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Alkan Y, Kaymaz A, Behcet M, Bayrak A. Topical Vancomycin is More Efficient than Povidone-Iodine Treatment in Controlling Bacterial Growth in Methicillin-Resistant Staphylococcus Aureus Keratitis Model in Rabbits. Curr Eye Res 2024; 49:923-929. [PMID: 38708825 DOI: 10.1080/02713683.2024.2349661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 03/04/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
To evaluate the efficacy of topical vancomycin and povidone iodine (PI) application on methicillin-resistant Staphylococcus aureus (MRSA) keratitis model in rabbits. MRSA keratitis was induced by injecting 0.1 mL MRSA containing 1000 colony-forming units (CFU) into central cornea of right eyes of 24 New Zealand White rabbits. Animals were divided into four groups (n = 6): control (treated with balanced salt solution), 50 mg/mL topical vancomycin, 5% topical PI, and combination; examined before and after treatment, and corneal tissues were harvested for analysis at 9th hour of treatment. Bacterial load was determined as: 7.63 ± 0.82 log10 CFU/g in control group, 6.95 ± 1.66 log10 CFU/g in PI group, 4.67 ± 0.77 log10 CFU/g in combination group, and 4.33 ± 0.71 log10 CFU/g in vancomycin group (p = 0.001). Median of total clinical score increased significantly from 7 [range: 5-8] to 11.5 [range: 11-15] (p = 0.001) in control group, did not change (6 [range: 5-8] to 7 [range: 5-7]; p = 0.695) in vancomycin group, increased significantly from 7 [range: 5-8] to 12.5 [range: 10-14] (p < 0.001) in PI group, increased significantly from 6.5 [range: 5-7] to 8 [range: 7-9] in combination group (p = 0.002). Post-treatment clinical scores for chemosis, conjunctival injection, iritis, hypopyon, epithelial erosion, and corneal infiltrate were significantly lower in vancomycin-treated groups compared to others (p < 0.05). In PI-treated groups, especially scores for chemosis, conjunctival injection, epithelial erosion and corneal infiltrate were significantly higher than vancomycin (p < 0.05). Topical vancomycin significantly inhibited bacterial growth in MRSA keratitis. However, PI was ineffective in controlling this growth; additionally, exerted toxic effect on ocular surface. When vancomycin was combined with PI, no additional increase in efficacy of treatment was detected compared to only vancomycin.
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Affiliation(s)
- Yunus Alkan
- Department of Ophthalmology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
- Department of Ophthalmology, Derik State Hospital, Mardin, Turkey
| | - Abdulgani Kaymaz
- Department of Ophthalmology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
| | - Mustafa Behcet
- Department of Medical Microbiology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
| | - Abdullah Bayrak
- Department of Ophthalmology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
- Department of Ophthalmology, Macuria-Die Makulaexperten, Meckenbeuren, Germany
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Guo X, Zhang Z, Chen Q, Wang L, Xu X, Wei Z, Zhang Y, Chen K, Wang Z, Lu X, Liang Q. Whole Genome Sequencing Highlights the Pathogenic Profile in Nocardia Keratitis. Invest Ophthalmol Vis Sci 2024; 65:26. [PMID: 38502137 PMCID: PMC10959193 DOI: 10.1167/iovs.65.3.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose Nocardia keratitis is a serious and sight-threatening condition. This study aims to reveal the virulence and antimicrobial resistance gene profile of Nocardia strains using whole genome sequencing. Methods Whole-genome sequencing was performed on 23 cornea-derived Nocardia strains. Together with genomic data from the respiratory tract and the environment, 141 genomes were then utilized for phylogenetic and pan-genome analyses, followed by virulence and antibiotic resistance analysis. The correlations between virulence genes and pathogenicity were experimentally validated, including the characteristics of Nocardia colonies and clinical and histopathological evaluations of Nocardia keratitis mice models. Results Whole-genome sequencing of 141 Nocardia strains revealed a mean of 220 virulence genes contributed to bacterial pathogenesis. The mce gene family analysis led to the categorization of strains from the cornea into groups A, B, and C. The colonies of group C had the largest diameter, height, and fastest growth rate. The size of corneal ulcers and the clinical scores showed a significant increase in mouse models induced by group C. The relative expression levels of pro-inflammatory cytokines (CD4, IFN-γ, IL-6Rα, and TNF-α) in the lesion area exhibited an increasing trend from group A to group C. Antibiotic resistance genes (ARGs) spanned nine distinct drug classes, four resistance mechanisms, and seven primary antimicrobial resistance gene families. Conclusions Whole genome sequencing highlights the pathogenic role of mce gene family in Nocardia keratitis. Its distribution pattern may contribute to the distinct characteristics of the growth of Nocardia colonies and the clinical severity of the mice models.
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Affiliation(s)
- Xiaoyan Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiankun Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Leying Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kexin Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhiqun Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinxin Lu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Tong WY, Tan WN, Kamarul Azizi MA, Leong CR, El Azab IH, Lim JW, Mahmoud MHH, Dailin DJ, Ibrahim MM, Chuah LF. Nanoparticle-laden contact lens for controlled release of vancomycin with enhanced antibiotic efficacy. CHEMOSPHERE 2023; 338:139492. [PMID: 37451643 DOI: 10.1016/j.chemosphere.2023.139492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Vancomycin is the last resort antibiotic for the treatment of severe bacterial keratitis. Its clinical application is limited due to its hydrophilicity and high molecular weight. To overcome this, this study aims to develop nanoparticles-laden contact lens for controlled ocular delivery of vancomycin. Polyvinyl alcohol (PVA) was used as encapsulant material. The nanoparticles had a negative surface charge and an average size of 147.6 nm. A satisfactory encapsulation efficiency (61.24%) was obtained. The release profile was observed to be slow and sustained, with a release rate of 1.29 μL mg-1 h-1 for 48 h. Five out of 6 test bacteria were suppressed by vancomycin nanoparticles-laden contact lens. Vancomycin is generally ineffective against Gram-negative bacteria and unable to pass through the outer membrane barrier. In this study, vancomycin inhibited Proteus mirabilis and Pseudomonas aeruginosa. Nano-encapsulation enables vancomycin to penetrate the Gram-negative cell wall and further destroy the bacterial cells. On Hohenstein challenge test, all test bacteria exhibited significant reduction in growth when exposed to vancomycin nanoparticles-laden contact lens. This study created an effective and long-lasting vancomycin delivery system via silicone hydrogel contact lenses, by using PVA as encapsulant. The antibiotic efficacy and vancomycin release should be further studied using ocular in vivo models.
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Affiliation(s)
- Woei Yenn Tong
- Universiti Kuala Lumpur, Branch Campus Institute of Medical Science Technology, A1, 1, Jalan TKS 1, Taman Kajang Sentral, 43000, Kajang, Selangor, Malaysia; Universiti Kuala Lumpur, Branch Campus Malaysian Institute of Chemical and Bioengineering Technology, Lot 1988 Kawasan Perindustrian Bandar Vendor, Taboh Naning, Alor Gajah, Melaka, Malaysia.
| | - Wen-Nee Tan
- School of Distance Education, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Muhammad Afif Kamarul Azizi
- Universiti Kuala Lumpur, Branch Campus Malaysian Institute of Chemical and Bioengineering Technology, Lot 1988 Kawasan Perindustrian Bandar Vendor, Taboh Naning, Alor Gajah, Melaka, Malaysia
| | - Chean Ring Leong
- Universiti Kuala Lumpur, Branch Campus Malaysian Institute of Chemical and Bioengineering Technology, Lot 1988 Kawasan Perindustrian Bandar Vendor, Taboh Naning, Alor Gajah, Melaka, Malaysia
| | - Islam H El Azab
- Department of Food Science and Nutrition, College of Science, Taif University, P.O. box 11099, Taif, 21944, Saudi Arabia
| | - Jun Wei Lim
- HICoE-Centre for Biofuel and Biochemical Research, Institute of Self Sustainable Building, Department of Fundamental and Applied Sciences, Universiti Teknologi PETRONAS, Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia; Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, 602105, India
| | - M H H Mahmoud
- Department of Chemistry, College of Science, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Daniel Joe Dailin
- Institute of Bioproduct Development, Universiti Teknologi Malaysia, Johor, Malaysia; Department of Bioprocess and Polymer Engineering, Faculty of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Johor, Malaysia.
| | - Mohamed M Ibrahim
- Department of Chemistry, College of Science, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Lai Fatt Chuah
- Faculty of Maritime Studies, Universiti Malaysia Terengganu, Terengganu, Malaysia.
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Singh RB, Das S, Chodosh J, Sharma N, Zegans ME, Kowalski RP, Jhanji V. Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis. Prog Retin Eye Res 2021; 88:101028. [PMID: 34813978 DOI: 10.1016/j.preteyeres.2021.101028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the "anti-biotic era". Although, we are expeditiously developing our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins. In this review article, we have provided an overview of the established classical diagnostic techniques and therapeutics for keratitis caused by various bacteria. We have extensively reported our recent in-roads through novel tools for accurate diagnosis of mono- and poly-bacterial corneal infections. Furthermore, we outlined the recent progress by our group and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discussed in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Leiden University Medical Center, 2333, ZA Leiden, the Netherlands
| | - Sujata Das
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneshwar, India
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Michael E Zegans
- Department of Ophthalmology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Xu J, Lin R, Chen Y, You X, Huang P, Lin C. Physiologically Based Pharmacokinetic Modeling and Dose Adjustment of Teicoplanin in Pediatric Patients With Renal Impairment. J Clin Pharmacol 2021; 62:620-630. [PMID: 34761398 DOI: 10.1002/jcph.2000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/07/2021] [Indexed: 12/29/2022]
Abstract
The pharmacokinetics of teicoplanin differs in children as compared with adults, and especially in renally impaired pediatric patients. Inappropriate empirical antibacterial therapy may lead to treatment-related antibacterial resistance and increased toxicity, making adjustment of the dosage regimen essential. In the present study, physiologically based pharmacokinetic (PBPK) models were developed to define the appropriate dosage regimen for pediatric patients with differing renal function. Our PBPK models accurately predicted teicoplanin exposures in both adult and pediatric subjects after single and multiple intravenous infusions, with a <1.36-fold error between predicted and observed data, and all observed data were within minimal and maximal data of the corresponding population simulation. The area under the plasma concentration-time curve was predicted to increase 1.25-fold, 1.95-fold, and 2.82-fold in pediatric patients with mild, moderate, and severe renal impairment, respectively, relative to that of healthy children. Subsequently, the results of Monte Carlo simulations indicated that the recommended dosing of 12, 9.5, 6, and 4 mg/kg at 12-hour intervals would be appropriate in pediatric patients with normal renal function and in those with mild, moderate, and severe renal impairment, respectively, at a susceptible minimum inhibitory concentration <2 mg/L. In conclusion, our PBPK model with an incorporated Monte Carlo simulation can provide improved guidance on dosing in pediatric patients with differing renal function and provide a basis for precision therapy with teicoplanin.
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Affiliation(s)
- Jianwen Xu
- Department of Pharmacy, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Rongfang Lin
- Department of Pharmacy, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yong Chen
- Department of Pharmacy, Fuzhou Children's Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
| | - Xiang You
- Department of Pharmacy, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Pinfang Huang
- Department of Pharmacy, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Cuihong Lin
- Department of Pharmacy, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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Chhabra M, Goel R, Khanam S, Singh S. Role of intrastromal vancomycin in recalcitrant corneal abscess after phacoemulsification. BMJ Case Rep 2021; 14:14/5/e241709. [PMID: 34031081 DOI: 10.1136/bcr-2021-241709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Side port infection and corneal abscess after cataract surgery can produce devastating outcomes. Topical antibacterial drugs are the mainstay in management of these cases. Although intrastromal antifungal agents are an established modality for fungal keratitis, such use of antibacterial agents is rarely reported due to better pharmacokinetic profile of antibacterial agents.We report a case of methicillin-resistant Staphylococcus aureus corneal abscess following phacoemulsification that responded to intrastromal vancomycin injection in addition to conventional therapy.This case of postphacoemulsification corneal abscess highlights the importance of postoperative hygiene practices, use of anterior segment optical coherence tomography for monitoring these patients and use of intrastromal vancomycin as an adjunct to topical and systemic therapy.
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Affiliation(s)
- Mohit Chhabra
- Ophthalmology, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Ruchi Goel
- Ophthalmology, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Samreen Khanam
- Ophthalmology, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Sonam Singh
- Ophthalmology, Maulana Azad Medical College, New Delhi, Delhi, India
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