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Wang Y, Yi SM, Huang SM, Xu WX, Wei YW, Qu Q, Qu J. Efficacy of omadacycline in the treatment of Legionella pneumonia: a case report. Front Cell Infect Microbiol 2024; 14:1380312. [PMID: 38836055 PMCID: PMC11148271 DOI: 10.3389/fcimb.2024.1380312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
Legionella, one of the main pathogens that causes community-acquired pneumonia, can lead to Legionella pneumonia, a condition characterized predominantly by severe pneumonia. This disease, caused by the bacterium Legionella pneumophila, can quickly progress to critical pneumonia and is often associated with damage to multiple organs. As a result, it requires close attention in terms of clinical diagnosis and treatment. Omadacycline, a new type of tetracycline derivative belonging to the aminomethylcycline class of antibiotics, is a semi-synthetic compound derived from minocycline. Its key structural feature, the aminomethyl modification, allows omadacycline to overcome bacterial resistance and broadens its range of effectiveness against bacteria. Clinical studies have demonstrated that omadacycline is not metabolized in the body, and patients with hepatic and renal dysfunction do not need to adjust their dosage. This paper reports a case of successful treatment of Legionella pneumonia with omadacycline in a patient who initially did not respond to empirical treatment with moxifloxacin. The patient also experienced electrolyte disturbance, as well as dysfunction in the liver and kidneys, delirium, and other related psychiatric symptoms.
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Affiliation(s)
- Yao Wang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
- Department of Pharmacy, Traffic Hospital of Hunan Province, Changsha, China
| | - Shui-Min Yi
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
- Department of Chemistry and Bioengineering, Yichun University, Yichun, China
| | - Si-Min Huang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
- Department of Pharmacy, Foresea Life Insurance Shaoguan Hospital, Shaoguan, China
| | - Wei-Xin Xu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Yi-Wen Wei
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Qu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
- Hunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China
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2
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Shin S, Koo S, Yang YJ, Lim HJ. Characteristics of the Mycoplasma pneumoniae Epidemic from 2019 to 2020 in Korea: Macrolide Resistance and Co-Infection Trends. Antibiotics (Basel) 2023; 12:1623. [PMID: 37998825 PMCID: PMC10669541 DOI: 10.3390/antibiotics12111623] [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: 10/11/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
Mycoplasma pneumoniae, a major etiological agent of community-acquired pneumonia, exhibits distinct cyclic epidemic patterns recurring every three to five years. Several cases of co-infection with severe acute respiratory syndrome coronavirus 2 have been reported globally, resulting in unfavorable clinical manifestations. This study investigated the epidemiological features of the recent M. pneumoniae outbreak (May 2019-April 2020) using retrospective data from the last five years. Molecular test data for macrolide resistance and co-infection were obtained from the Seegene Medical Foundation. National medical expenditure and hospitalization rates were analyzed using data from The Health Insurance Review and Assessment Service of Korea. The macrolide resistance rate was 69.67%, peaking at 71.30% during the epidemic period, which was considerably higher than the 60.89% rate during non-epidemic periods. The co-infection rate with other respiratory pathogens was 88.49%; macrolide-resistant M. pneumoniae strains showed a 2.33% higher co-infection rate than the susceptible strains. The epidemic period had 15.43% higher hospitalization and 78.27% higher medical budget expenditure per patient than non-epidemic periods. The increased rates of macrolide resistance and co-infection observed in macrolide-resistant M. pneumoniae during the epidemic period highlight the importance of monitoring future outbreaks, especially considering macrolide resistance and the risk of co-infection with other pathogens.
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Affiliation(s)
- Soyoun Shin
- Daejeon & Chungcheong Reference Lab., Seegene Medical Foundation, Daejeon 35203, Republic of Korea;
| | - Sunhoe Koo
- Daejeon & Chungcheong Reference Lab., Seegene Medical Foundation, Daejeon 35203, Republic of Korea;
| | - Yong-Jin Yang
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul 04805, Republic of Korea; (Y.-J.Y.); (H.-J.L.)
| | - Ho-Jae Lim
- Department of Molecular Diagnostics, Seegene Medical Foundation, Seoul 04805, Republic of Korea; (Y.-J.Y.); (H.-J.L.)
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3
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Du J, Liu Q, Pan Y, Xu S, Li H, Tang J. The Research Status, Potential Hazards and Toxicological Mechanisms of Fluoroquinolone Antibiotics in the Environment. Antibiotics (Basel) 2023; 12:1058. [PMID: 37370377 DOI: 10.3390/antibiotics12061058] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Fluoroquinolone antibiotics are widely used in human and veterinary medicine and are ubiquitous in the environment worldwide. This paper recapitulates the occurrence, fate, and ecotoxicity of fluoroquinolone antibiotics in various environmental media. The toxicity effect is reviewed based on in vitro and in vivo experiments referring to many organisms, such as microorganisms, cells, higher plants, and land and aquatic animals. Furthermore, a comparison of the various toxicology mechanisms of fluoroquinolone antibiotic residues on environmental organisms is made. This study identifies gaps in the investigation of the toxic effects of fluoroquinolone antibiotics and mixtures of multiple fluoroquinolone antibiotics on target and nontarget organisms. The study of the process of natural transformation toward drug-resistant bacteria is also recognized as a knowledge gap. This review also details the combined toxicity effect of fluoroquinolone antibiotics and other chemicals on organisms and the adsorption capacity in various environmental matrices, and the scarcity of data on the ecological toxicology evaluation system of fluoroquinolone antibiotics is identified. The present study entails a critical review of the literature providing guidelines for the government to control the discharge of pollutants into the environment and formulate policy coordination. Future study work should focus on developing a standardized research methodology for fluoroquinolone antibiotics to guide enterprises in the design and production of drugs with high environmental biocompatibility.
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Affiliation(s)
- Jia Du
- College of Materials and Environmental Engineering, Hangzhou Dianzi University, Hangzhou 310018, China
- Suzhou Fishseeds Biotechnology Co., Ltd., Suzhou 215138, China
- Hongze Fishseeds Biotechnology Co., Ltd., Huaian 223125, China
| | - Qinghua Liu
- Suzhou Fishseeds Biotechnology Co., Ltd., Suzhou 215138, China
- Hongze Fishseeds Biotechnology Co., Ltd., Huaian 223125, China
- Wisdom Lake Academy of Pharmacy, Xi'an Jiaotong-Liverpool University, Suzhou 215123, China
| | - Ying Pan
- College of Materials and Environmental Engineering, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Shaodan Xu
- College of Materials and Environmental Engineering, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Huanxuan Li
- College of Materials and Environmental Engineering, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Junhong Tang
- College of Materials and Environmental Engineering, Hangzhou Dianzi University, Hangzhou 310018, China
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4
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Shariati A, Arshadi M, Khosrojerdi MA, Abedinzadeh M, Ganjalishahi M, Maleki A, Heidary M, Khoshnood S. The resistance mechanisms of bacteria against ciprofloxacin and new approaches for enhancing the efficacy of this antibiotic. Front Public Health 2022; 10:1025633. [PMID: 36620240 PMCID: PMC9815622 DOI: 10.3389/fpubh.2022.1025633] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
For around three decades, the fluoroquinolone (FQ) antibiotic ciprofloxacin has been used to treat a range of diseases, including chronic otorrhea, endocarditis, lower respiratory tract, gastrointestinal, skin and soft tissue, and urinary tract infections. Ciprofloxacin's main mode of action is to stop DNA replication by blocking the A subunit of DNA gyrase and having an extra impact on the substances in cell walls. Available in intravenous and oral formulations, ciprofloxacin reaches therapeutic concentrations in the majority of tissues and bodily fluids with a low possibility for side effects. Despite the outstanding qualities of this antibiotic, Salmonella typhi, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa have all shown an increase in ciprofloxacin resistance over time. The rise of infections that are resistant to ciprofloxacin shows that new pharmacological synergisms and derivatives are required. To this end, ciprofloxacin may be more effective against the biofilm community of microorganisms and multi-drug resistant isolates when combined with a variety of antibacterial agents, such as antibiotics from various classes, nanoparticles, natural products, bacteriophages, and photodynamic therapy. This review focuses on the resistance mechanisms of bacteria against ciprofloxacin and new approaches for enhancing its efficacy.
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Affiliation(s)
- Aref Shariati
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
| | - Maniya Arshadi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mostafa Abedinzadeh
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mahsa Ganjalishahi
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Abbas Maleki
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran,Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran,*Correspondence: Mohsen Heidary
| | - Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran,Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran,Saeed Khoshnood
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5
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Feng T, Han Q, Su W, Yu Q, Yang J, Li H. Microbiota and mobile genetic elements influence antibiotic resistance genes in dust from dense urban public places. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 311:119991. [PMID: 35987288 DOI: 10.1016/j.envpol.2022.119991] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Many contaminants were carried by dust, a common environment media that is easy to contact with human beings, and antibiotic resistance genes (ARGs) as an emergency pollutant also harbor in dust and pose serious threats to human health especially those carried by opportunistic pathogens because inactivation of antibiotics caused by ARGs may enhance pathogenicity. Considering there is a gap of investigation of dust ARGs, 16 S rRNA gene sequences and high-throughput quantitative PCR were employed to obtain information of microbial communities and accumulated ARGs in dust from different urban places, including the malls, hospitals, schools and parks, to investigate the distribution and influencing factors of ARGs and discover the potential hosts of ARGs in dust. Here, 9 types of ARGs such as sulfonamide, tetracycline, and beta-lactamase and 71 subtypes of ARGs like sul1, tetM-01, and drfA1 were detected in dust. ARGs had varying distribution in different public places and seasons in dust. The abundances of total ARGs, MLSB and tetracycline genes were higher in spring than summer. The diversity of ARGs was highest in malls, follow by hospitals, schools, and parks. Additionally, multi-drug resistance genes in dust were more abundant in hospitals than in schools and parks. The microbes were distinguished as the most important driving factors for ARGs in dust, followed by the mobile genetic elements (MGEs) and different places, while dust physicochemical parameters only exert a negligible impact. Notably, several opportunistic pathogens like the Streptococcus, Vibrio, and Pseudomonas were inferred as potential hosts of high-risk ARGs such as mecA, tetM-02, and tetO-01 in dust because of strongly positive co-occurrence. These results imply that dust is likely an important reservoir of ARGs. We should realize that ARGs may be harbored in some opportunistic pathogens occur in dust and endanger human health because of dust contacting to human easily.
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Affiliation(s)
- Tianshu Feng
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Qian Han
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Wanghong Su
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Qiaoling Yu
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Jiawei Yang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Huan Li
- School of Public Health, Lanzhou University, Lanzhou, 730000, China; State Key Laboratory of Grassland Agro-ecosystems, Center for Grassland Microbiome, Lanzhou University, Lanzhou, 730000, China.
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Yang JL, Sun H, Zhou X, Yang M, Zhan XY. Antimicrobial susceptibility profiles and tentative epidemiological cutoff values of Legionella pneumophila from environmental water and soil sources in China. Front Microbiol 2022; 13:924709. [PMID: 36312931 PMCID: PMC9597688 DOI: 10.3389/fmicb.2022.924709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Legionnaires’ disease (LD), caused by Legionella, including the most prevalent Legionella pneumophila, has been treated primarily with antibiotics. Environmental water and soil are the reservoirs for L. pneumophila. Studying antimicrobial susceptibility using a large number of isolates from various environmental sources and regions could provide an unbiased result. In the present study, antimicrobial susceptibility of 1464 environmental L. pneumophila isolates that were derived from various environmental water and soil sources of 12 cities in China to rifampin (RIF), erythromycin (ERY), clarithromycin (CLA), azithromycin (AZI), ciprofloxacin (CIP), moxifloxacin (MOX), levofloxacin (LEV), and doxycycline (DOX) was investigated, and minimum inhibitory concentration (MIC) data were obtained. We show that regarding macrolides, ERY was least active (MIC90 = 0.5 mg/L), while CLA was most active (MIC90 = 0.063 mg/L). A total of three fluoroquinolones have similar MICs on L. pneumophila. Among these antimicrobials, RIF was the most active agent, while DOX was the most inactive one. We observed different susceptibility profiles between serogroup 1 (sg1) and sg2-15 or between water and soil isolates from different regions. The ECOFFs were ERY and AZI (0.5 mg/L), RIF (0.002 mg/L), CIP, CLA and MOX (0.125 mg/L), LEV (0.063 mg/), and DOX (32 mg/L). Overall, two fluoroquinolone-resistant environmental isolates (0.14%) were first documented based on the wild-type MIC distribution. Not all azithromycin-resistant isolates (44/46, 95.65%) harbored the lpeAB efflux pump. The MICs of the ERY and CLA on the lpeAB + isolates were not elevated. These results suggested that the lpeAB efflux pump might be only responsible for AZI resistance, and undiscovered AZI-specific resistant mechanisms exist in L. pneumophila. Based on the big MIC data obtained in the present study, the same defense strategies, particularly against both CLA and RIF, may exist in L. pneumophila. The results determined in our study will guide further research on antimicrobial resistance mechanisms of L. pneumophila and could be used as a reference for setting clinical breakpoints and discovering antimicrobial-resistant isolates in the clinic, contributing to the antibiotic choice in the treatment of LD.
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Eisenreich W, Rudel T, Heesemann J, Goebel W. Link Between Antibiotic Persistence and Antibiotic Resistance in Bacterial Pathogens. Front Cell Infect Microbiol 2022; 12:900848. [PMID: 35928205 PMCID: PMC9343593 DOI: 10.3389/fcimb.2022.900848] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/21/2022] [Indexed: 12/15/2022] Open
Abstract
Both, antibiotic persistence and antibiotic resistance characterize phenotypes of survival in which a bacterial cell becomes insensitive to one (or even) more antibiotic(s). However, the molecular basis for these two antibiotic-tolerant phenotypes is fundamentally different. Whereas antibiotic resistance is genetically determined and hence represents a rather stable phenotype, antibiotic persistence marks a transient physiological state triggered by various stress-inducing conditions that switches back to the original antibiotic sensitive state once the environmental situation improves. The molecular basics of antibiotic resistance are in principle well understood. This is not the case for antibiotic persistence. Under all culture conditions, there is a stochastically formed, subpopulation of persister cells in bacterial populations, the size of which depends on the culture conditions. The proportion of persisters in a bacterial population increases under different stress conditions, including treatment with bactericidal antibiotics (BCAs). Various models have been proposed to explain the formation of persistence in bacteria. We recently hypothesized that all physiological culture conditions leading to persistence converge in the inability of the bacteria to re-initiate a new round of DNA replication caused by an insufficient level of the initiator complex ATP-DnaA and hence by the lack of formation of a functional orisome. Here, we extend this hypothesis by proposing that in this persistence state the bacteria become more susceptible to mutation-based antibiotic resistance provided they are equipped with error-prone DNA repair functions. This is - in our opinion - in particular the case when such bacterial populations are exposed to BCAs.
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Affiliation(s)
- Wolfgang Eisenreich
- Bavarian NMR Center – Structural Membrane Biochemistry, Department of Chemistry, Technische Universität München, Garching, Germany
- *Correspondence: Wolfgang Eisenreich,
| | - Thomas Rudel
- Chair of Microbiology, Biocenter, University of Würzburg, Würzburg, Germany
| | - Jürgen Heesemann
- Max von Pettenkofer-Institute, Ludwig Maximilian University of Munich, München, Germany
| | - Werner Goebel
- Max von Pettenkofer-Institute, Ludwig Maximilian University of Munich, München, Germany
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Proteome Exploration of
Legionella pneumophila
To Identify Novel Therapeutics: a Hierarchical Subtractive Genomics and Reverse Vaccinology Approach. Microbiol Spectr 2022; 10:e0037322. [PMID: 35863001 PMCID: PMC9430848 DOI: 10.1128/spectrum.00373-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Legionella pneumophila
is a human pathogen distributed worldwide, causing Legionnaires’ disease (LD), a severe form of pneumonia and respiratory tract infection.
L. pneumophila
is emerging as an antibiotic-resistant strain, and controlling LD is now difficult. Hence, developing novel drugs and vaccines against
L. pneumophila
is a major research priority.
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Ginevra C, Beraud L, Pionnier I, Sallabery K, Bentayeb H, Simon B, Allam C, Chastang J, Ibranosyan M, Decroix V, Campese C, Jarraud S, Descours G. Detection of highly macrolide-resistant Legionella pneumophila strains from a hotel water network using systematic whole-genome sequencing. J Antimicrob Chemother 2022; 77:2167-2170. [PMID: 35678276 DOI: 10.1093/jac/dkac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/09/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Implementation of an antibiotic resistance detection tool in Legionella daily surveillance at the French National Reference Centre for Legionella. METHODS Systematic WGS of Legionella pneumophila isolates and bioinformatics detection of specific mutations linked to antibiotic resistance. Phenotypic validation of antibiotic resistance detected by WGS was performed by the broth microdilution method. RESULTS More than 3000 L. pneumophila strains were screened for antibiotic resistance. A macrolide resistance-associated A2052G mutation in the 23S rRNA gene was identified in the genome of eight isolates from a hotel water network. High-level macrolide resistance (i.e. MICs of 1024-2048 mg/L for azithromycin and erythromycin) with no cross-resistance to other antimicrobials was phenotypically confirmed by antimicrobial susceptibility testing for the eight isolates. CONCLUSIONS Systematic WGS of L. pneumophila is a powerful tool for first-line high-throughput screening of antibiotic resistance before phenotypic validation.
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Affiliation(s)
- Christophe Ginevra
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Team Legionella Pathogenesis, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Plateforme GenEPII, Lyon, France
| | - Laetitia Beraud
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France
| | | | | | - Houcine Bentayeb
- Centre Hospitalier Saint-Quentin, Service de Pneumologie, Saint-Quentin, France
| | - Bruno Simon
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Plateforme GenEPII, Lyon, France
| | - Camille Allam
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Team Legionella Pathogenesis, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - Joelle Chastang
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France
| | - Marine Ibranosyan
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Team Legionella Pathogenesis, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - Véronique Decroix
- Centre Hospitalier Saint-Quentin, Laboratoire de Biologie Médicale, Saint-Quentin, France
| | - Christine Campese
- Santé Publique France, Unité des infections respiratoires et vaccinations, Saint-Maurice, France
| | - Sophie Jarraud
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Team Legionella Pathogenesis, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Plateforme GenEPII, Lyon, France
| | - Ghislaine Descours
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Team Legionella Pathogenesis, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
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Gattuso G, Rizzo R, Lavoro A, Spoto V, Porciello G, Montagnese C, Cinà D, Cosentino A, Lombardo C, Mezzatesta ML, Salmeri M. Overview of the Clinical and Molecular Features of Legionella Pneumophila: Focus on Novel Surveillance and Diagnostic Strategies. Antibiotics (Basel) 2022; 11:antibiotics11030370. [PMID: 35326833 PMCID: PMC8944609 DOI: 10.3390/antibiotics11030370] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
Legionella pneumophila (L. pneumophila) is one of the most threatening nosocomial pathogens. The implementation of novel and more effective surveillance and diagnostic strategies is mandatory to prevent the occurrence of legionellosis outbreaks in hospital environments. On these bases, the present review is aimed to describe the main clinical and molecular features of L. pneumophila focusing attention on the latest findings on drug resistance mechanisms. In addition, a detailed description of the current guidelines for the disinfection and surveillance of the water systems is also provided. Finally, the diagnostic strategies available for the detection of Legionella spp. were critically reviewed, paying the attention to the description of the culture, serological and molecular methods as well as on the novel high-sensitive nucleic acid amplification systems, such as droplet digital PCR.
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Affiliation(s)
- Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Roberta Rizzo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Alessandro Lavoro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Vincenzoleo Spoto
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, National Cancer Institute IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (G.P.); (C.M.)
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit, National Cancer Institute IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (G.P.); (C.M.)
| | - Diana Cinà
- Health Management of the “Cannizzaro” Emergency Hospital of Catania, 95126 Catania, Italy;
- Clinical Pathology and Clinical Molecular Biology Unit, “Garibaldi Centro” Hospital, ARNAS Garibaldi, 95123 Catania, Italy
| | - Alessia Cosentino
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Cinzia Lombardo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Maria Lina Mezzatesta
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Mario Salmeri
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
- Correspondence: ; Tel.: +39-095-478-1244
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Proctor C, Garner E, Hamilton KA, Ashbolt NJ, Caverly LJ, Falkinham JO, Haas CN, Prevost M, Prevots DR, Pruden A, Raskin L, Stout J, Haig SJ. Tenets of a holistic approach to drinking water-associated pathogen research, management, and communication. WATER RESEARCH 2022; 211:117997. [PMID: 34999316 PMCID: PMC8821414 DOI: 10.1016/j.watres.2021.117997] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 05/10/2023]
Abstract
In recent years, drinking water-associated pathogens that can cause infections in immunocompromised or otherwise susceptible individuals (henceforth referred to as DWPI), sometimes referred to as opportunistic pathogens or opportunistic premise plumbing pathogens, have received considerable attention. DWPI research has largely been conducted by experts focusing on specific microorganisms or within silos of expertise. The resulting mitigation approaches optimized for a single microorganism may have unintended consequences and trade-offs for other DWPI or other interests (e.g., energy costs and conservation). For example, the ecological and epidemiological issues characteristic of Legionella pneumophila diverge from those relevant for Mycobacterium avium and other nontuberculous mycobacteria. Recent advances in understanding DWPI as part of a complex microbial ecosystem inhabiting drinking water systems continues to reveal additional challenges: namely, how can all microorganisms of concern be managed simultaneously? In order to protect public health, we must take a more holistic approach in all aspects of the field, including basic research, monitoring methods, risk-based mitigation techniques, and policy. A holistic approach will (i) target multiple microorganisms simultaneously, (ii) involve experts across several disciplines, and (iii) communicate results across disciplines and more broadly, proactively addressing source water-to-customer system management.
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Affiliation(s)
- Caitlin Proctor
- Department of Agricultural and Biological Engineering, Division of Environmental and Ecological Engineering, Purdue University, West Lafayette, IN, USA
| | - Emily Garner
- Wadsworth Department of Civil & Environmental Engineering, West Virginia University, Morgantown, WV, USA
| | - Kerry A Hamilton
- School of Sustainable Engineering and the Built Environment and The Biodesign Centre for Environmental Health Engineering, Arizona State University, Tempe, AZ, USA
| | - Nicholas J Ashbolt
- Faculty of Science and Engineering, Southern Cross University, Gold Coast. Queensland, Australia
| | - Lindsay J Caverly
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Charles N Haas
- Department of Civil, Architectural & Environmental Engineering, Drexel University, Philadelphia, PA, USA
| | - Michele Prevost
- Department of Civil, Geological and Mining Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - D Rebecca Prevots
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Amy Pruden
- Department of Civil & Environmental Engineering, Virginia Tech, Blacksburg, VA USA
| | - Lutgarde Raskin
- Department of Civil & Environmental Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Janet Stout
- Department of Civil & Environmental Engineering, University of Pittsburgh, and Special Pathogens Laboratory, Pittsburgh, PA, USA
| | - Sarah-Jane Haig
- Department of Civil & Environmental Engineering, and Department of Environmental & Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA.
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12
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Paukner S, Mariano D, Das AF, Moran GJ, Sandrock C, Waites KB, File TM. Lefamulin in Patients with Community-Acquired Bacterial Pneumonia Caused by Atypical Respiratory Pathogens: Pooled Results from Two Phase 3 Trials. Antibiotics (Basel) 2021; 10:antibiotics10121489. [PMID: 34943700 PMCID: PMC8698636 DOI: 10.3390/antibiotics10121489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
Lefamulin was the first systemic pleuromutilin antibiotic approved for intravenous and oral use in adults with community-acquired bacterial pneumonia based on two phase 3 trials (Lefamulin Evaluation Against Pneumonia [LEAP]-1 and LEAP-2). This pooled analysis evaluated lefamulin efficacy and safety in adults with community-acquired bacterial pneumonia caused by atypical pathogens (Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydia pneumoniae). In LEAP-1, participants received intravenous lefamulin 150 mg every 12 h for 5–7 days or moxifloxacin 400 mg every 24 h for 7 days, with optional intravenous-to-oral switch. In LEAP-2, participants received oral lefamulin 600 mg every 12 h for 5 days or moxifloxacin 400 mg every 24 h for 7 days. Primary outcomes were early clinical response at 96 ± 24 h after first dose and investigator assessment of clinical response at test of cure (5–10 days after last dose). Atypical pathogens were identified in 25.0% (91/364) of lefamulin-treated patients and 25.2% (87/345) of moxifloxacin-treated patients; most were identified by ≥1 standard diagnostic modality (M. pneumoniae 71.2% [52/73]; L. pneumophila 96.9% [63/65]; C. pneumoniae 79.3% [46/58]); the most common standard diagnostic modality was serology. In terms of disease severity, more than 90% of patients had CURB-65 (confusion of new onset, blood urea nitrogen > 19 mg/dL, respiratory rate ≥ 30 breaths/min, blood pressure <90 mm Hg systolic or ≤60 mm Hg diastolic, and age ≥ 65 years) scores of 0–2; approximately 50% of patients had PORT (Pneumonia Outcomes Research Team) risk class of III, and the remaining patients were more likely to have PORT risk class of II or IV versus V. In patients with atypical pathogens, early clinical response (lefamulin 84.4–96.6%; moxifloxacin 90.3–96.8%) and investigator assessment of clinical response at test of cure (lefamulin 74.1–89.7%; moxifloxacin 74.2–97.1%) were high and similar between arms. Treatment-emergent adverse event rates were similar in the lefamulin (34.1% [31/91]) and moxifloxacin (32.2% [28/87]) groups. Limitations to this analysis include its post hoc nature, the small numbers of patients infected with atypical pathogens, the possibility of PCR-based diagnostic methods to identify non-etiologically relevant pathogens, and the possibility that these findings may not be generalizable to all patients. Lefamulin as short-course empiric monotherapy, including 5-day oral therapy, was well tolerated in adults with community-acquired bacterial pneumonia and demonstrated high clinical response rates against atypical pathogens.
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Affiliation(s)
- Susanne Paukner
- Nabriva Therapeutics GmbH, Leberstrasse 20, 1110 Vienna, Austria
- Correspondence: ; Tel.: +43-1-74093-1224
| | - David Mariano
- Nabriva Therapeutics US, Inc., Fort Washington, PA 19034, USA;
| | | | | | - Christian Sandrock
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA;
| | - Ken B. Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
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13
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Cocuzza CE, Martinelli M, Perdoni F, Giubbi C, Vinetti MEA, Calaresu E, Frugoni S, Scaturro M, Ricci ML, Musumeci R. Antibiotic Susceptibility of Environmental Legionella pneumophila Strains Isolated in Northern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179352. [PMID: 34501942 PMCID: PMC8431511 DOI: 10.3390/ijerph18179352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
Legionella pneumophila is ubiquitous in aquatic environments and responsible for severe pneumonia in humans through inhalation of aerosol containing Legionella spp. Macrolides and fluoroquinolones are frequently used antimicrobials, but treatment failures are increasingly being reported. As susceptibility testing is not routinely performed, this study aimed to determine the minimum inhibitory concentrations (MICs) on 58 environmental Legionella pneumophila strains (24 of serogroup 1 and 34 of non-serogroup 1) isolated in Northern Italy. MICs of azithromycin, erythromycin, ciprofloxacin, levofloxacin, and rifampicin were determined by the microdilution method using buffered yeast extract broth supplemented with α-ketoglutarate (BYEα). Seventy-five percent of Legionella pneumophila isolates showed MIC values below the tentative highest MICs indicated by the European Committee on Antimicrobial Susceptibility Testing (EUCAST); rifampicin was the most active agent with MIC90 values below 0.008 mg/L. Interestingly, one isolate was tested and found to be PCR-positive for the azithromycin LpeAB active efflux system, further confirmed by the reserpine/resazurin microtiter assay. In conclusion, this study has provided additional susceptibility data for environmental Legionella pneumophila isolates from Northern Italy demonstrating, in general, low MICs values for the tested antimicrobials, although one strain tested was shown to possess the LpeAB resistance determinant, indicating that future surveillance studies are warranted.
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Affiliation(s)
- Clementina Elvezia Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.M.); (F.P.); (C.G.); (M.E.A.V.); (E.C.); (S.F.); (R.M.)
- MicroMiB Biorepository, University of Milano-Bicocca, Associated Member of the JRU MIRRI-IT, Via Cadore, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-335-627-2830
| | - Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.M.); (F.P.); (C.G.); (M.E.A.V.); (E.C.); (S.F.); (R.M.)
- MicroMiB Biorepository, University of Milano-Bicocca, Associated Member of the JRU MIRRI-IT, Via Cadore, 20900 Monza, Italy
| | - Federica Perdoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.M.); (F.P.); (C.G.); (M.E.A.V.); (E.C.); (S.F.); (R.M.)
- MicroMiB Biorepository, University of Milano-Bicocca, Associated Member of the JRU MIRRI-IT, Via Cadore, 20900 Monza, Italy
| | - Chiara Giubbi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.M.); (F.P.); (C.G.); (M.E.A.V.); (E.C.); (S.F.); (R.M.)
| | - Maria Erica Alessandra Vinetti
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.M.); (F.P.); (C.G.); (M.E.A.V.); (E.C.); (S.F.); (R.M.)
| | - Enrico Calaresu
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.M.); (F.P.); (C.G.); (M.E.A.V.); (E.C.); (S.F.); (R.M.)
| | - Sergio Frugoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.M.); (F.P.); (C.G.); (M.E.A.V.); (E.C.); (S.F.); (R.M.)
| | - Maria Scaturro
- National Reference Laboratory for Legionella, Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Roma, Italy; (M.S.); (M.L.R.)
| | - Maria Luisa Ricci
- National Reference Laboratory for Legionella, Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Roma, Italy; (M.S.); (M.L.R.)
| | - Rosario Musumeci
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.M.); (F.P.); (C.G.); (M.E.A.V.); (E.C.); (S.F.); (R.M.)
- MicroMiB Biorepository, University of Milano-Bicocca, Associated Member of the JRU MIRRI-IT, Via Cadore, 20900 Monza, Italy
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14
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Portal E, Descours G, Ginevra C, Mentasti M, Afshar B, Chand M, Day J, Echahidi F, Franzin L, Gaia V, Lück C, Meghraoui A, Moran-Gilad J, Ricci ML, Lina G, Uldum S, Winchell J, Howe R, Bernard K, Spiller OB, Chalker VJ, Jarraud S. Legionella antibiotic susceptibility testing: is it time for international standardization and evidence-based guidance? J Antimicrob Chemother 2021; 76:1113-1116. [PMID: 33608737 DOI: 10.1093/jac/dkab027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Legionella pneumophila, a Gram-negative bacillus, is the causative agent of Legionnaire's disease, a form of severe community-acquired pneumonia. Infection can have high morbidity, with a high proportion of patients requiring ICU admission, and up to 10% mortality, which is exacerbated by the lack of efficacy of typical empirical antibiotic therapy against Legionella spp. The fastidious nature of the entire Legionellaceae family historically required inclusion of activated charcoal in the solid medium to remove growth inhibitors, which inherently interferes with accurate antimicrobial susceptibility determination, an acknowledged methodological shortfall, now rectified by a new solid medium that gives results comparable to those of microbroth dilution. Here, as an international Legionella community (with authors representing various international reference laboratories, countries and clinical stakeholders for diagnosis and treatment of legionellosis), we set out recommendations for the standardization of antimicrobial susceptibility testing methods, guidelines and reference strains to facilitate an improved era of antibiotic resistance determination.
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Affiliation(s)
- Edward Portal
- Medical Microbiology, Department of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.,Bacteriology Reference Department, Public Health England, London, UK
| | - Ghislaine Descours
- Centre National de Reference des Legionelles, Hospices Civils de Lyon, University de Lyon, Lyon, France
| | - Christophe Ginevra
- Centre National de Reference des Legionelles, Hospices Civils de Lyon, University de Lyon, Lyon, France
| | | | - Baharak Afshar
- Bacteriology Reference Department, Public Health England, London, UK
| | - Meera Chand
- Bacteriology Reference Department, Public Health England, London, UK
| | - Jessica Day
- Bacteriology Reference Department, Public Health England, London, UK
| | - Fedoua Echahidi
- Department of Microbiology and Infection Control, National Reference Centre for Legionella pneumophila, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Valeria Gaia
- Department of Laboratory Medicine, Reference Centre for Legionella, Bellinzona, Switzerland
| | - Christian Lück
- German Consiliary Laboratory for Legionella, Institute of Medical Microbiology and Hygiene, Dresden University of Technology, Dresden, Germany
| | - Alaeddine Meghraoui
- Department of Microbiology, National Reference Centre for Legionella pneumophila, Laboratoire Hospitalier Universitaire de Bruxelles-University Laboratory of Brussels (LHUB-ULB), Belgium
| | - Jacob Moran-Gilad
- Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Gerard Lina
- Centre National de Reference des Legionelles, Hospices Civils de Lyon, University de Lyon, Lyon, France
| | - Søren Uldum
- Statens Serum Institute, Copenhagen, Denmark
| | - Jonas Winchell
- National Center for Immunization and Respiratory Diseases, Centres for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kathryn Bernard
- Special Bacteriology Unit, National Microbiology Laboratory-PHAC, Winnipeg, Canada
| | - Owen B Spiller
- Medical Microbiology, Department of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Victoria J Chalker
- Bacteriology Reference Department, Public Health England, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Respiratory Infections at Imperial College London in partnership with Public Health England (PHE), London, UK
| | - Sophie Jarraud
- Centre National de Reference des Legionelles, Hospices Civils de Lyon, University de Lyon, Lyon, France
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15
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Pouderoux C, Ginevra C, Descours G, Ranc AG, Beraud L, Boisset S, Magand N, Conrad A, Bergeron-Lafaurie A, Jarraud S, Ader F. Slowly or Nonresolving Legionnaires' Disease: Case Series and Literature Review. Clin Infect Dis 2021; 70:1933-1940. [PMID: 31242293 DOI: 10.1093/cid/ciz538] [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: 02/23/2019] [Accepted: 06/21/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rarely, Legionnaires' disease (LD) can progress into a slowly or nonresolving form. METHODS A nationwide retrospective study was conducted by the French National Reference Center for Legionella (2013-2017) including cases of slowly or nonresolving LD defined as persistent clinical symptoms, computed tomography (CT) scan abnormalities, and Legionella detection in lower respiratory tract specimens by culture and/or real-time (RT) polymerase chain reaction (PCR) >30 days after symptom onset. RESULTS Twelve cases of community-acquired slowly or nonresolving LD were identified among 1686 cases of culture-positive LD. Median (interquartile range [IQR]) age was 63 (29-82) years. Ten (83.3%) patients had ≥1 immunosuppressive factor. Clinically, 9 patients transiently recovered before further deterioration (median [IQR] symptom-free interval, 30 [18-55] days), 3 patients had uniformly persistent symptoms (median [IQR] time, 48 [41.5-54] days). Two patients had >2 recurrences. CT scan imagery found lung abscess in 5 (41.6%) cases. Slowly or nonresolving LD was diagnosed on positive Legionella cultures (n = 10, 83.3%) at 49.5 (IQR, 33.7-79) days. Two cases were documented through positive Legionella RT PCR at 52 and 53 days (cycle threshold detection of 21.5 and 33.7, respectively). No genomic microevolution and no Legionella resistance to antibiotics were detected. The median (IQR) duration of treatment was 46.5 (21-92.5) days. Two empyema cases required thoracic surgery. At a median (IQR) follow-up of 26 (14-41.5) months, LD-attributable mortality was 16.6% (n = 2). CONCLUSIONS Slowly or nonresolving LD may occur in immunocompromised patients, possibly leading to lung abscess and empyema.
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Affiliation(s)
- Cécile Pouderoux
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Paris, France.,Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France
| | - Christophe Ginevra
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | - Ghislaine Descours
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | - Anne-Gaëlle Ranc
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | - Laetitia Beraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France
| | - Sandrine Boisset
- Centre Hospitalier Universitaire de Grenoble, Institut de Biologie et de Pathologie, Paris, France
| | - Nicolas Magand
- Service de Radiologie, Hospices Civils de Lyon, Paris, France
| | - Anne Conrad
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Paris, France.,Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | | | - Sophie Jarraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | - Florence Ader
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Paris, France.,Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
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16
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Abstract
The major pathogens that cause atypical pneumonia are Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. Community-acquired pneumonia (CAP) caused by M. pneumoniae or C. pneumoniae is common in children and presents as a relatively mild and self-limiting disease. CAP due to L. pneumophila is very rare in children and progresses rapidly, with fatal outcomes if not treated early. M. pneumoniae, C. pneumoniae, and L. pneumophila have no cell walls; therefore, they do not respond to β-lactam antibiotics. Accordingly, macrolides, tetracyclines, and fluoroquinolones are the treatments of choice for atypical pneumonia. Macrolides are the first-line antibiotics used in children because of their low minimum inhibitory concentrations and high safety. The incidence of pneumonia caused by macrolide-resistant M. pneumoniae that harbors point mutations has been increasing since 2000, particularly in Korea, Japan, and China. The marked increase in macrolide-resistant M. pneumoniae pneumonia (MRMP) is partly attributed to the excessive use of macrolides. MRMP does not always lead to clinical nonresponsiveness to macrolides. Furthermore, severe complicated MRMP responds to corticosteroids without requiring a change in antibiotic. This implies that the hyper-inflammatory status of the host can induce clinically refractory pneumonia regardless of mutation. Empirical macrolide therapy in children with mild to moderate CAP, particularly during periods without M. pneumoniae epidemics, may not provide additional benefits over β-lactam monotherapy and can increase the risk of MRMP.
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Affiliation(s)
- Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University of Medicine, Seoul, Korea
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17
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Antibiotic Resistance of Legionella pneumophila in Clinical and Water Isolates-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165809. [PMID: 32796666 PMCID: PMC7459901 DOI: 10.3390/ijerph17165809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
The current systematic review investigates the antibiotic susceptibility pattern of Legionella pneumophila isolates from the 1980s to the present day, deriving data from clinical and/or water samples from studies carried out all over the world. Eighty-nine papers meeting the inclusion criteria, i.e., “Legionella pneumophila” and “resistance to antibiotics”, were evaluated according to pre-defined validity criteria. Sixty articles referred to clinical isolates, and 18 articles reported water-related L. pneumophila isolates, while 11 articles included both clinical and water isolates. Several methods have been proposed as suitable for the determination of MICs, such as the E-test, broth and agar dilution, and disk diffusion methods, in vivo and in vitro, using various media. The E-test method proposed by the European Society of Clinical Microbiology and Infectious Diseases (EUCAST) seems to be the second most frequently used method overall, but it is the preferred method in the most recent publications (2000–2019) for the interpretation criteria. Erythromycin has been proved to be the preference for resistance testing over the years. However, in the last 19 years, the antibiotics ciprofloxacin (CIP), erythromycin (ERM), levofloxacin (LEV) and azithromycin (AZM) were the ones that saw an increase in their use. A decrease in the sensitivity to antibiotics was identified in approximately half of the reviewed articles.
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18
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Mondino S, Schmidt S, Rolando M, Escoll P, Gomez-Valero L, Buchrieser C. Legionnaires’ Disease: State of the Art Knowledge of Pathogenesis Mechanisms of Legionella. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2020; 15:439-466. [DOI: 10.1146/annurev-pathmechdis-012419-032742] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Legionella species are environmental gram-negative bacteria able to cause a severe form of pneumonia in humans known as Legionnaires’ disease. Since the identification of Legionella pneumophila in 1977, four decades of research on Legionella biology and Legionnaires’ disease have brought important insights into the biology of the bacteria and the molecular mechanisms that these intracellular pathogens use to cause disease in humans. Nowadays, Legionella species constitute a remarkable model of bacterial adaptation, with a genus genome shaped by their close coevolution with amoebae and an ability to exploit many hosts and signaling pathways through the secretion of a myriad of effector proteins, many of which have a eukaryotic origin. This review aims to discuss current knowledge of Legionella infection mechanisms and future research directions to be taken that might answer the many remaining open questions. This research will without a doubt be a terrific scientific journey worth taking.
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Affiliation(s)
- Sonia Mondino
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
| | - Silke Schmidt
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
- Sorbonne Université, Collège doctoral, 75005 Paris, France
| | - Monica Rolando
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
| | - Pedro Escoll
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
| | - Laura Gomez-Valero
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
| | - Carmen Buchrieser
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
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19
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Actualités sur les infections à Legionella. Rev Med Interne 2019; 40:791-798. [DOI: 10.1016/j.revmed.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/25/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022]
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20
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Abstract
PURPOSE OF REVIEW The present review summarizes new knowledge about Legionella epidemiology, clinical characteristics, community-associated and hospital-based outbreaks, molecular typing and molecular epidemiology, prevention, and detection in environmental and clinical specimens. RECENT FINDINGS The incidence of Legionnaire's disease is rising and the mortality rate remains high, particularly for immunocompromised patients. Extracorporeal membrane oxygenation may help support patients with severe respiratory failure. Fluoroquinolones and macrolides appear to be equally efficacious for treating Legionnaires' disease. Whole genome sequencing is an important tool for determining the source for Legionella infections and for understanding routes of transmission and mechanisms by which new pathogenic clones emerge. Real-time quantitative polymerase chain reaction testing of respiratory specimens may improve our ability to diagnose Legionnaire's disease. The frequency of viable but nonculturable organisms is quite high in some water systems but their role in causing clinical disease has not been defined. SUMMARY Legionellosis remains an important public health threat. To prevent these infections, staff of municipalities and large buildings must implement effective water system management programs that reduce Legionella growth and transmission and all Medicare-certified healthcare facilities must have water management policies. In addition, we need better methods for detecting Legionella in water systems and in clinical specimens to improve prevention strategies and clinical diagnosis.
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Sreenath K, Chaudhry R, Vinayaraj EV, Thakur B. Antibiotic susceptibility of environmental Legionella pneumophila isolated in India. Future Microbiol 2019; 14:661-669. [PMID: 31148475 DOI: 10.2217/fmb-2019-0049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Data are limited regarding the antibiotic susceptibility of Legionella pneumophila in India. The aim of this study was to determine the drug susceptibility of environmental L. pneumophila isolates in India for antibiotics commonly used in clinical practice for Legionnaires' disease treatment. Materials & methods: The activities of seven antibiotics against 46 environmental isolates of L. pneumophila were evaluated by using E-test on buffered charcoal yeast extract-α agar. Results: Among the L. pneumophila isolates tested, no tendency toward drug resistance was observed. Rifampicin was the most potent drug followed by levofloxacin, while doxycycline and tetracycline were found to be the less active agents. Conclusion: Susceptibility testing of Legionella environmental isolates could be beneficial to notify resistance to antibiotics in the environment before it becomes evident in clinical strains.
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Affiliation(s)
- K Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - E V Vinayaraj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Thakur
- Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
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22
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Sohrabi SM, Mohammadi M, Tabatabaiepour SN, Tabatabaiepour SZ, Hosseini-Nave H, Soltani MF, Alizadeh H, Hadizadeh M. A SystematicIn SilicoAnalysis of theLegionellaceaeFamily for Identification of Novel Drug Target Candidates. Microb Drug Resist 2019; 25:157-166. [DOI: 10.1089/mdr.2017.0328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mohsen Mohammadi
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | | | - Hossein Hosseini-Nave
- Department of Microbiology and Virology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Fazel Soltani
- Molecular Genetics and Genetic Engineering, Department of Crop Production and Plant Breeding, School of Agriculture, Razi University, Kermanshah, Iran
| | - Hosniyeh Alizadeh
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Morteza Hadizadeh
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Natås OB, Brekken AL, Bernhoff E, Hetland MAK, Löhr IH, Lindemann PC. Susceptibility of Legionella pneumophila to antimicrobial agents and the presence of the efflux pump LpeAB. J Antimicrob Chemother 2019; 74:1545-1550. [DOI: 10.1093/jac/dkz081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Olav Bjarte Natås
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Anita Løvås Brekken
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Eva Bernhoff
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Iren Høyland Löhr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Paul Christoffer Lindemann
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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24
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Koshkolda T, Lück C. Antibiotic susceptibility of clinical Legionella pneumophila serogroup 1 strains isolated in Germany. J Antimicrob Chemother 2019; 73:541-542. [PMID: 29136147 DOI: 10.1093/jac/dkx386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Christian Lück
- Institute for Medical Microbiology and Hygiene, TU Dresden, Germany
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25
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Torre I, Alfano R, Borriello T, De Giglio O, Iervolino C, Montagna MT, Scamardo MS, Pennino F. Environmental surveillance and in vitro activity of antimicrobial agents against Legionella pneumophila isolated from hospital water systems in Campania, South Italy: a 5-year study. ENVIRONMENTAL RESEARCH 2018; 164:574-579. [PMID: 29625340 DOI: 10.1016/j.envres.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/26/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Legionellosis' treatment failures have been recently reported showing the possibility of resistance development to traditional therapy, especially in healthcare related disease cases. Environmental impact of antibiotic residues, especially in hospital waters, may act on the resistome of Legionella resulting in developing resistance mechanisms. OBJECTIVES In this study we investigate the antibiotic susceptibility of environmental Legionella pneumophila (Lpn) strains isolated from hospital water systems in Campania, a region located in Southwest Italy. METHODS 5321 hospital water samples were investigated for the presence of Lpn. Among positive samples, antibiotic susceptibility was tested for a random subset of 125 Lpn strains (25 Lpn isolates from each of the following serogroups: 1, 3, 5, 6, 8). Susceptibility testing was performed, using the E-test on buffered charcoal yeast extract agar supplemented with α-ketoglutarate, for 10 antimicrobial drugs: azithromycin, cefotaxime, clarithromycin, doxycycline, erythromycin, rifampicin, tigecycline, ciprofloxacin, levofloxacin and moxifloxacin. Non parametric tests were used to determine and assess the significant differences in susceptibility to the different antimicrobics between the serogroups. RESULTS Among the isolated strains, none showed resistance to the antibiotics tested. Rifampicin was the most active antibiotic against overall Legionella strains, followed by levofloxacin. Between the macrolides the clarithromycin was overall the most active drug, instead the azithromycin was the less active. Analyzing the different serogroups a significant difference was found between serogroup 1 and non-1 serogroup isolates for doxycycline and tigecycline. CONCLUSIONS Antibiotic susceptibility of environmental isolates of Legionella spp. might be useful for the early detection of resistance to antibiotics that directly impacts on mortality and length of hospital stay.
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Affiliation(s)
- Ida Torre
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
| | - Rossella Alfano
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Tonia Borriello
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Italy
| | - Carmela Iervolino
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Italy
| | - Marina Silvia Scamardo
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Francesca Pennino
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
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KKL-35 Exhibits Potent Antibiotic Activity against Legionella Species Independently of trans-Translation Inhibition. Antimicrob Agents Chemother 2018; 62:AAC.01459-17. [PMID: 29158279 PMCID: PMC5786812 DOI: 10.1128/aac.01459-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/04/2017] [Indexed: 11/20/2022] Open
Abstract
trans-Translation is a ribosome-rescue system that is ubiquitous in bacteria. Small molecules defining a new family of oxadiazole compounds that inhibit trans-translation have been found to have broad-spectrum antibiotic activity. We sought to determine the activity of KKL-35, a potent member of the oxadiazole family, against the human pathogen Legionella pneumophila and other related species that can also cause Legionnaires' disease (LD). Consistent with the essential nature of trans-translation in L. pneumophila, KKL-35 inhibited the growth of all tested strains at submicromolar concentrations. KKL-35 was also active against other LD-causing Legionella species. KKL-35 remained equally active against L. pneumophila mutants that have evolved resistance to macrolides. KKL-35 inhibited the multiplication of L. pneumophila in human macrophages at several stages of infection. No resistant mutants could be obtained, even during extended and chronic exposure. Surprisingly, KKL-35 was not synergistic with other ribosome-targeting antibiotics and did not induce the filamentation phenotype observed in cells defective for trans-translation. Importantly, KKL-35 remained active against L. pneumophila mutants expressing an alternate ribosome-rescue system and lacking transfer-messenger RNA, the essential component of trans-translation. These results indicate that the antibiotic activity of KKL-35 is not related to the specific inhibition of trans-translation and its mode of action remains to be identified. In conclusion, KKL-35 is an effective antibacterial agent against the intracellular pathogen L. pneumophila with no detectable resistance development. However, further studies are needed to better understand its mechanism of action and to assess further the potential of oxadiazoles in treatment.
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27
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Cecchini J, Tuffet S, Sonneville R, Fartoukh M, Mayaux J, Roux D, Kouatchet A, Boissier F, Tchir M, Thyrault M, Maury E, Jochmans S, Mekontso Dessap A, Brun-Buisson C, de Prost N. Antimicrobial strategy for severe community-acquired legionnaires' disease: a multicentre retrospective observational study. J Antimicrob Chemother 2018; 72:1502-1509. [PMID: 28204479 DOI: 10.1093/jac/dkx007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/03/2017] [Indexed: 11/15/2022] Open
Abstract
Background Legionnaires' disease (LD) is an important cause of community-acquired pneumonia with high mortality rates in the most severe cases. Objectives To evaluate the effect of antimicrobial strategy on ICU mortality. Methods Retrospective, observational study including patients admitted to 10 ICUs for severe community-acquired LD over a 10 year period (2005-15) and receiving an active therapy within 48 h of admission . Patients were stratified according to the antibiotic strategy administered: (i) fluoroquinolone-based versus non-fluoroquinolone-based therapy; and (ii) monotherapy versus combination therapy. The primary endpoint was in-ICU mortality. A multivariable Cox model and propensity score analyses were used. Results Two hundred and eleven patients with severe LD were included. A fluoroquinolone-based and a combination therapy were administered to 159 (75%) and 123 (58%) patients, respectively. One hundred and forty-six patients (69%) developed acute respiratory distress syndrome and 54 (26%) died in the ICU. In-ICU mortality was lower in the fluoroquinolone-based than in the non-fluoroquinolone-based group (21% versus 39%, P = 0.01), and in the combination therapy than in the monotherapy group (20% versus 34%, P = 0.02). In multivariable analysis, a fluoroquinolone-based therapy, but not a combination therapy, was associated with a reduced risk of mortality [HR = 0.41, 95% CI 0.19-0.89; P = 0.02]. Conclusions Patients with severe LD receiving a fluoroquinolone-based antimicrobial regimen in the early course of management had a lower in-ICU mortality, which persisted after adjusting for significant covariates.
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Affiliation(s)
- Jérôme Cecchini
- AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.,Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France
| | - Samuel Tuffet
- AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France
| | - Romain Sonneville
- AP-HP, Hôpital Bichat, Service de Réanimation Médicale et Infectieuse, Paris, France
| | - Muriel Fartoukh
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.,AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France.,Sorbonne Université, UPMC Université Paris 06, Paris, France
| | - Julien Mayaux
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France
| | - Damien Roux
- AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France
| | - Achille Kouatchet
- Hôpital Angers, Service de Réanimation Médicale et Médecine Hyperbare, Angers, France
| | - Florence Boissier
- AP-HP, Hôpital Européen Georges Pompidou, Service de Réanimation Médicale, Paris, France
| | - Martial Tchir
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.,Centre Hospitalier Intercommunal de Villeneuve Saint-Georges, Service de Réanimation Polyvalente, Villeneuve Saint-Georges, France
| | - Martial Thyrault
- Centre Hospitalier de Longjumeau, Service de Réanimation Médicale et Chirurgicale, Longjumeau, France
| | - Eric Maury
- AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | - Sebastien Jochmans
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.,Hôpital Marc Jacquet, Service de Médecine Intensive, Melun, France
| | - Armand Mekontso Dessap
- AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.,Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France
| | - Christian Brun-Buisson
- AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.,Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France
| | - Nicolas de Prost
- AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.,Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France
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28
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Massip C, Descours G, Ginevra C, Doublet P, Jarraud S, Gilbert C. Macrolide resistance in Legionella pneumophila: the role of LpeAB efflux pump. J Antimicrob Chemother 2018; 72:1327-1333. [PMID: 28137939 DOI: 10.1093/jac/dkw594] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/23/2016] [Indexed: 12/16/2022] Open
Abstract
Objectives A previous study on 12 in vitro -selected azithromycin-resistant Legionella pneumophila lineages showed that ribosomal mutations were major macrolide resistance determinants. In addition to these mechanisms that have been well described in many species, mutations upstream of lpeAB operon, homologous to acrAB in Escherichia coli , were identified in two lineages. In this study, we investigated the role of LpeAB and of these mutations in macrolide resistance of L. pneumophila . Methods The role of LpeAB was studied by testing the antibiotic susceptibility of WT, deleted and complemented L. pneumophila Paris strains. Translational fusion experiments using GFP as a reporter were conducted to investigate the consequences of the mutations observed in the upstream sequence of lpeAB operon. Results We demonstrated the involvement of LpeAB in an efflux pump responsible for a macrolide-specific reduced susceptibility of L. pneumophila Paris strain. Mutations in the upstream sequence of lpeAB operon were associated with an increased protein expression. Increased expression was also observed under sub-inhibitory macrolide concentrations in strains with both mutated and WT promoting regions. Conclusions LpeAB are components of an efflux pump, which is a macrolide resistance determinant in L. pneumophila Paris strain. Mutations observed in the upstream sequence of lpeAB operon in resistant lineages led to an overexpression of this efflux pump. Sub-inhibitory concentrations of macrolides themselves participated in upregulating this efflux and could constitute a first step in the acquisition of a high macrolide resistance level.
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Affiliation(s)
- Clémence Massip
- CIRI, Centre International de Recherche en Infectiologie, "Legionella pathogenesis" team, Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon F-69007, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, National Reference Centre of Legionella, Institute for Infectious Agents, 103 Grande rue de la Croix rousse, Lyon 69004, France
| | - Ghislaine Descours
- CIRI, Centre International de Recherche en Infectiologie, "Legionella pathogenesis" team, Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon F-69007, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, National Reference Centre of Legionella, Institute for Infectious Agents, 103 Grande rue de la Croix rousse, Lyon 69004, France
| | - Christophe Ginevra
- CIRI, Centre International de Recherche en Infectiologie, "Legionella pathogenesis" team, Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon F-69007, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, National Reference Centre of Legionella, Institute for Infectious Agents, 103 Grande rue de la Croix rousse, Lyon 69004, France
| | - Patricia Doublet
- CIRI, Centre International de Recherche en Infectiologie, "Legionella pathogenesis" team, Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon F-69007, France
| | - Sophie Jarraud
- CIRI, Centre International de Recherche en Infectiologie, "Legionella pathogenesis" team, Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon F-69007, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, National Reference Centre of Legionella, Institute for Infectious Agents, 103 Grande rue de la Croix rousse, Lyon 69004, France
| | - Christophe Gilbert
- CIRI, Centre International de Recherche en Infectiologie, "Legionella pathogenesis" team, Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon F-69007, France
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29
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Minimum inhibitory concentration (MIC) distribution among wild-type strains of Legionella pneumophila identifies a subpopulation with reduced susceptibility to macrolides owing to efflux pump genes. Int J Antimicrob Agents 2017; 50:684-689. [DOI: 10.1016/j.ijantimicag.2017.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/22/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022]
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30
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Digital PCR for Detection and Quantification of Fluoroquinolone Resistance in Legionella pneumophila. Antimicrob Agents Chemother 2017; 61:AAC.00628-17. [PMID: 28674045 DOI: 10.1128/aac.00628-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/19/2017] [Indexed: 11/20/2022] Open
Abstract
The emergence of fluoroquinolone (FQ)-resistant mutants of Legionella pneumophila in infected humans was previously reported using a next-generation DNA sequencing (NGS) approach. This finding could explain part of the therapeutic failures observed in legionellosis patients treated with these antibiotics. The aim of this study was to develop digital PCR (dPCR) assays allowing rapid and accurate detection and quantification of these resistant mutants in respiratory samples, especially when the proportion of mutants in a wild-type background is low. We designed three dPCRgyrA assays to detect and differentiate the wild-type and one of the three gyrA mutations previously described as associated with FQ resistance in L. pneumophila: at positions 248C→T (T83I), 259G→A (D87N), and 259G→C (D87H). To assess the performance of these assays, mixtures of FQ-resistant and -susceptible strains of L. pneumophila were analyzed, and the results were compared with those obtained with Sanger DNA sequencing and real-time quantitative PCR (qPCR) technologies. The dPCRgyrA assays were able to detect mutated gyrA sequences in the presence of wild-type sequences at up to 1:1,000 resistant/susceptible allele ratios. By comparison, Sanger DNA sequencing and qPCR were less sensitive, allowing the detection of gyrA mutants at up to 1:1 and 1:10 ratios, respectively. When testing 38 respiratory samples from 23 legionellosis patients (69.6% treated with an FQ), dPCRgyrA detected small amounts of gyrA mutants in four (10.5%) samples from three (13.0%) patients. These results demonstrate that dPCR is a highly sensitive alternative to quantify FQ resistance in L. pneumophila, and it could be used in clinical practice to detect patients that could be at higher risk of therapeutic failure.
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Sutera V, Hoarau G, Renesto P, Caspar Y, Maurin M. In vitro and in vivo evaluation of fluoroquinolone resistance associated with DNA gyrase mutations in Francisella tularensis, including in tularaemia patients with treatment failure. Int J Antimicrob Agents 2017; 50:377-383. [PMID: 28689870 DOI: 10.1016/j.ijantimicag.2017.03.022] [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: 11/16/2016] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 01/23/2023]
Abstract
Fluoroquinolones (FQs) are highly effective for treating tularaemia, a zoonosis caused by Francisella tularensis, but failures and relapses remain common in patients with treatment delay or immunocompromised status. FQ-resistant strains of F. tularensis harboring mutations in the quinolone-resistance determining region (QRDR) of gyrA and gyrB, the genes encoding subunits A and B of DNA gyrase, have been selected in vitro. Such mutants have never been isolated from humans as this microorganism is difficult to culture. In this study, the presence of FQ-resistant mutants of F. tularensis was assessed in tularaemia patients using combined culture- and PCR-based approaches. We analyzed 42 F. tularensis strains and 82 tissue samples collected from 104 tularaemia cases, including 32 (30.7%) with FQ treatment failure or relapse. Forty F. tularensis strains and 55 clinical samples were obtained before any FQ treatment, while 2 strains and 15 tissue samples were collected after treatment. FQ resistance was evaluated by the minimum inhibitory concentration (MIC) for the bacterial strains, and by newly developed PCR-based methods targeting the gyrA and gyrB QRDRs for both the bacterial strains and the clinical samples. None of the F. tularensis strains displayed an increased MIC compared with FQ-susceptible controls. Neither gyrA nor gyrB QRDR mutation was found in bacterial strains and tissue samples tested, including those from patients with FQ treatment failure or relapse. Further phenotypic and genetic resistance traits should be explored to explain the poor clinical response to FQ treatment in such tularaemia patients.
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Affiliation(s)
- V Sutera
- Centre National de Référence des Francisella, Laboratoire de Bactériologie-Hygiène Hospitalière, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France; Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications (TIMC-IMAG), Université Grenoble Alpes, CS 10170, 38042 Grenoble cedex 9, France; Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, 38042 Grenoble cedex 9, France
| | - G Hoarau
- Centre National de Référence des Francisella, Laboratoire de Bactériologie-Hygiène Hospitalière, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France; Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications (TIMC-IMAG), Université Grenoble Alpes, CS 10170, 38042 Grenoble cedex 9, France; Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, 38042 Grenoble cedex 9, France
| | - P Renesto
- Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications (TIMC-IMAG), Université Grenoble Alpes, CS 10170, 38042 Grenoble cedex 9, France; Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, 38042 Grenoble cedex 9, France
| | - Y Caspar
- Centre National de Référence des Francisella, Laboratoire de Bactériologie-Hygiène Hospitalière, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France; Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications (TIMC-IMAG), Université Grenoble Alpes, CS 10170, 38042 Grenoble cedex 9, France; Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, 38042 Grenoble cedex 9, France
| | - M Maurin
- Centre National de Référence des Francisella, Laboratoire de Bactériologie-Hygiène Hospitalière, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France; Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications (TIMC-IMAG), Université Grenoble Alpes, CS 10170, 38042 Grenoble cedex 9, France; Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, 38042 Grenoble cedex 9, France.
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32
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Ribosomal Mutations Conferring Macrolide Resistance in Legionella pneumophila. Antimicrob Agents Chemother 2017; 61:AAC.02188-16. [PMID: 28069647 DOI: 10.1128/aac.02188-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/04/2017] [Indexed: 01/15/2023] Open
Abstract
Monitoring the emergence of antibiotic resistance is a recent issue in the treatment of Legionnaires' disease. Macrolides are recommended as first-line therapy, but resistance mechanisms have not been studied in Legionella species. Our aim was to determine the molecular basis of macrolide resistance in L. pneumophila Twelve independent lineages from a common susceptible L. pneumophila ancestral strain were propagated under conditions of erythromycin or azithromycin pressure to produce high-level macrolide resistance. Whole-genome sequencing was performed on 12 selected clones, and we investigated mutations common to all lineages. We reconstructed the dynamics of mutation for each lineage and demonstrated their involvement in decreased susceptibility to macrolides. The resistant mutants were produced in a limited number of passages to obtain a 4,096-fold increase in erythromycin MICs. Mutations affected highly conserved 5-amino-acid regions of L4 and L22 ribosomal proteins and of domain V of 23S rRNA (G2057, A2058, A2059, and C2611 nucleotides). The early mechanisms mainly affected L4 and L22 proteins and induced a 32-fold increase in the MICs of the selector drug. Additional mutations related to 23S rRNA mostly occurred later and were responsible for a major increase of macrolide MICs, depending on the mutated nucleotide, the substitution, and the number of mutated genes among the three rrl copies. The major mechanisms of the decreased susceptibility to macrolides in L. pneumophila and their dynamics were determined. The results showed that macrolide resistance could be easily selected in L. pneumophila and warrant further investigations in both clinical and environmental settings.
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Sharma L, Losier A, Tolbert T, Dela Cruz CS, Marion CR. Atypical Pneumonia: Updates on Legionella, Chlamydophila, and Mycoplasma Pneumonia. Clin Chest Med 2016; 38:45-58. [PMID: 28159161 DOI: 10.1016/j.ccm.2016.11.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Community-acquired pneumonia (CAP) has multiple causes and is associated with illness that requires admission to the hospital and mortality. The causes of atypical CAP include Legionella species, Chlamydophila, and Mycoplasma. Atypical CAP remains a diagnostic challenge and, therefore, likely is undertreated. This article reviews the advancements in the evaluation and treatment of patients and discusses current conflicts and controversies of atypical CAP.
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Affiliation(s)
- Lokesh Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S440, New Haven, CT 06510, USA
| | - Ashley Losier
- Department of Internal Medicine, Norwalk Hospital, 34 Maple Street, Norwalk, CT 06856, USA
| | - Thomas Tolbert
- Department of Internal Medicine, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA
| | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S440, New Haven, CT 06510, USA
| | - Chad R Marion
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S440, New Haven, CT 06510, USA.
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Gavand PE, Janssen R, Martin A, Ledoux MP, Schneider F. Infection pulmonaire persistante à Legionella pneumophila et Enterococcus faecium : cherchez un abcès ! Presse Med 2016; 45:477-9. [DOI: 10.1016/j.lpm.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 11/29/2022] Open
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Bozzaro S. Emergence of Microbial Resistance During Hospitalization. EBioMedicine 2015; 2:1022. [PMID: 26501095 PMCID: PMC4588410 DOI: 10.1016/j.ebiom.2015.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Salvatore Bozzaro
- Department of Clinical and Biological Sciences, University of Turin, AOU S. Luigi, 10043 Orbassano (TO), Italy
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