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Yazdanian M, Barzegar PEF, Ranjbar R, Tahmasebi E, Tebyaniyan H, Barzegar KEF, Hayati FZ, Farjanikish G. The comparative effects of erythromycin and amikacin on acute respiratory Pseudomonas aeruginosa infection. Vet Med Sci 2023; 9:867-875. [PMID: 36318447 PMCID: PMC10029875 DOI: 10.1002/vms3.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND One of the most common causes of pneumonia is Pseudomonas aeruginosa (P. aeruginosa). As with other microbial pathogens, this bacterium tends to develop resistance to various antibiotics. Amikacin and erythromycin, which are from the aminoglycoside and macrolide antibiotic families, are used to treat respiratory infections caused by P. aeruginosa. OBJECTIVES This study explored whether amikacin, erythromycin or a combination of both works better against P. aeruginosa acute lung infection. METHODS For this study, 32 rats were used. The trachea of rats was exposed aseptically and their lung was infected with P. aeruginosa through trachea. Then, according to the group, they received amikacin, erythromycin or a combination of both for 1 week. Finally, they were euthanised on the 3rd and 7th days post-infection. The macroscopic and microscopic evaluations of the lungs, kidney and liver were performed. The right lung was collected for in vivo bacteriological analysis. RESULTS The amikacin group (A group) had a statistically significantly lower macroscopic and microscopic scores than the other groups (p < 0.05). In vivo bacteriological test revealed that the A group had significantly lower lung bacterial load (p < 0.05). CONCLUSIONS In summary, it was concluded that amikacin could help alleviate the respiratory infection caused by P. aeruginosa solely, and it was more effective than erythromycin.
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Affiliation(s)
- Mohsen Yazdanian
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Reza Ranjbar
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
- School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Elahe Tahmasebi
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | | | - Farhad Zadeh Hayati
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Lorestan University, Khorramabad, Iran
| | - Ghasem Farjanikish
- Department of Pathobiology, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran
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A personalised approach to antibiotic pharmacokinetics and pharmacodynamics in critically ill patients. Anaesth Crit Care Pain Med 2021; 40:100970. [PMID: 34728411 DOI: 10.1016/j.accpm.2021.100970] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/26/2021] [Accepted: 08/14/2021] [Indexed: 01/01/2023]
Abstract
Critically ill patients admitted to intensive care unit (ICU) with severe infections, or those who develop nosocomial infections, have poor outcomes with substantial morbidity and mortality. Such patients commonly have suboptimal antibiotic exposures at routinely used antibiotic doses related to an increased volume of distribution and altered clearance due to their underlying altered physiology. Furthermore, the use of extracorporeal devices such as renal replacement therapy and extracorporeal membrane oxygenation in these group of patients also has the potential to alter in vivo drug concentrations. Moreover, ICU patients are likely to be infected with less-susceptible pathogens. Therefore, one potential contributing cause to the poor outcomes observed in critically ill patients may be related to subtherapeutic antibiotic exposures. Newer concepts include the clinician considering optimised dosing based on a blood antibiotic exposure defined by pharmacokinetic modelling and therapeutic drug monitoring, combined with a knowledge of the antibiotic penetration into the site of infection, thereby achieving optimal bacterial killing. Such optimised dosing is likely to improve patient outcomes. The aim of this review is to highlight key aspects of antibiotic pharmacokinetics and pharmacodynamics (PK/PD) in critically ill patients and provide a PK/PD approach to tailor antibiotic dosing to the individual patient.
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Hwang JH, Lee SY, Choi J. Microscopic Analysis of Bacterial Inoculum Effect Using Micropatterned Biochip. Antibiotics (Basel) 2021; 10:antibiotics10030300. [PMID: 33805824 PMCID: PMC7998646 DOI: 10.3390/antibiotics10030300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/05/2022] Open
Abstract
Antimicrobial resistance has become a major problem in public health and clinical environments. Against this background, antibiotic susceptibility testing (AST) has become necessary to cure diseases in an appropriate and timely manner as it indicates the necessary concentration of antibiotics. Recently, microfluidic based rapid AST methods using microscopic analysis have been shown to reduce the time needed for the determination of the proper antibiotics. However, owing to the inoculum effect, the accurate measurement of the minimal inhibitory concentration (MIC) is difficult. We tested four standard bacteria: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis, against five different antibiotics: piperacillin, cefotaxime, amikacin, levofloxacin, and ampicillin. The results showed that overall, the microfluidic system has a similar inoculum effect compared to the conventional AST method. However, due to the different testing conditions and determination protocols of the growth of the microfluidic based rapid AST, a few results are not identical to the conventional methods using optical density. This result suggests that microfluidic based rapid AST methods require further research on the inoculum effect for practical use in hospitals and can then be used for effective antibiotic prescriptions.
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Affiliation(s)
- Jung Ho Hwang
- Department of Electrical and Computer Engineering, Undergraduate School, Michigan State University, 426 Auditorium Road, East Lansing, MI 48824, USA;
| | - Sang Young Lee
- Department of Mechanical Engineering, Undergraduate School, Kookmin University, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Korea;
| | - Jungil Choi
- School of Mechanical Engineering, Kookmin University, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Korea
- Correspondence: ; Tel.: +82-2-910-4684
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Xie Y, Chen Q, Huang G, Wang Y, Hu W, Yan Z, Wang X, Huang J, Gao M, Fei W, Luo G. Scaling up microreactors for kilogram‐scale synthesis of piperacillin: Experiments and computational fluid dynamics simulations. AIChE J 2021. [DOI: 10.1002/aic.17231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Yu Xie
- Department of Chemical Engineering, The State Key Lab of Chemical Engineering Tsinghua University Beijing China
| | - Qiang Chen
- Department of Chemical Engineering, The State Key Lab of Chemical Engineering Tsinghua University Beijing China
| | - Guoming Huang
- North China Pharmaceutical Group Co., Ltd. Shijiazhuang China
| | - Yujun Wang
- Department of Chemical Engineering, The State Key Lab of Chemical Engineering Tsinghua University Beijing China
| | - Weiguo Hu
- North China Pharmaceutical Group Co., Ltd. Shijiazhuang China
| | - Zhengren Yan
- North China Pharmaceutical Group Co., Ltd. Shijiazhuang China
| | - Xin Wang
- North China Pharmaceutical Group Co., Ltd. Shijiazhuang China
| | - Juan Huang
- North China Pharmaceutical Group Co., Ltd. Shijiazhuang China
| | - Mingtang Gao
- Department of Chemical Engineering, The State Key Lab of Chemical Engineering Tsinghua University Beijing China
| | - Weiyang Fei
- Department of Chemical Engineering, The State Key Lab of Chemical Engineering Tsinghua University Beijing China
| | - Guangsheng Luo
- Department of Chemical Engineering, The State Key Lab of Chemical Engineering Tsinghua University Beijing China
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Abstract
The phenomenon of attenuated antibacterial activity at inocula above those utilized for susceptibility testing is referred to as the inoculum effect. Although the inoculum effect has been reported for several decades, it is currently debatable whether the inoculum effect is clinically significant. The aim of the present review was to consolidate currently available evidence to summarize which β-lactam drug classes demonstrate an inoculum effect against specific bacterial pathogens. Review of the literature showed that the majority of studies that evaluated the inoculum effect of β-lactams were in vitro investigations of Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae and Staphylococcus aureus. Across all five pathogens, cephalosporins consistently displayed observable inoculum effects in vitro, whereas carbapenems were less susceptible to an inoculum effect. A handful of animal studies were available that validated that the in vitro inoculum effect translates into attenuated pharmacodynamics of β-lactams in vivo. Only a few clinical investigations were available and suggested that an in vitro inoculum effect of cefazolin against MSSA may correspond to an increased likeliness of adverse clinical outcomes in patients receiving cefazolin for bacteraemia. The presence of β-lactamase enzymes was the primary mechanism responsible for an inoculum effect, but the observation of an inoculum effect in multiple pathogens lacking β-lactamase enzymes indicates that there are likely multiple mechanisms that may result in an inoculum effect. Further clinical studies are needed to better define whether interventions made in the clinic in response to organisms displaying an in vitro inoculum effect will optimize clinical outcomes.
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Affiliation(s)
- Justin R Lenhard
- California Northstate University College of Pharmacy, Elk Grove, CA, USA
| | - Zackery P Bulman
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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Laishram S, Pragasam AK, Bakthavatchalam YD, Veeraraghavan B. An update on technical, interpretative and clinical relevance of antimicrobial synergy testing methodologies. Indian J Med Microbiol 2018; 35:445-468. [PMID: 29405135 DOI: 10.4103/ijmm.ijmm_17_189] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Testing for antimicrobial interactions has gained popularity in the last decade due to the increasing prevalence of drug-resistant organisms and limited options for the treatment of these infections. In vitro combination testing provides information, on which two or more antimicrobials can be combined for a good clinical outcome. Amongst the various in vitro methods of drug interactions, time-kill assay (TKA), checkerboard (CB) assay and E-test-based methods are most commonly used. Comparative performance of these methods reveals the TKA as the most promising method to detect synergistic combinations followed by CB assay and E-test. Various combinations of antimicrobials have been tested to demonstrate synergistic activity. Promising results were obtained for the combinations of meropenem plus colistin and rifampicin plus colistin against Acinetobacter baumannii, colistin plus carbapenem and carbapenem plus fluoroquinolones against Pseudomonas aeruginosa and colistin/polymyxin B plus rifampicin/meropenem against Klebsiella pneumoniae. Antagonism was detected in only few instances. The presence of synergy or antagonism with a combination seems to correlate with minimum inhibitory concentration of the agent and molecular mechanism involved in the resistance. Further studies need to be conducted to assess the utility of in vitro testing to predict clinical outcome and direct therapy for drug-resistant organisms.
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Affiliation(s)
- Shakti Laishram
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu,, India
| | - Agila Kumari Pragasam
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu,, India
| | | | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu,, India
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Dhaese SAM, Roberts JA, Carlier M, Verstraete AG, Stove V, De Waele JJ. Population pharmacokinetics of continuous infusion of piperacillin in critically ill patients. Int J Antimicrob Agents 2017; 51:594-600. [PMID: 29277531 DOI: 10.1016/j.ijantimicag.2017.12.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/30/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
Abstract
Dosing recommendations for continuous infusion of piperacillin, a broad-spectrum beta-lactam antibiotic, are mainly guided by outputs from population pharmacokinetic models constructed with intermittent infusion data. However, the probability of target attainment in patients receiving piperacillin by continuous infusion may be overestimated when drug clearance estimates from population pharmacokinetic models based on intermittent infusion data are used, especially when higher doses (e.g. 16 g/24 h or more) are simulated. Therefore, the purpose of this study was to describe the population pharmacokinetics of piperacillin when infused continuously in critically ill patients. For this analysis, 270 plasma samples from 110 critically ill patients receiving piperacillin were available for population pharmacokinetic model building. A one-compartment model with linear clearance best described the concentration-time data. The mean ± standard deviation parameter estimates were 8.38 ± 9.91 L/h for drug clearance and 25.54 ± 3.65 L for volume of distribution. Creatinine clearance improved the model fit and was supported for inclusion as a covariate. In critically ill patients with renal clearance higher than 90 mL/min/1.73 m2, a high-dose continuous infusion of 24 g/24 h is insufficient to achieve adequate exposure (pharmacokinetic/pharmacodynamic target of 100% fT>4 x MIC) against susceptible Pseudomonas aerginosa isolates (MIC ≤16 mg/L). These findings suggest that merely increasing the dose of piperacillin, even with continuous infusion, may not always result in adequate piperacillin exposure. This should be confirmed by evaluating piperacillin target attainment rates in critically ill patients exhibiting high renal clearance.
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Affiliation(s)
| | - Jason A Roberts
- Faculty of Medicine and School of Pharmacy, University of Queensland, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Mieke Carlier
- Ghent University Hospital, Laboratory Medicine, Ghent, Belgium
| | - Alain G Verstraete
- Ghent University Hospital, Laboratory Medicine, Ghent, Belgium; Ghent University, Clinical Chemistry, Microbiology and Immunology, Ghent, Belgium
| | - Veronique Stove
- Ghent University Hospital, Laboratory Medicine, Ghent, Belgium; Ghent University, Clinical Chemistry, Microbiology and Immunology, Ghent, Belgium
| | - Jan J De Waele
- Ghent University Hospital, Intensive Care, Ghent, Belgium
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Delis GA, Siarkou VI, Vingopoulou EI, Koutsoviti-Papadopoulou M, Batzias GC. Pharmacodynamic interactions of amikacin with selected β-lactams and fluoroquinolones against canine Escherichia coli isolates. Res Vet Sci 2017; 117:187-195. [PMID: 29291486 DOI: 10.1016/j.rvsc.2017.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/14/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
Knowledge of in vitro antimicrobial interactions can serve as a guide for clinical application of combination antimicrobial regimens. The aim of the present study was to determine the pharmacodynamic interactions of amikacin with either amoxicillin/clavulanic acid, ceftazidime, enrofloxacin or marbofloxacin against clinical canine Escherichia coli isolates. Bactericidal activity of individual antimicrobials was assessed by use of static kill curves. Interactions between amikacin and each of the β-lactams or fluoroquinolones were subsequently analyzed by employing the fractional maximal effect method. Amikacin, compared with all other agents, displayed the most rapid and extensive bacterial killing, the lowest level (with respect to MIC) at which half the maximal effect was observed and the most linear concentration-effect relationship. The combinations of amikacin with amoxicillin/clavulanic acid or ceftazidime were completely synergistic in four and three out of the five investigated isolates, respectively, with additivity being sporadically observed. On the other hand, the combinations of amikacin with enrofloxacin or marbofloxacin yielded a mosaic of interaction types with no discernible pattern or differentiation between fluoroquinolone-susceptible and resistant isolates; synergy was only infrequently observed, mainly at increased fluoroquinolone concentrations. In conclusion, the combinations of amikacin with the two β-lactams were found to be more promising, in terms of synergy achievement, compared with the respective combinations with the two fluoroquinolones.
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Affiliation(s)
- Georgios A Delis
- Laboratory of Pharmacology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece.
| | - Victoria I Siarkou
- Laboratory of Microbiology and Infectious Diseases, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Elpida I Vingopoulou
- Laboratory of Microbiology and Infectious Diseases, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Maria Koutsoviti-Papadopoulou
- Laboratory of Pharmacology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Georgios C Batzias
- Laboratory of Pharmacology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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Maneke E, Pridmore A, Goby L, Lang I. Kill rate of mastitis pathogens by a combination of cefalexin and kanamycin. J Appl Microbiol 2010; 110:184-90. [DOI: 10.1111/j.1365-2672.2010.04876.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kukavica-Ibrulj I, Levesque RC. Animal models of chronic lung infection with Pseudomonas aeruginosa: useful tools for cystic fibrosis studies. Lab Anim 2008; 42:389-412. [PMID: 18782827 DOI: 10.1258/la.2007.06014e] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cystic fibrosis (CF) is caused by a defect in the transmembrane conductance regulator (CFTR) protein that functions as a chloride channel. Dysfunction of the CFTR protein results in salty sweat, pancreatic insufficiency, intestinal obstruction, male infertility and severe pulmonary disease. In most patients with CF life expectancy is limited due to a progressive loss of functional lung tissue. Early in life a persistent neutrophylic inflammation can be demonstrated in the airways. The cause of this inflammation, the role of CFTR and the cause of lung morbidity by different CF-specific bacteria, mostly Pseudomonas aeruginosa, are not well understood. The lack of an appropriate animal model with multi-organ pathology having the characteristics of the human form of CF has hampered our understanding of the pathobiology and chronic lung infections of the disease for many years. This review summarizes the main characteristics of CF and focuses on several available animal models that have been frequently used in CF research. A better understanding of the chronic lung infection caused particularly by P. aeruginosa, the pathophysiology of lung inflammation and the pathogenesis of lung disease necessitates animal models to understand CF, and to develop and improve treatment.
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Affiliation(s)
- I Kukavica-Ibrulj
- Centre de Recherche sur la Fonction, Structure et Ingénierie des Protéines, Pavillon Charles-Eugène Marchand, Biologie Médicale, Faculté de Médecine, Université Laval, Québec G1K 7P4, Canada
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