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Plainvert C, Matuschek E, Dmytruk N, Gaillard M, Frigo A, Ballaa Y, Biesaga E, Kahlmeter G, Poyart C, Tazi A. Microbiological Epidemiology of Invasive Infections Due to Non-Beta-Hemolytic Streptococci, France, 2021. Microbiol Spectr 2023; 11:e0016023. [PMID: 37199642 PMCID: PMC10269528 DOI: 10.1128/spectrum.00160-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/29/2023] [Indexed: 05/19/2023] Open
Abstract
Non-beta-hemolytic streptococci (NBHS), also referred to as viridans streptococci, represent an underestimated cause of human invasive diseases. Their resistance to antibiotics, including beta-lactam agents, often complicate their therapeutic management. A prospective multicenter study was conducted by the French National Reference Center for Streptococci between March and April 2021 to describe the clinical and microbiological epidemiology of invasive infections due to NBHS, excluding pneumococcus. A total of 522 NBHS invasive cases were collected. Distribution among streptococcal groups was: Streptococcus anginosus (33%), Streptococcus mitis (28%), Streptococcus sanguinis (16%), Streptococcus bovis/equinus (15%), Streptococcus salivarius (8%), and Streptococcus mutans (<1%). Median age of infection was 68 years old (range <1 day to 100 years). Cases were more frequent in male patients (gender ratio M/F 2.1:1) and manifested mainly as bacteremia without focus (46%), intra-abdominal infections (18%) and endocarditis (11%). All isolates were susceptible to glycopeptides and displayed low-level inherent gentamicin resistance. All isolates of the S. bovis/equinus, S. anginosus, and S. mutans groups were susceptible to beta-lactams. Conversely, nonsusceptibility to beta-lactams was found in 31%, 28%, and 52% of S. mitis, S. salivarius, and S. sanguinis isolates, respectively. The screening for beta-lactam resistance using the recommended one unit benzylpenicillin disk screening failed to detect 21% of resistant isolates (21/99). Last, overall resistance rates to the alternative anti-streptococcal molecules clindamycin and moxifloxacin were 29% (149/522) and 1.6% (8/505), respectively. IMPORTANCE NBHS are recognized as opportunistic pathogens particularly involved in infections of the elderly and immunocompromised patients. This study underlines their importance as common causes of severe and difficult-to-treat infections such as endocarditis. Although species of the S. anginosus and S. bovis/equinus groups remain constantly susceptible to beta-lams, resistance in oral streptococci exceeds 30% and screening techniques are not fully reliable. Therefore, accurate species identification and antimicrobial susceptibility testing by MICs determination appears essential for the treatment of NBHS invasive infections, together with continued epidemiological surveillance.
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Affiliation(s)
- Céline Plainvert
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | | | - Nicolas Dmytruk
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Marine Gaillard
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Amandine Frigo
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Yassine Ballaa
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
| | - Eddy Biesaga
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
| | - Gunnar Kahlmeter
- EUCAST Development Laboratory, Växjö, Sweden
- Department of Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Claire Poyart
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
- Université Paris Cité, Paris, France
| | - Asmaa Tazi
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
- Université Paris Cité, Paris, France
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Beta-lactam antibiotics and viridans group streptococci. Rev Argent Microbiol 2022; 54:335-343. [DOI: 10.1016/j.ram.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/04/2022] [Accepted: 06/24/2022] [Indexed: 12/15/2022] Open
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Endocarditis Caused by Highly Penicillin-Resistant Viridans Group Streptococci: Still Room for Vancomycin-Based Regimens. Antimicrob Agents Chemother 2019; 63:AAC.00516-19. [PMID: 31182540 DOI: 10.1128/aac.00516-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/04/2019] [Indexed: 01/04/2023] Open
Abstract
Optimal treatment options remain unknown for infective endocarditis (IE) caused by penicillin-resistant (PEN-R) viridans group streptococcal (VGS) strains. The aims of this study were to report two cases of highly PEN-R VGS IE, perform a literature review, and evaluate various antibiotic combinations in vitro and in vivo The following combinations were tested by time-kill studies and in the rabbit experimental endocarditis (EE) model: PEN-gentamicin, ceftriaxone-gentamicin, vancomycin-gentamicin, daptomycin-gentamicin, and daptomycin-ampicillin. Case 1 was caused by Streptococcus parasanguinis (PEN MIC, 4 μg/ml) and was treated with vancomycin plus cardiac surgery. Case 2 was caused by Streptococcus mitis (PEN MIC, 8 μg/ml) and was treated with 4 weeks of vancomycin plus gentamicin, followed by 2 weeks of vancomycin alone. Both patients were alive and relapse-free after ≥6 months follow-up. For the in vitro studies, except for daptomycin-ampicillin, all combinations demonstrated both synergy and bactericidal activity against the S. parasanguinis isolate. Only PEN-gentamicin, daptomycin-gentamicin, and daptomycin-ampicillin demonstrated both synergy and bactericidal activity against the S. mitis strain. Both strains developed high-level daptomycin resistance (HLDR) during daptomycin in vitro passage. In the EE studies, PEN alone failed to clear S. mitis from vegetations, while ceftriaxone and vancomycin were significantly more effective (P < 0.001). The combination of gentamicin with PEN or vancomycin increased bacterial eradication compared to that with the respective monotherapies. In summary, two patients with highly PEN-R VGS IE were cured using vancomycin-based therapy. In vivo, regimens of gentamicin plus either β-lactams or vancomycin were more active than their respective monotherapies. Further clinical studies are needed to confirm the role of vancomycin-based regimens for highly PEN-R VGS IE. The emergence of HLDR among these strains warrants caution in the use of daptomycin therapy for VGS IE.
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Jamal W, Abdulkareem H, Rotimi VO. Comparative in vitro activity of ceftaroline and comparator agents against nosocomial Gram-negative and Gram-positive clinically significant bacterial isolates from patients in a teaching hospital in Kuwait. J Chemother 2018; 30:213-223. [PMID: 29466931 DOI: 10.1080/1120009x.2018.1438768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective was to test the in vitro activities of ceftaroline and comparator agents against clinical isolates of Gram-negative and Gram-positive bacteria. Isolates were identified with VITEK II. Susceptibility testing was with E test. A total of 1264 isolates were tested. Compared to other cephalosporins, ceftaroline demonstrated excellent in vitro activities (MIC90, ≤0.5 mg/L) against Escherichia coli, Salmonella spp. and Haemophilus influenzae. When matched with the comparator cephalosporins, ceftaroline demonstrated the greatest activity against methicillin-susceptible Staphylococcus aureus (MSSA), with MIC90 of 0.25 mg/L. Ceftaroline's MIC90s against both community-associated methicillin-resistant S. aureus (MRSA) and hospital-acquired MRSA were 0.5 and 1 mg/L, respectively. Major discrepancies were noted between E test and disc diffusion tests for ceftaroline only against 16 Gram-negative and 16 Gram-positive isolates. Ceftaroline demonstrated an excellent in vitro activity against the majority of clinically significant Gram-negative and Gram-positive isolates obtained from proven cases of bacterial infections.
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Affiliation(s)
- Wafaa Jamal
- a Faculty of Medicine, Department of Microbiology , Kuwait University , Jabriya , Kuwait
- b Microbiology Unit, Mubarak Al Kabir Hospital , Jabriya , Kuwait
| | | | - Vincent O Rotimi
- a Faculty of Medicine, Department of Microbiology , Kuwait University , Jabriya , Kuwait
- b Microbiology Unit, Mubarak Al Kabir Hospital , Jabriya , Kuwait
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Yim J, Smith JR, Singh NB, Rice S, Stamper K, Garcia de la Maria C, Bayer AS, Mishra NN, Miró JM, Tran TT, Arias CA, Sullam P, Rybak MJ. Evaluation of daptomycin combinations with cephalosporins or gentamicin against Streptococcus mitis group strains in an in vitro model of simulated endocardial vegetations (SEVs). J Antimicrob Chemother 2018; 72:2290-2296. [PMID: 28475731 DOI: 10.1093/jac/dkx130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/06/2017] [Indexed: 02/06/2023] Open
Abstract
Objectives Among viridans group streptococcal infective endocarditis (IE), the Streptococcus mitis group is the most common aetiological organism. Treatment of IE caused by the S. mitis group is challenging due to the high frequency of β-lactam resistance, drug allergy and intolerability of mainstay antimicrobial agents such as vancomycin or gentamicin. Daptomycin has been suggested as an alternative therapeutic option in these scenarios based on its excellent susceptibility profile against S. mitis group strains . However, the propensity of many S. mitis group strains to rapidly evolve stable, high-level daptomycin resistance potentially limits this approach. Methods We evaluated the activity of 6 mg/kg/day daptomycin alone or in combination with gentamicin, ceftriaxone or ceftaroline against two daptomycin-susceptible S. mitis group strains over 96 h in a pharmacokinetic/pharmacodynamic model of simulated endocardial vegetations. Results Daptomycin alone was not bactericidal and high-level daptomycin resistance evolved at 96 h in both organisms. Combinations of daptomycin + ceftriaxone and daptomycin + ceftaroline demonstrated enhanced killing activity compared with each antibiotic alone and prevented emergence of daptomycin resistance at 96 h. Use of gentamicin as an adjunctive agent neither improved the efficacy of daptomycin nor prevented the development of daptomycin resistance. Conclusions Addition of ceftriaxone or ceftaroline to daptomycin improves the bactericidal activity against S. mitis group strains and prevents daptomycin resistance emergence. Further investigation with combinations of daptomycin and β-lactams in a large number of strains is warranted to fully elucidate the clinical implications of such combinations for treatment of S. mitis group IE.
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Affiliation(s)
- Juwon Yim
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Jordan R Smith
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Nivedita B Singh
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Seth Rice
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Kyle Stamper
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | | | - Arnold S Bayer
- LA Biomedical Research Institute, Torrance, CA and Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Nagendra N Mishra
- LA Biomedical Research Institute, Torrance, CA and Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - José M Miró
- Infectious Diseases Service, Hosp. Clinic-IDIBAPS, Univ. Barcelona, Barcelona, Spain
| | - Truc T Tran
- The University of Texas Medical School, Houston, TX, USA
| | - Cesar A Arias
- LA Biomedical Research Institute, Torrance, CA and Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Paul Sullam
- University of California, San Francisco and VA Medical Center, San Francisco, CA, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.,School of Medicine, Wayne State University, Detroit, MI, USA
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Rolston KVI, Jamal MA, Nesher L, Shelburne SA, Raad I, Prince RA. In vitro activity of ceftaroline and comparator agents against Gram-positive and Gram-negative clinical isolates from cancer patients. Int J Antimicrob Agents 2017; 49:416-421. [PMID: 28257904 DOI: 10.1016/j.ijantimicag.2016.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/02/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
Bacterial infections are common in cancer patients. Ceftaroline (CFT) is a broad-spectrum cephalosporin with activity against most Gram-positive organisms (GPOs) and many Gram-negative organisms. In this study, the in vitro activity of CFT was compared with vancomycin (VAN), daptomycin (DAP), linezolid (LZD), trimethoprim/sulphamethoxazole (SXT) and tigecycline (TIG) against bacteria (predominantly blood culture isolates) isolated from cancer patients in 2014 and 2015. CFT was active against methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), methicillin-susceptible coagulase-negative staphylococci (MS-CoNS) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS) with MIC90 values (minimum inhibitory concentration that inhibited 90% of the isolates) of 0.25, 2.0, 0.12 and 0.5 mg/L, respectively. MIC90 values for other GPOs were: Bacillus spp., >8.0 mg/L; Corynebacterium spp., 2.0 mg/L; Micrococcus spp., <0.06 mg/L; viridans group streptococci, 0.5 mg/L; Streptococcus pneumoniae, 0.25 mg/L; and Streptococcus spp., <0.06 mg/L. Among the comparator agents, VAN, DAP, TIG and LZD were active against the majority of GPOs tested. CFT also had moderate activity against common extended-spectrum β-lactamase (ESBL)-negative Gram-negative bacilli such as Enterobacter cloacae, Escherichia coli, Klebsiella spp., Proteus mirabilis and Serratia spp.
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Affiliation(s)
- Kenneth V I Rolston
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The University of Houston College of Pharmacy, Houston, TX, USA.
| | - Mohamed A Jamal
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lior Nesher
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samuel A Shelburne
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Issam Raad
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randall A Prince
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The University of Houston College of Pharmacy, Houston, TX, USA
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