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Słota D, Jampilek J, Sobczak-Kupiec A. Targeted Clindamycin Delivery Systems: Promising Options for Preventing and Treating Bacterial Infections Using Biomaterials. Int J Mol Sci 2024; 25:4386. [PMID: 38673971 PMCID: PMC11050486 DOI: 10.3390/ijms25084386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Targeted therapy represents a real opportunity to improve the health and lives of patients. Developments in this field are confirmed by the fact that the global market for drug carriers was worth nearly $40 million in 2022. For this reason, materials engineering and the development of new drug carrier compositions for targeted therapy has become a key area of research in pharmaceutical drug delivery in recent years. Ceramics, polymers, and metals, as well as composites, are of great interest, as when they are appropriately processed or combined with each other, it is possible to obtain biomaterials for hard tissues, soft tissues, and skin applications. After appropriate modification, these materials can release the drug directly at the site requiring a therapeutic effect. This brief literature review characterizes routes of drug delivery into the body and discusses biomaterials from different groups, options for their modification with clindamycin, an antibiotic used for infections caused by aerobic and anaerobic Gram-positive bacteria, and different methods for the final processing of carriers. Examples of coating materials for skin wound healing, acne therapy, and bone tissue fillers are given. Furthermore, the reasons why the use of antibiotic therapy is crucial for a smooth and successful recovery and the risks of bacterial infections are explained. It was demonstrated that there is no single proven delivery scheme, and that the drug can be successfully released from different carriers depending on the destination.
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Affiliation(s)
- Dagmara Słota
- Department of Materials Science, Faculty of Materials Engineering and Physics, KrakowUniversity of Technology, 37 Jana Pawła II Av., 31-864 Krakow, Poland;
| | - Josef Jampilek
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University, Ilkovicova 6, 842 15 Bratislava, Slovakia
- Department of Chemical Biology, Faculty of Science, Palacky University, Slechtitelu 27, 783 71 Olomouc, Czech Republic
| | - Agnieszka Sobczak-Kupiec
- Department of Materials Science, Faculty of Materials Engineering and Physics, KrakowUniversity of Technology, 37 Jana Pawła II Av., 31-864 Krakow, Poland;
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Peng X, Chen J, Gan Y, Yang L, Luo Y, Bu C, Huang Y, Chen X, Tan J, Yang YY, Yuan P, Ding X. Biofunctional lipid nanoparticles for precision treatment and prophylaxis of bacterial infections. SCIENCE ADVANCES 2024; 10:eadk9754. [PMID: 38578994 PMCID: PMC10997193 DOI: 10.1126/sciadv.adk9754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 04/07/2024]
Abstract
The lack of bacterial-targeting function in antibiotics and their prophylactic usage have caused overuse of antibiotics, which lead to antibiotic resistance and inevitable long-term toxicity. To overcome these issues, we develop neutrophil-bacterial hybrid cell membrane vesicle (HMV)-coated biofunctional lipid nanoparticles (LNP@HMVs), which are designed to transport antibiotics specifically to bacterial cells at the infection site for the effective treatment and prophylaxis of bacterial infection. The dual targeting ability of HMVs to inflammatory vascular endothelial cells and homologous Gram-negative bacterial cells results in targeted accumulation of LNP@HMVs in the site of infections. LNP@HMVs loaded with the antibiotic norfloxacin not only exhibit enhanced activity against planktonic bacteria and bacterial biofilms in vitro but also achieve potent therapeutic efficacy in treating both systemic infection and lung infection. Furthermore, LNP@HMVs trigger the activation of specific humoral and cellular immunity to prevent bacterial infection. Together, LNP@HMVs provide a promising strategy to effectively treat and prevent bacterial infection.
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Affiliation(s)
- Xinran Peng
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Jiaoyu Chen
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Yingying Gan
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Li Yang
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Yuanjing Luo
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Changxin Bu
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Yi Huang
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Xinhai Chen
- Institute of Infectious Diseases, Shenzhen Bay Laboratory, Shenzhen 518132, PR China
| | - Jeremy Tan
- Bioprocessing Technology Institute, Agency for Science, Technology and Research (A*STAR), 20 Biopolis Way, Centros #06-01, Singapore 138668, Singapore
| | - Yi Yan Yang
- Bioprocessing Technology Institute, Agency for Science, Technology and Research (A*STAR), 20 Biopolis Way, Centros #06-01, Singapore 138668, Singapore
| | - Peiyan Yuan
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Xin Ding
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
- School of Medicine, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
- State Key Laboratory of Anti-Infective Drug Discovery and Development; School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
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Birgand G, Dhar P, Holmes A. The threat of antimicrobial resistance in surgical care: the surgeon's role and ownership of antimicrobial stewardship. Br J Surg 2023; 110:1567-1569. [PMID: 37758500 PMCID: PMC10638523 DOI: 10.1093/bjs/znad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Gabriel Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Regional Center for Infection Prevention and Control, Region of Pays de la Loire, Nantes University Hospital, Nantes, France
- Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, Nantes Université, Nantes, France
| | - Puneet Dhar
- Surgical Gastroenterology, Amrita Hospital, Faridabad, India
| | - Alison Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Faculty of Health Sciences, University of Liverpool, Liverpool, UK
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Chand U, Priyambada P, Kushawaha PK. Staphylococcus aureus vaccine strategy: Promise and challenges. Microbiol Res 2023; 271:127362. [PMID: 36958134 DOI: 10.1016/j.micres.2023.127362] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/21/2023] [Accepted: 03/11/2023] [Indexed: 03/14/2023]
Abstract
Staphylococcus aureus (S. aureus) is a leading and crucial infectious threat to global public health due to the widespread emergence of antibiotic-resistant strains such as Methicillin-Resistant S. aureus (MRSA). MRSA infects immunocompromised patients and healthy individuals and has rapidly spread from the healthcare setting to the outside community. The development of flawless vaccines become a medical need worldwide against multi-drug resistant S. aureus. Therefore, protection by an immune-based strategy may provide valuable measures to contain the spread of invasive S. aureus infections. Several vaccine candidates have been prepared which are either in the preclinical phase or in the early clinical phase, whereas several candidates have failed to show a protective efficacy in human subjects. Currently, research is focusing on identifying novel vaccine formulations able to elicit potent humoral and cellular immune responses. Several approaches have also been made to the development of monoclonal or polyclonal antibodies for passive immunization to protect against S. aureus infections. In recent years, a multi-epitope vaccine has emerged as a novel platform for subunit vaccine design by using computational approaches. Therefore, in this review, we have summarized and discussed the mechanistic overview of different strategies used to develop potential vaccine candidates and passive interventions which are in different stages of clinical trials to fight multi-drug resistant S. aureus infections.
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Affiliation(s)
- Umesh Chand
- Department of Microbiology, School of Basic Sciences, Central University of Punjab, VPO Ghudda, Bathinda, Punjab 151401, India
| | - Pragnya Priyambada
- Department of Microbiology, School of Basic Sciences, Central University of Punjab, VPO Ghudda, Bathinda, Punjab 151401, India
| | - Pramod Kumar Kushawaha
- Department of Microbiology, School of Basic Sciences, Central University of Punjab, VPO Ghudda, Bathinda, Punjab 151401, India.
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Birgand G, Ahmad R, Bulabula ANH, Singh S, Bearman G, Sánchez EC, Holmes A. Innovation for infection prevention and control-revisiting Pasteur's vision. Lancet 2022; 400:2250-2260. [PMID: 36528378 PMCID: PMC9754656 DOI: 10.1016/s0140-6736(22)02459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
Louis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Examples from across the globe help inform future thinking for IPC innovation, adoption, scale up and sustained use.
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Affiliation(s)
- Gabriel Birgand
- Centre d'appui pour la Prévention des Infections Associées aux Soins, Nantes, France; National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
| | - Raheelah Ahmad
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK; School of Health and Psychological Sciences, City University of London, London, UK; Institute of Business and Health Management, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Sanjeev Singh
- Department of Medicine, Amrita Institute of Medical Sciences, Amrita University, Kerala, India
| | - Gonzalo Bearman
- Division of Infectious Diseases, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Enrique Castro Sánchez
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK; College of Nursing, Midwifery and Healthcare, Richard Wells Centre, University of West London, London, UK
| | - Alison Holmes
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
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Espindola R, Vella V, Benito N, Mur I, Tedeschi S, Rossi N, Hendriks JGE, Sorlí L, Murillo O, Scarborough M, Scarborough C, Kluytmans J, Ferrari MC, Pletz MW, Mcnamara I, Escudero-Sanchez R, Arvieux C, Batailler C, Dauchy FA, Liu WY, Lora-Tamayo J, Praena J, Ustianowski A, Cinconze E, Pellegrini M, Bagnoli F, Rodríguez-Baño J, Del Toro MD. Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: A multinational matched case-control study. Clin Microbiol Infect 2022; 28:1359-1366. [PMID: 35597508 DOI: 10.1016/j.cmi.2022.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aim to identify the preoperative and perioperative risk factors associated with post-surgical Staphylococcus aureus prosthetic joint infections (PJI), and to develop and validate risk-scoring systems, to allow a better identification of high-risk patients for more efficient targeted interventions. METHODS We performed a multicenter matched case-control study of patients who underwent a primary hip and knee arthroplasty from 2014 to 2016. Two multivariable models by logistic regression were performed, one for the preoperative and one for perioperative variables; also, predictive scores were developed and validated in an external cohort. RESULTS In total, 130 cases and 386 controls were included. The variables independently associated with S. aureus-PJI in the preoperative period were (adjusted OR; 95% CI): BMI >30 kg/m2 (3.0; 1.9-4.8), resident in a long-term care facility (2.8; 1.05-7.5), fracture as reason for arthroplasty (2.7; 1.4-5.03), skin disorders (2.5; 0.9-7.04), previous surgery in the index joint (2.4; 1.3-4.4), male sex (1.9; 1.2-2.9) and ASA score 3-4 (1.8; 1.2-2.9). The AUROC curve was 0.73 (95% CI 0.68-0.78). In perioperative model, the risk factors were the previous ones plus surgical antibiotic prophylaxis administered out of the first 60 minutes before incision (5.9; 2.1-16.2), wound drainage for >72h after arthroplasty (4.5; 1.9-19.4) and use of metal bearing material vs. ceramic (1.9; 1.1-3.3). The AUROC curve was 0.78 (95% CI 0.72-0.83). The predictive scores developed were validated in the external cohort. CONCLUSIONS Predictive scores for S. aureus-PJI were developed and validated; this information would be useful for implementation of specific preventive measures.
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Affiliation(s)
- Reinaldo Espindola
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | | | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau /Sant Pau Institute for Biomedical Research; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau /Sant Pau Institute for Biomedical Research; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sara Tedeschi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Nicolò Rossi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | - Luisa Sorlí
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Pompeu Fabra, Barcelona, Spain
| | - Oscar Murillo
- Servicio de Enfermedades Infecciosas, Hospital Universitari Bellvitge. IDIBELL, Barcelona, Spain
| | | | | | | | | | | | - Iain Mcnamara
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Cedric Arvieux
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Cecile Batailler
- Orthopedic Surgery department, Croix Rousse Hospital, Lyon, France
| | | | - Wai-Yan Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Julia Praena
- Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | | | | | | | | | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Dolores Del Toro
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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Morikane K, Russo PL, Lee KY, Chakravarthy M, Ling ML, Saguil E, Spencer M, Danker W, Seno A, Charles EE. Expert commentary on the challenges and opportunities for surgical site infection prevention through implementation of evidence-based guidelines in the Asia-Pacific Region. Antimicrob Resist Infect Control 2021; 10:65. [PMID: 33795007 PMCID: PMC8017777 DOI: 10.1186/s13756-021-00916-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) are a significant source of morbidity and mortality in the Asia-Pacific region (APAC), adversely impacting patient quality of life, fiscal productivity and placing a major economic burden on the country's healthcare system. This commentary reports the findings of a two-day meeting that was held in Singapore on July 30-31, 2019, where a series of consensus recommendations were developed by an expert panel composed of infection control, surgical and quality experts from APAC nations in an effort to develop an evidence-based pathway to improving surgical patient outcomes in APAC. METHODS The expert panel conducted a literature review targeting four sentinel areas within the APAC region: national and societal guidelines, implementation strategies, postoperative surveillance and clinical outcomes. The panel formulated a series of key questions regarding APAC-specific challenges and opportunities for SSI prevention. RESULTS The expert panel identified several challenges for mitigating SSIs in APAC; (a) constraints on human resources, (b) lack of adequate policies and procedures, (c) lack of a strong safety culture, (d) limitation in funding resources, (e) environmental and geographic challenges, (f) cultural diversity, (g) poor patient awareness and (h) limitation in self-responsibility. Corrective strategies for guideline implementation in APAC were proposed that included: (a) institutional ownership of infection prevention strategies, (b) perform baseline assessments, (c) review evidence-based practices within the local context, (d) develop a plan for guideline implementation, (e) assess outcome and stakeholder feedback, and (f) ensure long-term sustainability. CONCLUSIONS Reducing the risk of SSIs in APAC region will require: (a) ongoing consultation and collaboration among stakeholders with a high level of clinical staff engagement and (b) a strong institutional and national commitment to alleviate the burden of SSIs by embracing a safety culture and accountability.
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Affiliation(s)
- K Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan
| | - P L Russo
- School of Nursing and Midwifery, Monash University, Frankston, VC, Australia
| | - K Y Lee
- Department of Surgery, KyungHee University Medical Center, Seoul, South Korea
| | | | - M L Ling
- Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - E Saguil
- Philippine General Hospital, Manila, Philippines
| | - M Spencer
- Infection Prevention Consultant, Boston, MA, USA
| | - W Danker
- Ethicon, Johnson and Johnson Medical Device Companies, Somerville, NJ, USA
| | - A Seno
- Johnson and Johnson Medical Asia Pacific, Singapore, Singapore
| | - E Edmiston Charles
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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Guan H, Dong W, Lu Y, Jiang M, Zhang D, Aobuliaximu Y, Dong J, Niu Y, Liu Y, Guan B, Tang J, Lu S. Distribution and Antibiotic Resistance Patterns of Pathogenic Bacteria in Patients With Chronic Cutaneous Wounds in China. Front Med (Lausanne) 2021; 8:609584. [PMID: 33816517 PMCID: PMC8010674 DOI: 10.3389/fmed.2021.609584] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background: To determine the distribution and antimicrobial susceptibility pattern of pathogenic bacteria in patients with chronic cutaneous wounds on a national scale. Methods: A retrospective study was conducted using the data recorded between January 1, 2018 and January1, 2020 in 195 hospitals across China. After screening the data, 815 patients with chronic wounds were finally analyzed. The data collected included information about the patients' general condition and local cutaneous wound assessments, especially microbial culture and antibiotic susceptibility tests. The analyses were performed using SPSS Version 26. Results: The study included 815 patients (290 [35.6%] females; 63 [50-74] years). The most common causes of chronic cutaneous wounds were diabetes (183, 22.5%), infection (178, 21.8%), and pressure (140, 17.2%). Among these, 521(63.9%) samples tested yielded microbial growth, including 70 (13.4%) polymicrobial infection and 451 (86.6%) monomicrobial infection. The positive rate of microbial culture was highest in wound tissue of ulcers caused by infection (87.6%), followed by pressure (77.1%), diabetes (68.3%), and venous diseases (67.7%). Bates-Jensen wound assessment tool (BWAT) scores >25 and wounds that lasted for more than 3 months had a higher positive rate of microbial culture. BWAT scores >25 and wounds in the rump, perineum, and feet were more likely to exhibit polymicrobial infection. A total of 600 strains were isolated, of which 46.2% (277 strains) were Gram-positive bacteria, 51.3% (308 strains) were Gram-negative bacteria, and 2.5% (15 strains) were fungi. The most common bacterial isolates were Staphylococcus aureus (29.2%), Escherichia coli (11.5%), Pseudomonas aeruginosa (11.0%), Proteus mirabilis (8.0%), and Klebsiella pneumoniae (5.8%). The susceptibility tests showed that 116 cultured bacteria were Multidrug resistant (MDR) strains. The resistance rates of S. aureus were 92.0% (161/175) to penicillin, 58.3% (102/175) to erythromycin, and 50.9% (89/175) to clindamycin. Vancomycin was the most effective antibiotic (0% resistance rate) against all Gram-positive bacteria. Besides, the resistance rates of E. coli were 68.1% (47/69) to ampicillin, 68.1% (47/69) to ciprofloxacin, 60.9% (42/69) to levofloxacin. However, all the isolated Gram-negative bacteria showed low resistance rates to tigecycline (3.9%) and amikacin (3.6%). Conclusions: The distribution of bacteria isolated from chronic cutaneous wounds varies with the BWAT scores, causes, duration, and the location of wounds. Multidrug resistance is a serious health issue, and therefore antibiotics used in chronic wounds must be under strict regulation. Our findings may help clinicians in making informed decisions regarding antibiotic therapy.
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Affiliation(s)
- Haonan Guan
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wei Dong
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yechen Lu
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Minfei Jiang
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Di Zhang
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yakupu Aobuliaximu
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiaoyun Dong
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yiwen Niu
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yingkai Liu
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Bingjie Guan
- Department of General Surgery, School of Medicine, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiajun Tang
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shuliang Lu
- Department of Burn, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.,Wound Healing Center, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
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Costa ACD, Santa-Cruz F, Ferraz ÁAB. WHAT'S NEW IN INFECTION ON SURGICAL SITE AND ANTIBIOTICOPROPHYLAXIS IN SURGERY? ACTA ACUST UNITED AC 2021; 33:e1558. [PMID: 33503118 PMCID: PMC7836071 DOI: 10.1590/0102-672020200004e1558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/11/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Infection of the surgical site is the common complication, with significant rates of morbidity and mortality, representing a considerable economic problem for the health system. OBJECTIVE To carry out a narrative review of the literature on surgical site infection and the principles of antibiotic prophylaxis to update the knowledge of its use in surgery. METHOD Medline, Ovid, Google Scholar, National Library of Medicine (PubMed), Cochrane and SciELO were used for the research. The keywords used were "anti-bacterial agents"; "antibioticoprophylaxis" AND "surgical wound infection". The inclusion criteria were articles of recent publication, with full texts available and performed in humans. RESULT A total of 29 articles were evaluated and selected according to the eligibility criteria. CONCLUSION Infection of the surgical site is the most common postoperative complication. The key point of its prevention is the combination of several interventions that aim to reduce risk factors, such as: compliance with the new guidelines of the Center for Disease Control and Prevention; the principles of the use of prophylactic antibiotics; factors and risk index of the surgical site; administration time; duration and dosage of antibiotics. These data are available in this article.
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Affiliation(s)
| | | | - Álvaro A B Ferraz
- Department of Surgery, Federal University of Pernambuco, Recife, PE, Brazil
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Haupenthal J, Kautz Y, Elgaher WAM, Pätzold L, Röhrig T, Laschke MW, Tschernig T, Hirsch AKH, Molodtsov V, Murakami KS, Hartmann RW, Bischoff M. Evaluation of Bacterial RNA Polymerase Inhibitors in a Staphylococcus aureus-Based Wound Infection Model in SKH1 Mice. ACS Infect Dis 2020; 6:2573-2581. [PMID: 32886885 DOI: 10.1021/acsinfecdis.0c00034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic wounds infected with pathogens such as Staphylococcus aureus represent a worldwide health concern, especially in patients with a compromised immune system. As antimicrobial resistance has become an immense global problem, novel antibiotics are urgently needed. One strategy to overcome this threatening situation is the search for drugs targeting novel binding sites on essential and validated enzymes such as the bacterial RNA polymerase (RNAP). In this work, we describe the establishment of an in vivo wound infection model based on the pathogen S. aureus and hairless Crl:SKH1-Hrhr (SKH1) mice. The model proved to be a valuable preclinical tool to study selected RNAP inhibitors after topical application. While rifampicin showed a reduction in the loss of body weight induced by the bacteria, an acceleration of wound healing kinetics, and a reduced number of colony forming units in the wound, the ureidothiophene-2-carboxylic acid 1 was inactive under in vivo conditions, probably due to strong plasma protein binding. The cocrystal structure of compound 1 with RNAP, that we hereby also present, will be of great value for applying appropriate structural modifications to further optimize the compound, especially in terms of plasma protein binding.
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Affiliation(s)
- Jörg Haupenthal
- Department of Drug Design and Optimization, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)−Helmholtz Centre for Infection Research (HZI), Campus Building E8.1, 66123 Saarbrücken, Saarland, Germany
| | - Yannik Kautz
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421 Homburg, Saarland, Germany
| | - Walid A. M. Elgaher
- Department of Drug Design and Optimization, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)−Helmholtz Centre for Infection Research (HZI), Campus Building E8.1, 66123 Saarbrücken, Saarland, Germany
| | - Linda Pätzold
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421 Homburg, Saarland, Germany
| | - Teresa Röhrig
- Department of Drug Design and Optimization, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)−Helmholtz Centre for Infection Research (HZI), Campus Building E8.1, 66123 Saarbrücken, Saarland, Germany
| | - Matthias W. Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg, Saarland, Germany
| | - Thomas Tschernig
- Institute of Anatomy and Cell Biology, Saarland University, 66421 Homburg, Saarland, Germany
| | - Anna K. H. Hirsch
- Department of Drug Design and Optimization, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)−Helmholtz Centre for Infection Research (HZI), Campus Building E8.1, 66123 Saarbrücken, Saarland, Germany
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Saarland, Germany
| | - Vadim Molodtsov
- Department of Biochemistry and Molecular Biology, The Center for RNA Molecular Biology, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Katsuhiko S. Murakami
- Department of Biochemistry and Molecular Biology, The Center for RNA Molecular Biology, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Rolf W. Hartmann
- Department of Drug Design and Optimization, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS)−Helmholtz Centre for Infection Research (HZI), Campus Building E8.1, 66123 Saarbrücken, Saarland, Germany
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Saarland, Germany
| | - Markus Bischoff
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421 Homburg, Saarland, Germany
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11
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Miller LS, Fowler VG, Shukla SK, Rose WE, Proctor RA. Development of a vaccine against Staphylococcus aureus invasive infections: Evidence based on human immunity, genetics and bacterial evasion mechanisms. FEMS Microbiol Rev 2020; 44:123-153. [PMID: 31841134 PMCID: PMC7053580 DOI: 10.1093/femsre/fuz030] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022] Open
Abstract
Invasive Staphylococcus aureus infections are a leading cause of morbidity and mortality in both hospital and community settings, especially with the widespread emergence of virulent and multi-drug resistant methicillin-resistant S. aureus strains. There is an urgent and unmet clinical need for non-antibiotic immune-based approaches to treat these infections as the increasing antibiotic resistance is creating a serious threat to public health. However, all vaccination attempts aimed at preventing S. aureus invasive infections have failed in human trials, especially all vaccines aimed at generating high titers of opsonic antibodies against S. aureus surface antigens to facilitate antibody-mediated bacterial clearance. In this review, we summarize the data from humans regarding the immune responses that protect against invasive S. aureus infections as well as host genetic factors and bacterial evasion mechanisms, which are important to consider for the future development of effective and successful vaccines and immunotherapies against invasive S. aureus infections in humans. The evidence presented form the basis for a hypothesis that staphylococcal toxins (including superantigens and pore-forming toxins) are important virulence factors, and targeting the neutralization of these toxins are more likely to provide a therapeutic benefit in contrast to prior vaccine attempts to generate antibodies to facilitate opsonophagocytosis.
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Affiliation(s)
- Lloyd S Miller
- Immunology, Janssen Research and Development, 1400 McKean Road, Spring House, PA, 19477, USA.,Department of Dermatology, Johns Hopkins University School of Medicine, 1550 Orleans Street, Cancer Research Building 2, Suite 209, Baltimore, MD, 21231, USA.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD, 21287, USA.,Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.,Department of Materials Science and Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
| | - Vance G Fowler
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, 315 Trent Drive, Hanes House, Durham, NC, 27710, USA.,Duke Clinical Research Institute, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Sanjay K Shukla
- Center for Precision Medicine Research, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, WI, 54449, USA.,Computation and Informatics in Biology and Medicine, University of Wisconsin, 425 Henry Mall, Room 3445, Madison, WI, 53706, USA
| | - Warren E Rose
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA.,Pharmacy Practice Division, University of Wisconsin-Madison, 777 Highland Avenue, 4123 Rennebohm Hall, Madison, WI, 53705 USA
| | - Richard A Proctor
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA.,Department of Medical Microbiology and Immunology, University of Wisconsin-Madison School of Medicine and Public Health, 1550 Linden Drive, Microbial Sciences Building, Room 1334, Madison, WI, 53705, USA
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12
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Troeman DPR, Van Hout D, Kluytmans JAJW. Antimicrobial approaches in the prevention of Staphylococcus aureus infections: a review. J Antimicrob Chemother 2020; 74:281-294. [PMID: 30376041 PMCID: PMC6337897 DOI: 10.1093/jac/dky421] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The prophylactic application of antimicrobials that are active against Staphylococcus aureus can prevent infections. However, implementation in clinical practice is limited. We have reviewed antimicrobial approaches for the prevention of S. aureus infections. Methods We searched the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE databases and trial registries using synonyms for S. aureus, infections and prevention as search terms. We included randomized controlled trials and systematic reviews only. Results Most studies were conducted with mupirocin. Mupirocin is effective in preventing S. aureus infections in patients receiving dialysis treatment and in surgical patients, particularly if the patients are carriers of S. aureus. The combination of mupirocin and chlorhexidine, but not chlorhexidine alone, is also effective against S. aureus infections. So far, vaccines have not proven successful in protecting against S. aureus infections. Regarding prophylactic povidone-iodine and systemic antibiotics, there is limited evidence supporting their effectiveness against S. aureus infections. Antimicrobial honey has not been proven to be more effective or non-inferior to mupirocin in protecting against S. aureus infections. Conclusions The current evidence supports the use of mupirocin as prophylaxis for preventing infections with S. aureus, particularly in carriers and in the surgical setting or in patients receiving dialysis treatment. Other antimicrobial agents have not been sufficiently proven to be effective so far, or have been proven ineffective. New trials with vaccines and anti-staphylococcal peptides are currently underway and may lead to new preventive strategies in the future.
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Affiliation(s)
- D P R Troeman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Heidelberglaan 100, 3584 CG Utrecht, The Netherlands
| | - D Van Hout
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Heidelberglaan 100, 3584 CG Utrecht, The Netherlands
| | - J A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Heidelberglaan 100, 3584 CG Utrecht, The Netherlands.,Department of Infection Control, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
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13
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Rapid and Broad Immune Efficacy of a Recombinant Five-Antigen Vaccine against Staphylococcus Aureus Infection in Animal Models. Vaccines (Basel) 2020; 8:vaccines8010134. [PMID: 32197534 PMCID: PMC7157245 DOI: 10.3390/vaccines8010134] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus (S. aureus) is a leading cause of both healthcare-and community-associated infections globally, which result in severe disease and readily developing antibiotic resistance. Developing an efficacious vaccine against S. aureus is urgently required. In the present study, we selected five conserved antigens, including the secreted factors α-hemolysin (Hla), staphylococcal enterotoxin B (SEB) and the three surface proteins staphylococcal protein A (SpA), iron surface determinant B N2 domain (IsdB-N2) and manganese transport protein C (MntC). They were all well-characterized virulence factor of S. aureus and developed a recombinant five-antigen S. aureus vaccine (rFSAV), rFSAV provided consistent protection in S. aureus lethal sepsis and pneumonia mouse models, and it showed broad immune protection when challenged with a panel of epidemiologically relevant S. aureus strains. Meanwhile, rFSAV immunized mice were able to induce comprehensive cellular and humoral immune responses to reduce bacterial loads, inflammatory cytokine expression, inflammatory cell infiltration and decrease pathology after challenge with a sub-lethal dose of S. aureus. Moreover, the importance of specific antibodies in protection was demonstrated by antibody function tests in vitro and in vivo. Altogether, our data demonstrate that rFSAV is a potentially promising vaccine candidate for defensing against S. aureus infection.
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14
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Creech CB, Frenck RW, Fiquet A, Feldman R, Kankam MK, Pathirana S, Baber J, Radley D, Cooper D, Eiden J, Gruber WC, Jansen KU, Anderson AS, Gurtman A. Persistence of Immune Responses Through 36 Months in Healthy Adults After Vaccination With a Novel Staphylococcus aureus 4-Antigen Vaccine (SA4Ag). Open Forum Infect Dis 2019; 7:ofz532. [PMID: 31993453 PMCID: PMC6978999 DOI: 10.1093/ofid/ofz532] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022] Open
Abstract
Background Staphylococcus aureus causes serious health care- and community-associated disease, requiring improved preventive measures such as vaccines. The investigational S. aureus 4-antigen vaccine (SA4Ag), comprising capsular polysaccharide serotypes 5 and 8 (CP5 and CP8) conjugated to CRM197, recombinant mutant clumping factor A (rmClfA), and recombinant manganese transporter protein C (rP305A or rMntC), was well tolerated, inducing robust functional immune responses to all 4 antigens through 12 months postvaccination. This is a serological extension study through 36 months postvaccination. Methods In 2 previous studies, healthy adults received SA4Ag, SA3Ag (without rMntC), or placebo; serology was also assessed at ~24 and ~36 months postvaccination. Functional immune responses (antibody responses that facilitate killing of S. aureus or neutralize S. aureus virulence mechanisms) were assessed with opsonophagocytic activity killing assays (CP5 or CP8) and a fibrinogen-binding inhibition assay (ClfA). A competitive Luminex immunoassay assessed ClfA and rMntC responses. Adverse events within 48 hours of blood draw were recorded. Results Four hundred forty subjects (18-64 years old, 255; 65-85 years old, 185) were enrolled. At 24 and 36 months postvaccination, subjects receiving SA4Ag had substantially higher geometric mean titers (GMTs) for CP5, CP8, and ClfA vs baseline; geometric mean fold rises (GMFRs) from baseline to month 36 were 2.7-8.1. For rMntC, 36-month GMTs declined from peak levels but remained above baseline for all SA4Ag groups; GMFRs from baseline to month 36 were 1.8 and 1.5 in the younger and older cohorts, respectively. Conclusions Persistent functional immune responses to S. aureus antigens were observed through 36 months in healthy adults. ClinicalTrialsgov NCT01643941 and NCT01364571.
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Affiliation(s)
- C Buddy Creech
- Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital, Nashville, Tennessee, USA
| | - Robert W Frenck
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anne Fiquet
- Pfizer Vaccines Research & Development, Hurley, Berkshire, UK
| | - Robert Feldman
- QPS-MRA, Miami Research Associates LLC, Miami, Florida, USA
| | - Martin K Kankam
- Vince and Associates Clinical Research, Overland Park, Kansas, USA
| | - Sudam Pathirana
- Pfizer Vaccines Research & Development, Pearl River, New York, USA
| | - James Baber
- Pfizer Vaccines Research & Development, Sydney, New South Wales, Australia
| | - David Radley
- Pfizer Vaccines Research & Development, Pearl River, New York, USA
| | - David Cooper
- Pfizer Vaccines Research & Development, Pearl River, New York, USA
| | - Joseph Eiden
- Pfizer Vaccines Research & Development, Pearl River, New York, USA
| | - William C Gruber
- Pfizer Vaccines Research & Development, Pearl River, New York, USA
| | - Kathrin U Jansen
- Pfizer Vaccines Research & Development, Pearl River, New York, USA
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15
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Andersson R, Søreide K, Ansari D. Surgical Infections and Antibiotic Stewardship: In Need for New Directions. Scand J Surg 2019; 110:110-112. [PMID: 31826717 DOI: 10.1177/1457496919891617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Patients undergoing surgery are prone to infections, either at the site of surgery (superficial or organ-space) or at remote sites (e.g. pneumonia or urinary tract). Surgical site infections are associated with substantial morbidity and mortality, increased length of hospital stay and represent a huge burden to the health economy across all healthcare systems. Here we discuss recent advances and challenges in the field of surgical site infections. MATERIAL AND METHODS Review of pertinent English language literature. RESULTS Numerous guidelines and recommendations have been published in order to prevent surgical site infections. Compliance with these evidence-based guidelines vary and has not resulted in any major decrease in the surgical site infection rate. To date, most efforts to reduce surgical site infection have focused on the role of the surgeon, but a more comprehensive approach is necessary. CONCLUSION Surgical site infections need to be addressed in a structured way, including checklists, audits, monitoring, and measurements. All stakeholders, including the medical profession, the society, and the patient, need to work together to reduce surgical site infections. Most surgical site infections are preventable-and we need a paradigm shift to tackle the problem.
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Affiliation(s)
- R Andersson
- Department of Surgery, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - D Ansari
- Department of Surgery, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
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16
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Barie PS, Narayan M, Sawyer RG. Immunization Against Staphylococcus aureus Infections. Surg Infect (Larchmt) 2019; 19:750-756. [PMID: 31033407 DOI: 10.1089/sur.2018.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Infections caused by Staphylococcus aureus continue to plague surgical patients, whether as surgical site infections or other nosocomial infections that complicate surgical care. The only meaningful methods available to decrease the risk of developing such infections are topical skin antisepsis (pre-operative skin preparation) and peri-operative antibiotic prophylaxis, neither of which offer a panacea. Alternatives to the latter are sought so as to minimize antibiotic selection pressure as a factor in the increasing problem of antimicrobial drug resistance. This review considers the possibility that immunization against S. aureus may offer a viable alternative for prophylaxis. Methods: Review and synthesis of pertinent English-language medical literature. Results: Vaccination against viral pathogens has been in successful clinical use for more than two centuries and was instrumental in the eradication of smallpox and the near-elimination of diseases such as poliomyelitis. Vaccinations against a limited number of bacterial pathogens (e.g., Bordetella pertussis, Clostridium tetanii, Corynebacterium diphtheriae, Haemophilus influenzae type b, Neisseria meningiditis, Streptococcus pneumoniae) have also been introduced with success, whereas others against bacteria are in development (C. difficile, Pseudomonas aeruginosa, S. aureus). Vaccination against S. aureus infection is in current veterinary use (e.g., to prevent mastitis among dairy cattle) but has not been successful to date in human beings despite multiple attempts, although development continues. Conclusions: Because of its complex microbiology, including multiple virulence factors and the ability to evade host immune surveillance, S. aureus presents numerous antigenic targets for vaccine development. Failure of two prior single-antigen vaccines in clinical trials has led to the consensus that future vaccine candidates must be directed against multiple antigens. Two distinct four-antigen vaccines are in clinical trials, but efficacy is yet to be determined.
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Affiliation(s)
- Philip S Barie
- 1 Department of Surgery, Weill Cornell Medicine , New York, New York
- 2 Department of Medicine, Weill Cornell Medicine , New York, New York
| | - Mayur Narayan
- 1 Department of Surgery, Weill Cornell Medicine , New York, New York
| | - Robert G Sawyer
- 3 Department of Surgery, Western Michigan University , Kalamazoo, Michigan
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17
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Ansari S, Jha RK, Mishra SK, Tiwari BR, Asaad AM. Recent advances in Staphylococcus aureus infection: focus on vaccine development. Infect Drug Resist 2019; 12:1243-1255. [PMID: 31190912 PMCID: PMC6526327 DOI: 10.2147/idr.s175014] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/19/2019] [Indexed: 12/17/2022] Open
Abstract
Staphylococcus aureus normally colonizes the nasal cavity and pharynx. After breaching the normal habitat, the organism is able to cause a number of infections at any site of the body. The development of antibiotic resistance has created a global challenge for treating infections. Therefore, protection by vaccines may provide valuable measures. Currently, several vaccine candidates have been prepared which are either in preclinical phase or in early clinical phase, whereas several candidates have failed to show a protective efficacy in human subjects. Approaches have also been made in the development of monoclonal or polyclonal antibodies for passive immunization to protect from S. aureus infections. Therefore, in this review we have summarized the findings of recently published scientific literature to make a concise report.
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Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Rajesh Kumar Jha
- Department of Systems and Diseases (Pharmacology), Saba University School of Medicine, Saba, Dutch Caribbean
| | - Shyam Kumar Mishra
- Department of Microbiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Ahmed Morad Asaad
- Department of Microbiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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18
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Peel TN. Studying Biofilm and Clinical Issues in Orthopedics. Front Microbiol 2019; 10:359. [PMID: 30863390 PMCID: PMC6399144 DOI: 10.3389/fmicb.2019.00359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/12/2019] [Indexed: 12/12/2022] Open
Abstract
The association between biofilm-forming microorganisms and prosthetic joint infection influences all aspect of management including approaches to diagnosis, management and prevention. This article will provide an overview of new anti-biofilm strategies for management of prosthetic joint infection.
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Affiliation(s)
- Trisha N Peel
- Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
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19
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Jiranek W, Kigera JWM, Klatt BA, Küçükdurmaz F, Lieberman J, Moser C, Mulhall K, Nahouli H, Schwarz E, Shohat N, Tarabichi M. General Assembly, Prevention, Host Risk Mitigation - General Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S43-S48. [PMID: 30348564 DOI: 10.1016/j.arth.2018.09.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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20
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Mohamed N, Timofeyeva Y, Jamrozy D, Rojas E, Hao L, Silmon de Monerri NC, Hawkins J, Singh G, Cai B, Liberator P, Sebastian S, Donald RGK, Scully IL, Jones CH, Creech CB, Thomsen I, Parkhill J, Peacock SJ, Jansen KU, Holden MTG, Anderson AS. Molecular epidemiology and expression of capsular polysaccharides in Staphylococcus aureus clinical isolates in the United States. PLoS One 2019; 14:e0208356. [PMID: 30641545 PMCID: PMC6331205 DOI: 10.1371/journal.pone.0208356] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Abstract
Staphylococcus aureus capsular polysaccharides (CP) are important virulence factors under evaluation as vaccine antigens. Clinical S. aureus isolates have the biosynthetic capability to express either CP5 or CP8 and an understanding of the relationship between CP genotype/phenotype and S. aureus epidemiology is valuable. Using whole genome sequencing, the clonal relatedness and CP genotype were evaluated for disease-associated S. aureus isolates selected from the Tigecycline Evaluation and Surveillance Trial (T.E.S.T) to represent different geographic regions in the United States (US) during 2004 and 2009–10. Thirteen prominent clonal complexes (CC) were identified, with CC5, 8, 30 and 45 representing >80% of disease isolates. CC5 and CC8 isolates were CP type 5 and, CC30 and CC45 isolates were CP type 8. Representative isolates from prevalent CC were susceptible to in vitro opsonophagocytic killing elicited by anti-CP antibodies, demonstrating that susceptibility to opsonic killing is not linked to the genetic lineage. However, as not all S. aureus isolates may express CP, isolates representing the diversity of disease isolates were assessed for CP production. While approximately 35% of isolates (primarily CC8) did not express CP in vitro, CP expression could be clearly demonstrated in vivo for 77% of a subset of these isolates (n = 20) despite the presence of mutations within the capsule operon. CP expression in vivo was also confirmed indirectly by measuring an increase in CP specific antibodies in mice infected with CP5 or CP8 isolates. Detection of antigen expression in vivo in relevant disease states is important to support the inclusion of these antigens in vaccines. Our findings confirm the validity of CP as vaccine targets and the potential of CP-based vaccines to contribute to S. aureus disease prevention.
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Affiliation(s)
- Naglaa Mohamed
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Yekaterina Timofeyeva
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Dorota Jamrozy
- The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | - Eduardo Rojas
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Li Hao
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | | | - Julio Hawkins
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Guy Singh
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Bing Cai
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Paul Liberator
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Shite Sebastian
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Robert G. K. Donald
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - Ingrid L. Scully
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - C. Hal Jones
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | - C. Buddy Creech
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Isaac Thomsen
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Julian Parkhill
- The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | - Sharon J. Peacock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathrin U. Jansen
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
| | | | - Annaliesa S. Anderson
- Pfizer Vaccine Research and Development, Pearl River, New York, United States of America
- * E-mail:
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21
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Inoue M, Yonemura T, Baber J, Shoji Y, Aizawa M, Cooper D, Eiden J, Gruber WC, Jansen KU, Anderson AS, Gurtman A. Safety, tolerability, and immunogenicity of a novel 4-antigen Staphylococcus aureus vaccine (SA4Ag) in healthy Japanese adults. Hum Vaccin Immunother 2018; 14:2682-2691. [PMID: 30084709 PMCID: PMC6314418 DOI: 10.1080/21645515.2018.1496764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/06/2018] [Accepted: 06/22/2018] [Indexed: 11/29/2022] Open
Abstract
A novel Staphylococcus aureus 4-antigen vaccine (SA4Ag) is under development, comprising capsular polysaccharide serotypes 5 and 8 (CP5 and CP8) conjugated to CRM197, recombinant protein clumping factor A (rmClfA), and recombinant manganese transporter protein C (MntC). We evaluated SA4Ag safety, tolerability, and immunogenicity in Japanese adults aged 20 to 64 and 65 to 85 years. A total of 136 healthy Japanese adults (68 per age group) were randomized 1:1 to receive single-dose SA4Ag or placebo intramuscularly (Day 1). Safety assessments included reactogenicity and adverse events. The ability of the vaccine to induce immune responses that are considered functional due to their ability to facilitate the killing of S. aureus or neutralize S. aureus virulence mechanisms was assessed using 5 different antigen-specific assays. SA4Ag was well tolerated in both age groups, with no safety concerns. At Day 29, > 85% of SA4Ag recipients in each age group achieved predefined thresholds for each antigen. Antibody geometric mean-fold rises from baseline to Day 29 in SA4Ag groups were: > 80 and > 30 for CP5 and CP8 (opsonophagocytic activity assay), > 10 for ClfA (fibrinogen-binding inhibition assay), and > 15 and > 7 for ClfA and MntC (competitive Luminex® immunoassay), respectively. Antibody titers decreased through Month 12 but remained well above baseline and placebo levels. SA4Ag had an acceptable safety profile and induced rapid and robust functional immune responses in both age groups. These results support ongoing development of SA4Ag for the prevention of invasive S. aureus disease in elective-surgery patients in Japan, North America, and Europe.
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Affiliation(s)
| | | | - James Baber
- Pfizer Vaccine Research and Development, Sydney, NSW, Australia
| | - Yasuko Shoji
- Pfizer Vaccine Research and Development, Tokyo, Japan
| | | | - David Cooper
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
| | - Joseph Eiden
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
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Abstract
The problem of antimicrobial resistance (AMR) and the associated morbidity and mortality due to antibiotic resistant bacterial pathogens is not new. However, AMR has been increasing at an alarming rate with appearances of diseases caused by bacteria exhibiting resistance to not just one but multiple classes of antibiotics. The World Health Organization (WHO) supported by governments, health ministries and health agencies has formulated global action plans to combat the rise in AMR, supporting a number of proven initiatives such as antimicrobial stewardship, investments in development of new classes of antibiotics, and educational programs designed to eliminate inappropriate antibiotic use. Vaccines as tools to reduce AMR have historically been under-recognized, yet the positive effect in reducing AMR has been well established. For example Haemophilus influenzae type B (Hib) as well as Streptococcus pneumoniae (pneumococcal) conjugate vaccines have impressive track records in not only preventing life threatening diseases caused by these bacteria, but also reducing antibiotic use and AMR. This paper will describe the drivers of antibiotic use and subsequent development of AMR; it will make the case how existing vaccines are already participating in combatting AMR, describe future prospects for the role of new vaccines in development to reduce AMR, and highlight challenges associated with future vaccine development to combat AMR.
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Affiliation(s)
- Kathrin U Jansen
- a Pfizer Vaccine Research and Development , Pearl River , NY , USA
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Liu Y, Bai P, Woischnig AK, Charpin-El Hamri G, Ye H, Folcher M, Xie M, Khanna N, Fussenegger M. Immunomimetic Designer Cells Protect Mice from MRSA Infection. Cell 2018; 174:259-270.e11. [PMID: 29937224 PMCID: PMC6057273 DOI: 10.1016/j.cell.2018.05.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/26/2018] [Accepted: 05/16/2018] [Indexed: 12/25/2022]
Abstract
Many community- and hospital-acquired bacterial infections are caused by antibiotic-resistant pathogens. Methicillin-resistant Staphylococcus aureus (MRSA) predisposes humans to invasive infections that are difficult to eradicate. We designed a closed-loop gene network programming mammalian cells to autonomously detect and eliminate bacterial infections. The genetic circuit contains human Toll-like receptors as the bacterial sensor and a synthetic promoter driving reversible and adjustable expression of lysostaphin, a bacteriolytic enzyme highly lethal to S. aureus. Immunomimetic designer cells harboring this genetic circuit exhibited fast and robust sense-and-destroy kinetics against live staphylococci. When tested in a foreign-body infection model in mice, microencapsulated cell implants prevented planktonic MRSA infection and reduced MRSA biofilm formation by 91%. Notably, this system achieved a 100% cure rate of acute MRSA infections, whereas conventional vancomycin treatment failed. These results suggest that immunomimetic designer cells could offer a therapeutic approach for early detection, prevention, and cure of pathogenic infections in the post-antibiotic era. Video Abstract
A closed-loop gene network with bacterial sense-and-destroy actuation Direct diagnosis of implant-associated infections through blood biomarkers Early prevention of MRSA infection, as well as biofilm formation, in vivo Curing acute MRSA infections as an alternative to antibiotic therapy
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Affiliation(s)
- Ying Liu
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Peng Bai
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Anne-Kathrin Woischnig
- Laboratory of Infection Biology, Department of Biomedicine, University and University Hospital Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | | | - Haifeng Ye
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Dongchuan Road 500, 200241 Shanghai, People's Republic of China
| | - Marc Folcher
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Mingqi Xie
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Nina Khanna
- Laboratory of Infection Biology, Department of Biomedicine, University and University Hospital Basel, Hebelstrasse 20, 4031 Basel, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Martin Fussenegger
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, 4058 Basel, Switzerland; Faculty of Science, University of Basel, 4031 Basel, Switzerland.
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24
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Jansen KU, Knirsch C, Anderson AS. The role of vaccines in preventing bacterial antimicrobial resistance. Nat Med 2018; 24:10-19. [DOI: 10.1038/nm.4465] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/04/2017] [Indexed: 01/03/2023]
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25
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Mawang C, Lim Y, Ong K, Muhamad A, Lee S. Identification of α-tocopherol as a bioactive component ofDicranopteris lineariswith disrupting property against preformed biofilm ofStaphylococcus aureus. J Appl Microbiol 2017; 123:1148-1159. [DOI: 10.1111/jam.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/13/2017] [Accepted: 08/25/2017] [Indexed: 12/12/2022]
Affiliation(s)
- C.I. Mawang
- School of Science; Monash University Malaysia; Bandar Sunway Selangor Malaysia
- Tropical Medicine and Biology Multidisciplinary Platform; Monash University Malaysia; Bandar Sunway Selangor Malaysia
| | - Y.Y. Lim
- School of Science; Monash University Malaysia; Bandar Sunway Selangor Malaysia
| | - K.S. Ong
- School of Science; Monash University Malaysia; Bandar Sunway Selangor Malaysia
- Tropical Medicine and Biology Multidisciplinary Platform; Monash University Malaysia; Bandar Sunway Selangor Malaysia
| | - A. Muhamad
- Structural and Biophysics Facility; Malaysia Genome Institute (MGI); National Institutes of Biotechnology Malaysia (NIBM); Kajang Selangor Malaysia
| | - S.M. Lee
- School of Science; Monash University Malaysia; Bandar Sunway Selangor Malaysia
- Tropical Medicine and Biology Multidisciplinary Platform; Monash University Malaysia; Bandar Sunway Selangor Malaysia
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Chang BC, Wang SJ. The newly filed patent applications for vaccines against staphylococcus aureus. Hum Vaccin Immunother 2017; 13:2637-2638. [PMID: 28846468 DOI: 10.1080/21645515.2017.1361577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus (S. aureus) frequently causes life threatening disease. To release the threat, vaccine has been proposed as a preventive intervention against the cause. However, the development of the vaccines is still in early stages. Thus, highlighting the related newly filed patent applications would stimulate further developments.
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Affiliation(s)
- Bao-Chi Chang
- a Rehabilitation Center , Taipei Veterans General Hospital , Taipei , Taiwan.,b School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Shyh-Jen Wang
- a Rehabilitation Center , Taipei Veterans General Hospital , Taipei , Taiwan.,c Division of Experimental Surgery, Department of Surgery , Taipei Veterans General Hospital , Taipei , Taiwan.,d Institute of Hospital and Health Care Administration and Institute , National Yang-Ming University , Taipei , Taiwan
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27
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Hinchliffe RJ, Earnshaw JJ. Surgical infection. Br J Surg 2017; 104:e8-e10. [PMID: 28121043 DOI: 10.1002/bjs.10468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022]
Abstract
Real and present danger
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Affiliation(s)
- R J Hinchliffe
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J J Earnshaw
- Department of Vascular Surgery, Cheltenham General Hospital, Sandford Road, Cheltenham, UK
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