004-January 2007) the introduction of a national risk group immunization program with "Prevenar" in Austria. The IPD incidence rates, per 100,000, for IPD were 7.6 before and 6.4 after the risk group immunization program, while there was a significant reduction (p<0.05) for meningitis, 3.1 before and 1.6 after. Overall, the most commonly observed serotypes were 14 (34.2%), 6B (11.7%), and 23F (6.7%). 71.7% of the identified strains were vaccine types; 12.5% were vaccine-related serotypes. No clinically relevant changes in the incidence rate of IPDs or shift/replacement of serotypes was documented. Antimicrobial resistance predominated against erythromycin (32.5%) and clarithromycin (26.7%). Our data show that this risk group vaccination program had no impact on the incidence of IPD in young children.
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Mulvey MR, Simor AE. Antimicrobial resistance in hospitals: how concerned should we be? CMAJ 2009; 180:408-15. [PMID: 19221354 DOI: 10.1503/cmaj.080239] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Michael R Mulvey
- Department of Nosocomial Infections, National Microbiology Laboratory, Public Health Agency of Canada, University of Manitoba, Winnipeg, Man
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Borg M, Tiemersma E, Scicluna E, van de Sande-Bruinsma N, de Kraker M, Monen J, Grundmann H. Prevalence of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae isolates reported by laboratories in the southern and eastern Mediterranean region. Clin Microbiol Infect 2009; 15:232-7. [DOI: 10.1111/j.1469-0691.2008.02651.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gerber D, Maerkl SJ, Quake SR. An in vitro microfluidic approach to generating protein-interaction networks. Nat Methods 2009; 6:71-4. [PMID: 19098921 PMCID: PMC4117197 DOI: 10.1038/nmeth.1289] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 11/11/2008] [Indexed: 01/26/2023]
Abstract
We developed an in vitro protein expression and interaction analysis platform based on a highly parallel and sensitive microfluidic affinity assay, and used it for 14,792 on-chip experiments, which exhaustively measured the protein-protein interactions of 43 Streptococcus pneumoniae proteins in quadruplicate. The resulting network of 157 interactions was denser than expected based on known networks. Analysis of the network revealed previously undescribed physical interactions among members of some biochemical pathways.
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Affiliation(s)
- Doron Gerber
- Department of Bioengineering, Stanford University and Howard Hughes Medical Institute, 318 Campus Drive, Stanford, CA 94305, USA
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Chico RM, Pittrof R, Greenwood B, Chandramohan D. Azithromycin-chloroquine and the intermittent preventive treatment of malaria in pregnancy. Malar J 2008; 7:255. [PMID: 19087267 PMCID: PMC2632633 DOI: 10.1186/1475-2875-7-255] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 12/16/2008] [Indexed: 11/12/2022] Open
Abstract
In the high malaria-transmission settings of sub-Saharan Africa, malaria in pregnancy is an important cause of maternal, perinatal and neonatal morbidity. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) reduces the incidence of low birth-weight, pre-term delivery, intrauterine growth-retardation and maternal anaemia. However, the public health benefits of IPTp are declining due to SP resistance. The combination of azithromycin and chloroquine is a potential alternative to SP for IPTp. This review summarizes key in vitro and in vivo evidence of azithromycin and chloroquine activity against Plasmodium falciparum and Plasmodium vivax, as well as the anticipated secondary benefits that may result from their combined use in IPTp, including the cure and prevention of many sexually transmitted diseases. Drug costs and the necessity for external financing are discussed along with a range of issues related to drug resistance and surveillance. Several scientific and programmatic questions of interest to policymakers and programme managers are also presented that would need to be addressed before azithromycin-chloroquine could be adopted for use in IPTp.
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Affiliation(s)
- R Matthew Chico
- Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK.
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Risk Factors for Multidrug-Resistant Pneumococcal Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e31817eec69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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