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Nashebi R, Sari M, Kotil SE. Mathematical modelling of antibiotic interaction on evolution of antibiotic resistance: an analytical approach. PeerJ 2024; 12:e16917. [PMID: 38426146 PMCID: PMC10903357 DOI: 10.7717/peerj.16917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
Background The emergence and spread of antibiotic-resistant pathogens have led to the exploration of antibiotic combinations to enhance clinical effectiveness and counter resistance development. Synergistic and antagonistic interactions between antibiotics can intensify or diminish the combined therapy's impact. Moreover, these interactions can evolve as bacteria transition from wildtype to mutant (resistant) strains. Experimental studies have shown that the antagonistically interacting antibiotics against wildtype bacteria slow down the evolution of resistance. Interestingly, other studies have shown that antibiotics that interact antagonistically against mutants accelerate resistance. However, it is unclear if the beneficial effect of antagonism in the wildtype bacteria is more critical than the detrimental effect of antagonism in the mutants. This study aims to illuminate the importance of antibiotic interactions against wildtype bacteria and mutants on the deacceleration of antimicrobial resistance. Methods To address this, we developed and analyzed a mathematical model that explores the population dynamics of wildtype and mutant bacteria under the influence of interacting antibiotics. The model investigates the relationship between synergistic and antagonistic antibiotic interactions with respect to the growth rate of mutant bacteria acquiring resistance. Stability analysis was conducted for equilibrium points representing bacteria-free conditions, all-mutant scenarios, and coexistence of both types. Numerical simulations corroborated the analytical findings, illustrating the temporal dynamics of wildtype and mutant bacteria under different combination therapies. Results Our analysis provides analytical clarification and numerical validation that antibiotic interactions against wildtype bacteria exert a more significant effect on reducing the rate of resistance development than interactions against mutants. Specifically, our findings highlight the crucial role of antagonistic antibiotic interactions against wildtype bacteria in slowing the growth rate of resistant mutants. In contrast, antagonistic interactions against mutants only marginally affect resistance evolution and may even accelerate it. Conclusion Our results emphasize the importance of considering the nature of antibiotic interactions against wildtype bacteria rather than mutants when aiming to slow down the acquisition of antibiotic resistance.
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Affiliation(s)
- Ramin Nashebi
- Department of Mathematics, Yildiz Technical University, Istanbul, Turkey
| | - Murat Sari
- Department of Mathematical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Seyfullah Enes Kotil
- Department of Biophysics, Bahcesehir University, Istanbul, Turkey
- Department of Molecular Biology and Genetics, Bogazici University, Istanbul, Turkey
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Grillo Perez S, Diaz-Brochero C, Garzon Herazo JR, Muñoz Velandia OM. Short-term versus usual-term antibiotic treatment for uncomplicated Staphylococcus aureus bacteremia: a systematic review and meta-analysis. Ther Adv Infect Dis 2024; 11:20499361241237615. [PMID: 38476737 PMCID: PMC10929032 DOI: 10.1177/20499361241237615] [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: 11/02/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Uncomplicated Staphylococcus aureus bacteremia remains a leading cause of morbidity and mortality in hospitalized patients. Current guidelines recommend a minimum of 14 days of treatment. Objective To evaluate the efficacy and safety of short versus usual antibiotic therapy in adults with uncomplicated S. aureus bacteremia (SAB). Methods We developed a search strategy to identify systematic review and meta-analysis of non-randomized studies (NRS), comparing short versus usual or long antibiotic regimens for uncomplicated SAB in MEDLINE, Embase, and the Cochrane Register up to June 2023. The risk of bias was assessed using the ROBINS I tool. The meta-analysis was performed using Review Manager software with a random effect model. Results Six NRS with a total of 1700 patients were included. No significant differences were found when comparing short versus prolonged antibiotic therapy as defined by the authors for 90-day mortality [odds ratio (OR): 1.09; 95% confidence interval (CI): 0.82-1.46, p: 0.55; I2 = 0%] or 90-day recurrence or relapse of bacteremia [OR: 0.72; 95% CI: 0.31-1.68, p: 0.45; I2 = 26%]. Sensitivity analysis showed similar results when comparing a predefined duration of <14 days versus ⩾14 days and when excluding the only study with a high risk of bias. Conclusion Shorter-duration regimens could be considered as an alternative option for uncomplicated SAB in low-risk cases. However, based on a small number of studies with significant methodological limitations and risk of bias, the benefits and harms of shorter regimens should be analyzed with caution. Randomized clinical trials are needed to determine the best approach regarding the optimal duration of therapy.
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Affiliation(s)
- Santiago Grillo Perez
- Department of Internal Medicine, Hospital Universitario San Ignacio, Carrera 7 No 40-62, 7th Floor, Bogotá 110231, Colombia
- School of medicine, Pontifical Xavierian University, Carrera 7 No 40-62, 8th Floor, Bogotá 110231, Colombia
| | - Candida Diaz-Brochero
- Pontifical Xavierian University, Bogotá, Colombia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia
- Infectious Diseases Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Javier Ricardo Garzon Herazo
- Pontifical Xavierian University, Bogotá, Colombia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia
- Infectious Diseases Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Oscar Mauricio Muñoz Velandia
- Pontifical Xavierian University, Bogotá, Colombia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia
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Mourad A, Fowler VG, Holland TL. Which trial do we need? Next-generation sequencing to individualize therapy in Staphylococcus aureus bacteraemia. Clin Microbiol Infect 2023; 29:955-958. [PMID: 37040826 PMCID: PMC11105115 DOI: 10.1016/j.cmi.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/16/2023] [Accepted: 04/02/2023] [Indexed: 04/13/2023]
Abstract
We propose a two-stage clinical trial in patients with Staphylococcus aureus bacteremia (SAB). In Stage 1 we will evaluate metagenomic next generation sequencing from blood as a quantitative biological surrogate for clinical endpoint in patients with SAB, similar to quantitative HIV viral load in HIV-infected patients. In Stage 2, we will conduct a randomized controlled trial to individualize duration of antibiotic therapy for based upon the presence of S. aureus genetic material in patients’ blood. The proposed study addresses two critical aspects of treatment of patients with SAB: the identification of a surrogate biological endpoint for future clinical trials, and a new approach by which to individualize patient management.
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Affiliation(s)
- Ahmad Mourad
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
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Abstract
PURPOSE OF REVIEW To review recently published evidence relevant to Staphylococcus aureus bacteremia (SAB). RECENT FINDINGS Staphylococcus aureus is the most common pathogen causing co-infections and superinfections in patients with COVID-19. Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia ratios have sharply risen during the pandemic. SAB mortality is 18% at 1 month and 27% at 3 months but has gradually decreased over the last 30 years. Recurrences and reinfections are common (9%). Standardised items to define complicated SAB, and a new cut-off defining persisting bacteremia after 2 days with positive blood cultures have been proposed. Multiple antibiotic combinations have been trialled including vancomycin or daptomycin with β-lactams, fosfomycin, or clindamycin, without significant results. In the recently published guidelines, vancomycin remains the first line of treatment for MRSA bacteremia. For the management of methicillin-susceptible Staphylococcus aureus , cefazolin less frequently causes acute kidney injury than flucloxacillin, and when susceptibility is demonstrated, de-escalation to penicillin G is suggested. SUMMARY Our review confirms that Staphylococcus aureus represents a special aetiology among all causes of bloodstream infections. Pending results of platform and larger trials, its distinct epidemiology and determinants mandate careful integration of clinical variables and best available evidence to optimize patient outcomes.
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Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services
- Queensland University of Technology
- Faculty of Medicine, University of Queensland
| | - Kevin B Laupland
- Queensland University of Technology
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Davis JS, Petersiel N, Tong SYC. How I manage a patient with MRSA bacteraemia. Clin Microbiol Infect 2021; 28:190-194. [PMID: 34757117 DOI: 10.1016/j.cmi.2021.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/13/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Staphylococcus aureus bloodstream infections are common and associated with a high mortality of 15-25%. Methicillin-resistant S. aureus (MRSA) bloodstream infection accounts for 10-40% of cases, and has an even higher mortality. Despite being the 'bread and butter' of clinical infectious diseases practice, robust evidence to guide optimal management is often lacking and there is wide variation in practice. OBJECTIVES To provide a real-world example of a case of MRSA bacteraemia and the thought processes of the authors as key management decision points are reached. SOURCES The discussion is based on recent literature searches of relevant topics. In making recommendations, randomized clinical trial data have been prioritized and highlighted, and where these are not available recommendations are based on the experience and opinions of the authors. CONTENT For a patient with MRSA bacteraemia and a primary bone and joint infection the following points are discussed: empirical antibiotic choice for suspected S. aureus bacteraemia; directed antibiotic choice for MRSA; monitoring and dosing of vancomycin; the role of combination therapy when bacteraemia is persistent; and the duration of therapy and role of switching to oral antibiotics. IMPLICATIONS While broad principles of aggressive source control and appropriate choice and duration of antibiotics are important, the heterogeneity of S. aureus bacteraemia means that a tailored rather than algorithmic approach to management is often required. Further randomized controlled trials are needed to strengthen the evidence base for the management of MRSA bacteraemia.
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Affiliation(s)
- Joshua S Davis
- Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia.
| | - Neta Petersiel
- Victorian Infectious Diseases Service, The Royal Melbourne and Hospital, At the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Steven Y C Tong
- Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; Victorian Infectious Diseases Service, The Royal Melbourne and Hospital, At the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Tong SYC, Walls G. Shortening the duration of therapy for Staphylococcus aureus bacteremia: opening the Overton window. Clin Infect Dis 2021; 73:873-875. [PMID: 33675649 DOI: 10.1093/cid/ciab205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Genevieve Walls
- Department of Infectious Diseases, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
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Thorlacius-Ussing L, Sandholdt H, Nissen J, Rasmussen J, Skov R, Frimodt-Møller N, Dahl Knudsen J, Østergaard C, Benfield T. Comparable outcomes of short-course and prolonged-course therapy in selected cases of methicillin-susceptible Staphylococcus aureus bacteremia:A pooled cohort study. Clin Infect Dis 2021; 73:866-872. [PMID: 33677515 DOI: 10.1093/cid/ciab201] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The recommended duration of antimicrobial treatment for Staphylococcus aureus bacteremia (SAB) is a minimum of 14 days. We compared the clinical outcomes of patients receiving short-course (SC), 6-10 days, or prolonged-course (PC), 10-16 days, antibiotic therapy for low risk methicillin-susceptible SAB (MS-SAB). METHODS Adults with MS-SAB in 1995-2018 were included from three independent retrospective cohorts. Logistic regression models fitted with inverse probability of treatment weighting were used to assess the association between the primary outcome of 90-day mortality and treatment duration for the individual cohorts as well as a pooled cohort analysis. RESULTS A total of 645, 219 and 141 patients with low risk MS-SAB were included from Cohort I, II and III. Median treatment duration in the three SC groups were 8 days (interquartile range [IQR] 7-10), 9 days (IQR 8-10), and 8 days (IQR 7-10). In the PC groups patients received a median therapy of 14 days (IQR 13-15), 14 days (IQR 13-15) and 13 days (IQR 12-15). No significant differences in 90-day mortality were observed between the SC and PC group in Cohort I (Odds ratio [OR] 0.85, 95% confidence interval [CI] 0.49-1.41), Cohort II (OR 1.24, 95% CI 0.60-2.62) nor Cohort III (OR 1.15, 95% CI 0.24-4.019). This result was consistent in the pooled cohort analysis (OR 1.05, 95% CI 0.71-1.51). Furthermore, duration of therapy was not associated with the risk of relapse. CONCLUSION In patients with low risk MS-SAB, shorter courses of antimicrobial therapy yielded similar clinical outcomes compared to longer courses of therapy.
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Affiliation(s)
- Louise Thorlacius-Ussing
- CREDID (Center of Research & Disruption of Infectious Diseases), Department of Infectious Diseases, Copenhagen University Hospital -Amager and Hvidovre, Copenhagen, Denmark
| | - Håkon Sandholdt
- CREDID (Center of Research & Disruption of Infectious Diseases), Department of Infectious Diseases, Copenhagen University Hospital -Amager and Hvidovre, Copenhagen, Denmark
| | - Jette Nissen
- Department of Gynaecology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jon Rasmussen
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Thomas Benfield
- CREDID (Center of Research & Disruption of Infectious Diseases), Department of Infectious Diseases, Copenhagen University Hospital -Amager and Hvidovre, Copenhagen, Denmark
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