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Mannheim J, Kumar M, Bhagat PH, Nelson A. Assessing the Concordance of MRSA Carriage Screening With MRSA Infections. Hosp Pediatr 2024; 14:84-92. [PMID: 38247356 DOI: 10.1542/hpeds.2023-007368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES This study focused on children with confirmed methicillin-resistant Staphylococcus aureus (MRSA) infections to determine MRSA screening utility in guiding empirical anti-MRSA treatment of children without history of MRSA infection. We examined the concordance of screens to assess differences by infection type and used statistical analysis to determine significant contributors to concordance. METHODS Pediatric hospital patients admitted from 2002 through 2022 were included. Subjects had MRSA infections subsequent to MRSA surveillance screens performed the preceding year. Statistical analysis identified associations between MRSA screens and infections. Number needed to treat analysis calculated the utility of rescreening. RESULTS Among 246 subjects, 39.0% had concordant screens; 151 (61.4%) screens were obtained in the 2 weeks preceding infection. Sensitivity for bacteremia was 50.0% (n = 42), for endotracheal/respiratory 44.4% (n = 81), and 29.4% (n = 102) for skin and soft-tissue infection. For children aged younger than 6 months, sensitivity was 35.9% (n = 78). Multivariable analysis significantly associated days since screening with decreasing likelihood of concordance. Regression modeled the probability of concordance to drop below 50.0% for all infections after 4 days, after 6 days for bacteremia specifically, and 12 days for endotracheal/respiratory infections. CONCLUSIONS The concordance of screens was far lower than negative predictive values found previously; earlier studies were possibly impacted by low prevalence and exclusion of children at high risk to inform high negative predictive values. We suggest that negative MRSA screens should not invalidate reasonable suspicion for MRSA infection in patients with high pretest probabilities.
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Affiliation(s)
- Jonathan Mannheim
- UChicago Medicine Comer Children's Hospital, Chicago, Illinois; and Department of Pediatric Infectious Diseases, University of Chicago, Chicago, Illinois
| | - Madan Kumar
- UChicago Medicine Comer Children's Hospital, Chicago, Illinois; and Department of Pediatric Infectious Diseases, University of Chicago, Chicago, Illinois
| | - Palak H Bhagat
- UChicago Medicine Comer Children's Hospital, Chicago, Illinois; and Department of Pediatric Infectious Diseases, University of Chicago, Chicago, Illinois
| | - Allison Nelson
- UChicago Medicine Comer Children's Hospital, Chicago, Illinois; and Department of Pediatric Infectious Diseases, University of Chicago, Chicago, Illinois
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Crawford L, Pertsovskaya V, Shanklin A, Zhang A, Hamdy RF. Predictive Value of Methicillin-Resistant Staphylococcus aureus Nasal Swab PCR Assay for MRSA Infection in Critically Ill Pediatric Patients. J Pediatric Infect Dis Soc 2024; 13:84-90. [PMID: 38070165 DOI: 10.1093/jpids/piad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Critically ill pediatric patients are frequently initiated methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics during infection evaluation even though MRSA infections are rare in many patient populations. The MRSA nasal swab polymerase chain reaction assay (MRSA-NS-PCR) is a test that has been shown to have a high negative predictive value (NPV) for MRSA infection in adults. This study evaluated the diagnostic test characteristics of the MRSA-NS-PCR in predicting the presence of MRSA infection in critically ill pediatric patients. STUDY DESIGN A retrospective cohort study was performed in a 44-bed pediatric intensive care unit (PICU) between 2013 and 2017. 3860 pediatric patients (54% male, median age 4 years [IQR 1-11 years]) admitted to the PICU who met pediatric systemic inflammatory response syndrome (pSIRS) criteria, were screened with a MRSA-NS-PCR, and had cultures obtained within seven days of MRSA-NS-PCR collection were included. Predictive values and post-test probabilities of the MRSA-NS-PCR for MRSA infection were calculated. RESULTS MRSA-NS-PCR was positive in 8.6% of patients. MRSA infection was identified in 40 patients, equaling an incidence rate of 2 per 1000 patient days. The MRSA-NS-PCR demonstrated a positive predictive value (PPV) of 9.7%, a NPV of 99.8%, and a post-test probability for a negative test of 0.2% for MRSA infection. CONCLUSIONS The MRSA-NS-PCR has a poor PPV but a high NPV for MRSA infection in PICU patients when the incidence of MRSA infection is low. Creation of protocols to guide antimicrobial selection based on MRSA-NS-PCR results may lead to improved antimicrobial stewardship and significant risk reduction.
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Affiliation(s)
- Lexi Crawford
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Vera Pertsovskaya
- The George Washington University School of Medicine and Health Sciences, Department of Pediatrics, The George Washington University, Washington, District of Columbia, USA
| | - Alice Shanklin
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Anqing Zhang
- The George Washington University School of Medicine and Health Sciences, Department of Pediatrics, The George Washington University, Washington, District of Columbia, USA
- Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, District of Columbia, USA
| | - Rana F Hamdy
- The George Washington University School of Medicine and Health Sciences, Department of Pediatrics, The George Washington University, Washington, District of Columbia, USA
- Division of Infectious Diseases, Children's National Hospital, Washington, District of Columbia, USA
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Population Pharmacokinetic and Pharmacokinetic/Pharmacodynamic Target Attainment Analyses for Dalbavancin in Pediatric Patients. Pediatr Infect Dis J 2023; 42:99-105. [PMID: 36638392 PMCID: PMC9835671 DOI: 10.1097/inf.0000000000003764] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Dalbavancin, approved for the treatment of pediatric and adult patients with acute bacterial skin and skin structure infections, has a terminal half-life of >14 days allowing administration as a single-dose regimen. METHODS We developed a population pharmacokinetic (PK) model using 1124 dalbavancin concentrations from 211 pediatric patients, with allometric scaling of clearance and volume parameter exponents fixed at 0.75 and 1, respectively. Serum albumin was included as a covariate on all PK parameters; creatinine clearance or estimated glomerular filtration rate was a covariate on clearance. The final model, qualified by visual predictive checks and bootstrapping, was used to simulate 1000 PK profiles for a range of pediatric age groups. PK/pharmacodynamic target attainment (PTA) was calculated for targets associated with stasis, 1-log kill, and 2-log kill of Staphylococcus aureus (neutropenic murine thigh infection model). RESULTS Dalbavancin PK was well characterized by a three-compartment model. No additional significant covariates were identified. Simulations showed that single-dose (30-minute intravenous infusion) regimens of 22.5 mg/kg (patients <6 years) and 18 mg/kg (patients 6 years to <18 years) resulted in PTA ≥94% for minimal inhibitory concentrations ≤2 mg/L and ≤0.5 mg/L for the stasis and 2-log kill targets, respectively. PTA for pediatric patients was similar to adults with exposures within the range for adults administered 1500 mg dalbavancin. CONCLUSION Dalbavancin PK in pediatric patients was well characterized by a three-compartment model. Simulations with the final model demonstrated adequate PTA across the entire age range for the approved pediatric dalbavancin doses.
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Dastidar DG, Singh P, Bhattacharjee R, Ghosh D, Banerjee M, Biswas S, Mukherjee SK, Mandal S. Development of Copper Nanoparticle Conjugated Chitosan Microparticle as a Stable Source of 2nm Copper Nanoparticle Effective against Methicillin- resistant Staphylococcus aureus. Pharm Nanotechnol 2022; 10:310-326. [PMID: 36017866 DOI: 10.2174/2211738510666220823152415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Copper nanoparticle (CuNP) has well-established antimicrobial activity. Instability in an aqueous medium due to aggregation into larger particles, conversion into metal ions, and oxidation into metal oxides are the major limitations of its practical use against bacterial infections. OBJECTIVE Development of CuNP Conjugated Chitosan Microparticles as a reservoir that will release CuNP effective against notorious bacteria like Methicillin-resistant Staphylococcus aureus. METHODS CuNP conjugated chitosan microparticles (CNCCM) were synthesized using a simple twostep process. In the first step, a solution of chitosan in 2% (w/v) ascorbic acid was added dropwise in copper sulphate solution to prepare Cu ion conjugated chitosan beads. In the second step, these beads were soaked in sodium hydroxide solution to get the CNCCM. The dried CNCCM were characterized thoroughly for surface conjugation of CuNP, and the release of CuNP in a suitable medium. The physicochemical properties of release CuNP were further verified with the in silico modelled CuNP. The Antimicrobial and antibiofilm activities of released CuNp were evaluated against methicillin-resistant Staphylococcus aureus (MRSA). RESULTS 2% (w/v) ascorbic acid solution (pH 3.5) was the optimum medium for the release of ~2 nm CuNP from CNCCM. The CuNP had an optical band gap of ~ 2 eV. It inhibited the cell wall synthesis of MRSA. The minimum inhibitory concentration was 200 nM. At 100 nM dose, the CuNP caused ~73% reduction in biofilm development after 24 h of growth. The cytotoxic effect of CuNP on the human cell line (HEK 293) was significantly less than that on MRSA. The 48 h IC50 value against HEK 293 was 3.45-fold higher than the MIC value against MRSA after 24 h treatment. CONCLUSION CuNP Conjugated Chitosan Microparticle has been developed. It works as a stable reservoir of ~2 nm CuNP. The CuNP is released in an aqueous medium containing 2% (w/v) ascorbic acid (pH 3.5). The released CuNP has a bacteriostatic effect against MRSA at a concentration safe for human cells.
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Affiliation(s)
- Debabrata Ghosh Dastidar
- Department of Pharmaceutics, Guru Nanak Institute of Pharmaceutical Science & Technology, 157/F Nilgunj Road, Panihati, Kolkata 700114, West Bengal, India
| | - Prabhakar Singh
- Electron Microscopy Facility, Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110029 India
| | - Romit Bhattacharjee
- Department of Pharmaceutics, Guru Nanak Institute of Pharmaceutical Science & Technology, 157/F Nilgunj Road, Panihati, Kolkata 700114, West Bengal, India
| | - Dipanjan Ghosh
- Department of Biotechnology and Dr. B.C. Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, 35 Ballygunge Circular Road, Kolkata, WB, 700019, India
| | - Malabika Banerjee
- Department of Microbiology, University of Kalyani, Kalyani, West Bengal 741235, India
| | - Samik Biswas
- Department of Microbiology, University of Kalyani, Kalyani, West Bengal 741235, India
| | - Samir Kumar Mukherjee
- Department of Microbiology, University of Kalyani, Kalyani, West Bengal 741235, India
| | - Supratim Mandal
- Department of Microbiology, University of Kalyani, Kalyani, West Bengal 741235, India
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AL MUSAWI SAFIYA, ALKHALEEFA QASSIM, ALNASSRI SAMIA, ALAMRI AISHAM, ALNIMR AMANI. Eleven-Year surveillance of methicillin-resistant Staphylococcus aureus infections at an Academic Health Centre. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E132-E138. [PMID: 35647383 PMCID: PMC9121672 DOI: 10.15167/2421-4248/jpmh2022.63.1.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen associated with nosocomial and community infections. There is a continual focus on the epidemiology of this public health threat owing to the increase in its spread and rapid development of resistance. AIM We aimed to demonstrate the time trend of antibiotic resistance by describing the epidemiology of MRSA infections at an academic health centre. METHODOLOGY We retrospectively reviewed cases during an 11-year period (from January 2009 to December 2019) with positive cultures for MRSA from various clinical sites in King Fahad Hospital of the University, to understand their clinical and microbiological profiles. Screening and colonisation samples were excluded. RESULTS A total of 1338 MRSA isolates were identified, with an increasing trend from 5.2% to 14.5% during 2009-2019. Skin and soft tissue samples were the most common source (52.4%) of MRSA infections. Vancomycin activity remained stable against MRSA, and only one isolate showed resistance to linezolid (< 1%). A significant reduction in susceptibility to clindamycin (p = 0.003), trimethoprim-sulfamethoxazole (p = 0.001), and rifampin (p < 0.0001) was detected over the study period. CONCLUSIONS MRSA infections still represent a significant burden on healthcare systems. Our data support the need for constant local and regional surveillance to devise relevant protocols to manage MRSA infections. Empirical therapy needs to consider the changing antimicrobial susceptibility trends among MRSA isolates.
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Affiliation(s)
- SAFIYA AL MUSAWI
- Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain
| | - QASSIM ALKHALEEFA
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - SAMIA ALNASSRI
- Department of Infection Control, King Fahad Hospital of the University, Dammam, Kingdom of Saudi Arabia
| | - AISHA M ALAMRI
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - AMANI ALNIMR
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
- Correspondence: Amani Mansour Mohmad Alnimr, Department of Microbiology, Collage of Medicine, Imam Abdul Rahman Bin Faisal University (IAU), P.O. Box 1982, Dammam 31441, Saudi Arabia - Tel.: +966 56 318 1019 - E-mail:
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Camacho-Cruz J, Gutiérrez IF, Brand-López K, Sosa-Rodríguez YA, Vásquez-Hoyos P, Gómez-Cortés LC, Romero-Higuera LN, Rojas-Rojas DP, Ortiz-Mendez CA, Camacho-Moreno G, Wilches-Cuadros MA, Hernandez-Vargas JC, Velandia-Páez JP, Mancera-Gutiérrez LA, Palacios-Ariza MA, Beltrán-Higuera SJ. Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics: Multicenter Cohort Study Conducted in Bogotá, Colombia, 2014-2018. Pediatr Infect Dis J 2022; 41:12-19. [PMID: 34889869 PMCID: PMC8658953 DOI: 10.1097/inf.0000000000003349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) has changed in recent years. The present article is intended to establish differences between clinical, laboratory and imaging findings and outcomes of MSSA and MRSA infections, as well as among subgroups of infection such as skin and soft tissue infection, osteoarticular, bacteremia or pneumonia in a pediatric population from Bogota, Colombia. METHODS Retrospective cohort study using clinical records of patients under 18 years of age treated at the participating centers in Bogota, Colombia, between 2014 and 2018. The first positive S. aureus culture was studied. MSSA and MRSA were compared. The χ2 test, Fisher exact test, and Kruskal-Wallis test were calculated, and the statistical significance was presented using the difference and its 95% CI. RESULTS Five hundred fifty-one patients were included; 211 (38%) corresponded to MRSA and 340 (62%) to MSSA for a total of 703 cultures. A significantly higher probability of having an MSSA infection than MRSA was found in patients with previous heart disease (3.3% vs. 0.5%), neurologic disease (5.9% vs. 2.5%), recent major surgeries (11% vs. 5%) or who has an implanted device (11% vs. 4%). In contrast, in severe MRSA infections (bacteremia, osteoarticular infections and pneumonia), a higher rate of complications was seen (admission to the pediatric intensive care unit, mechanical ventilation and vasoactive support), and in osteoarticular MRSA, more than 1 surgery per case was seen (89% vs. 61%). Laboratory results and mortality were similar. CONCLUSIONS MRSA was associated with a more severe course in bacteremia, osteoarticular infections and pneumonia. Some classical risk factors associated with MRSA infections were found to be related to MSSA. In general, with the exception of skin and soft tissue infection, there was an increased risk of pediatric intensive care unit admission and mechanical and inotropic support with MRSA in a pediatric population.
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Affiliation(s)
- Jhon Camacho-Cruz
- From the Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Sociedad de Cirugía de Bogotá-Hospital de San José
- Departamento de Pediatría, Clínica Pediátrica, Clínica Colsanitas SA
- Facultad de Medicina, Fundación Universitaria Sanitas
| | - Iván Felipe Gutiérrez
- Division of Pediatric Infectious Diseases, Clínica Santa María del Lago, Clínica Colsanitas SA
- Facultad de Medicina, Fundación Universitaria Sanitas
- Colsubsidio Investiga Research Group, Clínica Infantil Colsubsidio
| | | | | | - Pablo Vásquez-Hoyos
- Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Sociedad de cirugía de Bogotá-Hospital de San José and Universidad Nacional de Colombia
| | | | | | - Diana Paola Rojas-Rojas
- Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José
| | - Cesar Alfredo Ortiz-Mendez
- Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Sociedad de cirugía de Bogotá-Hospital de San José
| | - Germán Camacho-Moreno
- Division of Pediatric Infectious Diseases, Hospital Infantil Universitario de San José and Universidad Nacional de Colombia
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Aljassim NA, Almashraki N, Tageldein M, Tamimi O, Kabbani MS, Zahraa J, Alshehri M. Complicated community-acquired methicillin-resistant Staphylococcus aureus pancarditis with cardiac pseudoaneurysm in a healthy child: A case report. Int J Surg Case Rep 2020; 77:71-75. [PMID: 33157337 PMCID: PMC7644799 DOI: 10.1016/j.ijscr.2020.10.085] [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: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Infective endocarditis is more prevalent among children with congenital heart diseases as compared to healthy children. Community-acquired methicillin-resistant Staphylococcus aureus is a causative pathogen of infective endocarditis, and it rarely causes pancarditis in healthy children. The clinical decision for surgical intervention of left-sided heart vegetation is challenging despite the availability of management guidelines. PRESENTATION OF CASE We report a case of a previously healthy 12-year-old girl who presented with aggressive endocarditis secondary to community-acquired methicillin-resistant Staphylococcus aureus infection, with left-sided vegetation, mitral valve regurgitation, pancarditis, brain abscess, and stroke. She underwent an emergency vegetectomy and mitral valve repair. Three weeks after the first surgery, she developed left ventricular pseudoaneurysm that required life-saving surgical intervention. The child gradually recovered and was discharged home with acceptable cardiac function and mild neurological deficit. DISCUSSION Pancarditis, especially with an aggressive progression resulting in intracardiac pseudoaneurysm, is rarely reported in healthy children. The definition of the optimal timing of surgical intervention in pediatric infective endocarditis management is lacking and the clinical decision-making process remains challenging. The development of left ventricular pseudoaneurysm is serious and also needs an immediate intervention, given the high risk of its rupture and subsequent devastating outcomes. CONCLUSION Community-acquired methicillin-resistant Staphylococcus aureus is an etiology for aggressive infective pancarditis in a healthy child, leading to an intracardiac pseudoaneurysm. Emergency surgical interventions should be considered in children with left-sided vegetation to prevent devastating consequences.
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Affiliation(s)
- Nada A Aljassim
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Nabeel Almashraki
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Mohamed Tageldein
- Department of Pediatrics Cardiology, King Salman Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Omer Tamimi
- Department of Pediatrics Cardiology, King Salman Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Mohamed S Kabbani
- Department of Cardiac Sciences, Division of Pediatric Cardiac ICU, MC 1423, King Abdulaziz Medical City, Ministry of National Guard, P.O. Box: 22490, Riyadh, 11426, Saudi Arabia.
| | - Jihad Zahraa
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Mohammed Alshehri
- Department of Pediatrics Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia.
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Banerjee S, Vishakha K, Das S, Dutta M, Mukherjee D, Mondal J, Mondal S, Ganguli A. Antibacterial, anti-biofilm activity and mechanism of action of pancreatin doped zinc oxide nanoparticles against methicillin resistant Staphylococcus aureus. Colloids Surf B Biointerfaces 2020; 190:110921. [PMID: 32172163 DOI: 10.1016/j.colsurfb.2020.110921] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
Staphylococcus aureus are known to cause diseases from normal skin wound to life intimidating infections. Among the drug resistant strain, management of methicillin resistant Staphylococcus aureus (MRSA) is very difficult by using conventional antibiotic treatment. Both Zinc oxide nanoparticles (ZnONPs) and pancreatin (PK) are known to have antibacterial activity. Our main objective is to dope PK on ZnONPs to reduced zinc-oxide toxicity but increased anti-bacterial and anti-biofilms activity. In present study, we showed that, functions of zinc oxide nanoparticles with pancreatin enzyme (ZnONPs-PK) have anti-bacterial, anti-biofilms, anti-motility and anti-virulence properties against MRSA. Moreover, ZnONPs-PK were more potent to eradicate MRSA than only ZnONPs and PK. Application of the produced nano-composites as treatment on infected swine dermis predominantly reflects the potential treatment property of it. The vancomycin sensitivity of MRSA was significantly increased on application with ZnONPs-PK. Further study revealed cell membrane was the target of the ZnONPs-PK and that leads to oxidative damage of the cells. The produced nanoparticles were found completely non-toxic to human's keratinocytes and lung epithelial cell lines at its bactericidal concentration. Overall, this study emphasizes the potential mechanisms underlying the selective bactericidal properties of ZnONPs-PK against MRSA. This novel nanoparticle strategy may provide the ideal solution for comprehensive management of MRSA and its associated diseases with minimising the use of antibiotics.
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Affiliation(s)
- Satarupa Banerjee
- Department of Microbiology, Techno India University, EM - 4 Sector -V, Saltlake City, Kolkata, West Bengal, 700091, India
| | - Kumari Vishakha
- Department of Microbiology, Techno India University, EM - 4 Sector -V, Saltlake City, Kolkata, West Bengal, 700091, India
| | - Shatabdi Das
- Department of Microbiology, Techno India University, EM - 4 Sector -V, Saltlake City, Kolkata, West Bengal, 700091, India
| | - Moumita Dutta
- Division of Electron Microscopy, ICMR-National Institute of Cholera and Enteric Diseases, P- C.I.T. Scheme XM, Beleghata, 33, CIT Rd, Subhas Sarobar Park, Phool Bagan, Beleghata, Kolkata, West Bengal, 700010, India
| | - Debolina Mukherjee
- Department of Microbiology, Techno India University, EM - 4 Sector -V, Saltlake City, Kolkata, West Bengal, 700091, India
| | - Jyotsna Mondal
- Department of Microbiology, Techno India University, EM - 4 Sector -V, Saltlake City, Kolkata, West Bengal, 700091, India
| | - Sandhimita Mondal
- Department of Microbiology, Techno India University, EM - 4 Sector -V, Saltlake City, Kolkata, West Bengal, 700091, India
| | - Arnab Ganguli
- Department of Microbiology, Techno India University, EM - 4 Sector -V, Saltlake City, Kolkata, West Bengal, 700091, India.
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Hoff EA, Artim CM, Brown JS, Alabi CA. Sensitivity of Antibacterial Activity to Backbone Sequence in Constitutionally Isomeric OligoTEAs. Macromol Biosci 2018; 18:e1800241. [PMID: 30238615 DOI: 10.1002/mabi.201800241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/03/2018] [Indexed: 01/28/2023]
Abstract
Antimicrobial peptides are promising alternatives to traditional antibiotics but their translational potential is limited due to rapid degradation by serum proteases. Recently, a number of peptidomimetics with backbones resistant to proteolysis have been synthesized and their antimicrobial potential evaluated as a function of their hydrophobic to cationic ratio. However, these mimetics also have a fixed backbone thus making it difficult to isolate the effect of backbone hydrophobic composition and sequence. In this work, advantage is taken of the oligothioetheramide (oligoTEA) synthetic strategy that allows for precise control over backbone and pendant group placement to systematically study the effect of backbone hydrophobic sequence while keeping pendant group constant. Biophysical data acquired with a set of constitutional oligoTEA isomers show that backbone hydrophobic sequence, that is, local hydrophobicity, affects the mode of oligoTEA interaction with lipid bilayers. This differential interaction among the constitutionally isomeric oligoTEAs is manifested in their antibacterial activities and points to the possibility of using backbone hydrophobic sequence to tune antibacterial potency and selectivity.
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Affiliation(s)
- Emily A Hoff
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, NY, 14853, USA
| | - Christine M Artim
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, NY, 14853, USA
| | - Joseph S Brown
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, NY, 14853, USA
| | - Christopher A Alabi
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, NY, 14853, USA
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Randomized Multicenter Study Comparing Safety and Efficacy of Daptomycin Versus Standard-of-care in Pediatric Patients With Staphylococcal Bacteremia. Pediatr Infect Dis J 2018; 37:893-900. [PMID: 29406465 DOI: 10.1097/inf.0000000000001926] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Staphylococcus aureus, including community-associated methicillin-resistant S. aureus, is an important cause of pediatric bacteremia. Daptomycin is a well-established treatment option for Gram-positive bacteremia in adults, but its safety and efficacy in children require confirmation. METHODS This was a randomized (2:1), evaluator-blinded, multicenter, phase 4 clinical trial comparing intravenous daptomycin with standard-of-care (SOC) for treatment of S. aureus bacteremia in 1- to 17-year-old patients (Clinicaltrials.gov: NCT01728376). Total treatment duration (intravenous followed by oral step-down therapy) was 5-42 days. Daptomycin was dosed once daily by patient age: 12-17 years, 7 mg/kg; 7-11 years, 9 mg/kg and 1-6 years, 12 mg/kg. The primary objective was to evaluate daptomycin safety in children who received ≥1 dose; secondary objectives included comparing daptomycin efficacy with SOC (the trial was not designed to confirm noninferiority) and pharmacokinetic analysis. RESULTS Fifty-five children were randomized to daptomycin and 27 to SOC (primarily vancomycin or cefazolin); 90% had S. aureus. In both groups, 15% of patients had drug-related adverse events, primarily diarrhea (4% daptomycin, 8% SOC) and increased creatine phosphokinase (4% daptomycin, 0% SOC). Clinical success (blinded evaluator-assessed complete/partial resolution of bacteremia signs and symptoms 7-14 days after end-of-treatment) rates were similar for daptomycin (88%) and SOC (77%; 95% confidence interval for difference: -9% to 31%). Daptomycin plasma levels across age groups were comparable with those in adults receiving daptomycin at 6 mg/kg. CONCLUSIONS Once-daily, age-appropriate daptomycin was well tolerated in children with staphylococcal bacteremia; efficacy was comparable with SOC. Daptomycin in age-adjusted doses is a safe treatment alternative in this setting.
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Artim CM, Phan NN, Alabi CA. Effect of Composition on Antibacterial Activity of Sequence-Defined Cationic Oligothioetheramides. ACS Infect Dis 2018; 4:1257-1263. [PMID: 29750860 DOI: 10.1021/acsinfecdis.8b00079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In response to the urgent need for new antibiotic development strategies, antimicrobial peptides and their synthetic mimetics are being investigated as promising alternatives to traditional antibiotics. To facilitate their development into clinically viable candidates, we need to understand what molecular features and physicochemical properties are needed to induce cell death. Within the context of sequence-defined oligothioetheramides (oligoTEAs), we explore the impact of the cationic pendant group and backbone hydrophobicity on the potency and selectivity of antibacterial oligoTEAs. Through antibacterial, cytotoxicity, membrane destabilization, and membrane depolarization assays, we find a strong dependency on the nature of the cationic group and improved selectivity toward bacteria by tuning backbone hydrophobicity. In particular, compounds with the guanidinium headgroup are more potent than those with amines. Finally, we identify a promising oligoTEA, PDT-4G, with enhanced activity in vitro (minimum inhibitory concentration (MIC) ∼ 0.78 μM) and moderate activity in a mouse thigh infection model of methicillin-resistant Staphylococcus aureus. The studies outlined in this work provide insights into the effect of macromolecular physicochemical properties on antibacterial potency. This knowledge base will be vital for researchers engaged in the ongoing development of clinically viable antibacterial agents.
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Affiliation(s)
- Christine M. Artim
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, New York 14853, United States
| | - Ngoc N. Phan
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, New York 14853, United States
| | - Christopher A. Alabi
- Robert F. Smith School of Chemical and Biomolecular Engineering, Cornell University, 120 Olin Hall, Ithaca, New York 14853, United States
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12
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Bradford BD, Macias D, Liu YF, Inman JC, Dyleski RA. Utility of nasal swab and age in detecting methicillin-resistant Staphylococcus aureus in pediatric head and neck abscesses. Laryngoscope 2017; 127:2407-2412. [PMID: 28271495 DOI: 10.1002/lary.26535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/27/2016] [Accepted: 01/23/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify risk factors associated with the presence of methicillin-resistant Staphylococcus aureus (MRSA) in surgical cultures taken from incision and drainage (I&D) of head and neck abscesses in the pediatric population. STUDY DESIGN Retrospective case series. METHODS All patients under 18 years of age with a head and neck abscess requiring I&D from 2009 to 2015 were reviewed. MRSA nasal swab cultures were taken from all patients upon hospitalization. Surgical cultures were obtained from all patients and correlated with MRSA nasal swab results. Univariate and multivariate logistic regression was performed, and odds ratios (ORs) along with descriptive statistics were analyzed. RESULTS Of a total of 272 patients, there were 68 (25%) MRSA-positive abscesses. The majority (86.8%) of these abscesses were in children under 2 years of age. Overall, 12 (4.4%) presented with positive admission MRSA nasal swabs. Of these, 91.7% had MRSA-positive abscess cultures. Decreasing age in years showed an OR of 1.650 (P < 0.001) for MRSA-positive abscess, with children less than 1 year old having the highest OR of 10.74 (P < 0.001). CONCLUSION Younger age and MRSA nasal colonization were two statistically significant risk factors for developing an MRSA abscess of the head and neck. This study demonstrates a high positive predictive value for MRSA-positive neck abscesses when nasal swab screenings were MRSA-positive (91.7%). Children under 2 years of age-especially those under 1 year of age-or those with MRSA nasal colonization can be considered a high-risk population that may benefit from empiric antibiotics against MRSA for head and neck abscesses. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2407-2412, 2017.
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Affiliation(s)
- Benjamin D Bradford
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - David Macias
- Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Yuan F Liu
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Jared C Inman
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Robin A Dyleski
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
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13
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Lyles RD, Trick WE, Hayden MK, Lolans K, Fogg L, Logan LK, Shulman ST, Weinstein RA, Lin MY. Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus Among Critically Ill Children in a State With Mandated Active Surveillance. J Pediatric Infect Dis Soc 2016; 5:409-416. [PMID: 26407280 PMCID: PMC8376206 DOI: 10.1093/jpids/piv050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/18/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND In theory, active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) reduces MRSA spread by identifying all MRSA-colonized patients and placing them under contact precautions. In October 2007, Illinois mandated active MRSA surveillance in all intensive care units, including neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). We evaluated MRSA trends in a large metropolitan region in the wake of this law. METHODS Chicago hospitals with a NICU or PICU were recruited for 8 single-day point prevalence surveys that occurred twice-yearly between June 2008 and July 2011 and then yearly in 2012 to 2013. Samples from all patients were cultured for MRSA (nose and umbilicus for neonates, nose and groin for pediatric patients). Hospital-reported admission MRSA-screening results also were obtained. Point prevalence cultures were screened for MRSA by using broth enrichment, chromogenic agar, and standard confirmatory methods. RESULTS All eligible hospitals (N = 10) participated (10 NICUs, 6 PICUs). Hospital-reported adherence to state-mandated MRSA screening at admission was high (95% for NICUs, 94% for PICUs). From serial point prevalence surveys, overall MRSA prevalences in the NICUs and PICUs were 4.2% (89 of 2101) and 5.7% (36 of 632), respectively. MRSA colonization prevalences were unchanged in the NICUs (year-over-year risk ratio [RR], 0.93 [95% confidence interval (CI), 0.78-1.12]; P = .45) and trended toward an increase in the PICUs (RR, 1.25 [95% CI, 0.72-2.12]; P = .053). We estimated that 81% and 40% of MRSA-positive patients in the NICUs and PICUs, respectively, had newly acquired MRSA. CONCLUSIONS In a region with mandated active MRSA surveillance, we found ongoing unchanged rates of MRSA colonization and acquisition among NICU and PICU patients.
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Affiliation(s)
- Rosie D. Lyles
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
| | - William E. Trick
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois;,Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Mary K. Hayden
- Department of Medicine, Rush University Medical Center, Chicago, Illinois;,Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Karen Lolans
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Louis Fogg
- Department of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Latania K. Logan
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Stanford T. Shulman
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Robert A. Weinstein
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois;,Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Michael Y. Lin
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
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14
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Alrabiah K, Al Alola S, Al Banyan E, Al Shaalan M, Al Johani S. Characteristics and risk factors of hospital acquired - Methicillin-resistant Staphylococcus aureus (HA-MRSA) infection of pediatric patients in a tertiary care hospital in Riyadh, Saudi Arabia. Int J Pediatr Adolesc Med 2016; 3:71-77. [PMID: 30805471 PMCID: PMC6372458 DOI: 10.1016/j.ijpam.2016.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/18/2022]
Abstract
Background and objectives The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections has been steadily increasing. These infections are considered to be either hospital-acquired MRSA (HA-MRSA) or community-acquired MRSA (CA-MRSA). Children are at higher risk of infection than adults. HA-MRSA has been reported to have more serious outcomes than CA-MRSA. However, there are not enough studies in Saudi Arabia to study the characteristics of HA-MRSA in children. We aim to describe the characteristics of HA-MRSA infection, including risk factors, culture site, clinical manifestations, complications, and outcomes among pediatric patients in a tertiary care hospital in Riyadh, Saudi Arabia. Design and settings This is a retrospective chart review study. It was conducted in King Abdulaziz medical city in Riyadh. Patients and methods The study included all patients 14 years of age or younger who were culture-positive from any site in the body during the period from January 1, 2009 to December 31, 2011. The time of culture compared to admission time was used to differentiate between CA-MRSA (within 72 h of admission) and HA-MRSA (more than 72 h after admission). The final sample size was 39 patients. Results We found HA-MRSA to be more common in males and those with risk factors such as previous surgery and previous hospitalization. Patients had a high Pediatric intensive care unit (PICU) admission rate and were commonly septic with positive blood cultures. Seventy-four percent of patients fully recovered, 10% recovered with complications and 15% died. Conclusion HA-MRSA is an infection that can cause serious complications and a high rate of PICU admissions. Clinical manifestations such as shock are associated with higher mortality and morbidity rates. Special care should be given to those admitted to PICU, as they have high rates of mortality and morbidity.
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Affiliation(s)
- Khalid Alrabiah
- Corresponding author. King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Tel.: +966 500121366 (Saudi mobile number), +1 5146259855 (Canada mobile number).
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15
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Jones MB, Montgomery CP, Boyle-Vavra S, Shatzkes K, Maybank R, Frank BC, Peterson SN, Daum RS. Genomic and transcriptomic differences in community acquired methicillin resistant Staphylococcus aureus USA300 and USA400 strains. BMC Genomics 2014; 15:1145. [PMID: 25527145 PMCID: PMC4630920 DOI: 10.1186/1471-2164-15-1145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is a human pathogen responsible for substantial morbidity and mortality through its ability to cause a number of human infections including bacteremia, pneumonia and soft tissue infections. Of great concern is the emergence and dissemination of methicillin-resistant Staphylococcus aureus strains (MRSA) that are resistant to nearly all β-lactams. The emergence of the USA300 MRSA genetic background among community associated S. aureus infections (CA-MRSA) in the USA was followed by the disappearance of USA400 CA-MRSA isolates. RESULTS To gain a greater understanding of the potential fitness advantages and virulence capacity of S. aureus USA300 clones, we performed whole genome sequencing of 15 USA300 and 4 USA400 clinical isolates. A comparison of representative genomes of the USA300 and USA400 pulsotypes indicates a number of differences in mobile genome elements. We examined the in vitro gene expression profiles by microarray hybridization and the in vivo transcriptomes during lung infection in mice of a USA300 and a USA400 MRSA strain by performing complete genome qRT-PCR analysis. The unique presence and increased expression of 6 exotoxins in USA300 (12- to 600-fold) compared to USA400 may contribute to the increased virulence of USA300 clones. Importantly, we also observed the up-regulation of prophage genes in USA300 (compared with USA400) during mouse lung infection (including genes encoded by both prophages ΦSa2usa and ΦSa3usa), suggesting that these prophages may play an important role in vivo by contributing to the elevated virulence characteristic of the USA300 clone. CONCLUSIONS We observed differences in the genetic content of USA300 and USA400 strains, as well as significant differences of in vitro and in vivo gene expression of mobile elements in a lung pneumonia model. This is the first study to document the global transcription differences between USA300 and USA400 strains during both in vitro and in vivo growth.
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Affiliation(s)
- Marcus B Jones
- J. Craig Venter Institute, 4120 Capricorn Lane, La Jolla, CA, 92037, USA.
| | - Christopher P Montgomery
- Department of Pediatrics, Section of Critical Care, University of Chicago, Chicago, IL, 60637, USA.
| | - Susan Boyle-Vavra
- Department of Pediatrics, Section of Infectious Diseases, Chicago, IL, 60637, USA.
| | - Kenneth Shatzkes
- Department of Medicine, Center for Emerging and Re-emerging Pathogens, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ, 07103, USA.
| | - Rosslyn Maybank
- Battelle National Biodefense Institute, National Biodefense Analysis and Countermeasures Center, Frederick, MD, 21702, USA.
| | - Bryan C Frank
- J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Scott N Peterson
- Sanford Burnham Medical Research Institute, 10901 N. Torrey Pines Rd, La Jolla, CA, 92037, USA.
| | - Robert S Daum
- Department of Pediatrics, Section of Critical Care, University of Chicago, Chicago, IL, 60637, USA. .,Department of Pediatrics, Section of Infectious Diseases, Chicago, IL, 60637, USA.
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Lutsar I, Telling K, Metsvaht T. Treatment option for sepsis in children in the era of antibiotic resistance. Expert Rev Anti Infect Ther 2014; 12:1237-52. [PMID: 25189378 DOI: 10.1586/14787210.2014.956093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sepsis caused by multidrug-resistant microorganisms is one of the most serious infectious diseases of childhood and poses significant challenges for pediatricians involved in management of critically ill children. This review discusses the use of pharmacokinetic/dynamic principles (i.e., prolonged infusion of β-lactams and vancomycin, once-daily administration of aminoglycosides and rationale of therapeutic drug monitoring) when prescribing antibiotics to critically ill patients. The potential of 'old' agents (i.e., colistin, fosfomycin) and newly approved antibiotics is critically reviewed. The pros and cons of combination antibacterial therapy are discussed and finally suggestions for the treatment of sepsis caused by multidrug-resistant organisms are provided.
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Affiliation(s)
- Irja Lutsar
- Institute of Medical Microbiology, University of Tartu, Ravila 19, 50411 Tartu, Estonia
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