New antibiotic agents for bloodstream infections

Carbon quantum dots modified Ag2S/CS nanocomposite as effective antibacterial agents

The present study attempted to synthesize carbon quantum dots (CQDs) through Aldol polymerization reaction, wherein acetone was used as the carbon source. A nano composite CQDs/Ag₂S/CS was developed by loading as prepared CQDs and Ag₂S nanoparticles on a chitosan substrate (CS). An in-situation growth of nanocomposites was adopted to study their antibacterial properties. Staphylococcus aureus (Gram-positive), Escherichia coli (Gram-negative) and methicillin-resistant Staphylococcus aureus were selected as the model bacteria. The CQDs/Ag₂S/CS nanocomposites exhibited excellent inhibition not only against common pathogenic bacteria, but also those well-known drug-resistant bacteria. Moreover, compared to traditional antibiotics, the as prepared nanocomposites in the present work do not likely cause bacterial drug resistance, which make them a potential candidate for a new type of clinically applicable antibiotics.

Antibiotic Lock Therapy with Linezolid for the Treatment of Persistent Catheter-Related Infection in Children with Cancer

Objective Central venous catheter (CVC) colonization is a common problem in the pediatric oncology department. Initial colonization of CVC by coagulase-negative staphylococci (CoNS), Staphylococcus aureus, and enterococci is followed by the growth of intraluminal biofilm formation, and results in antibiotic therapy failure. The removal of the old CVC and insertion of new CVC is a difficult and expensive procedure in small children with cancer. The present article aimed to study our treatment results of antibiotic lock therapy (ALT) with linezolid in pediatric cancer patients.

Methods This study was planned as retrospective presentation of case series with eight pediatric cancer patients treated with 11 courses of systemic and linezolid lock therapy. Demographic information, clinical findings, laboratory data, blood culture results, complications, and outcome were collected for each patient retrospectively and descriptive statistical methods were used.

Results Prior to treatment, peripheral and CVC blood culture results showed Staphylococcus epidermidis in seven patients and Staphylococcus hominis in four patients. All pathogens were susceptible to vancomycin and teicoplanin; first-line treatment was vancomycin in six and teicoplanin in five patients. After first-line treatment, peripheral blood cultures of all patients were negative, whereas blood cultures from CVC remained positive. During second-line therapy with linezolid, microbiological eradication was achieved on the fourth day of treatment in each patient. Median catheter survival time for all patients was 14 (range: 8–30) months. No side effects were observed during the treatment and no resistant organisms were documented.

Conclusion Although multicentric prospective controlled trials will be required to provide more generalizable results, we suggest that systemic antibiotics combined with linezolid lock therapy used in pediatric cancer patients may be an effective option in treating catheter-related bloodstream infection (CRBSI) and prolonging CVC survival when CoNS are identified.

Isolation and Structural Elucidation of Brevibacillin, an Antimicrobial Lipopeptide from Brevibacillus laterosporus That Combats Drug-Resistant Gram-Positive Bacteria

A new environmental bacterial strain exhibited strong antimicrobial characteristics against methicillin-resistant Staphylococcus aureus, vancomycin-resistant strains of Enterococcus faecalis and Lactobacillus plantarum, and other Gram-positive bacteria. The producer strain, designated OSY-I1, was determined to be Brevibacillus laterosporusvia morphological, biochemical, and genetic analyses. The antimicrobial agent was extracted from cells of OSY-I1 with isopropanol, purified by high-performance liquid chromatography, and structurally analyzed using mass spectrometry (MS) and nuclear magnetic resonance (NMR). The MS and NMR results, taken together, uncovered a linear lipopeptide consisting of 13 amino acids and an N-terminal C6 fatty acid (FA) chain, 2-hydroxy-3-methylpentanoic acid. The lipopeptide (FA-Dhb-Leu-Orn-Ile-Ile-Val-Lys-Val-Val-Lys-Tyr-Leu-valinol, where Dhb is α,β-didehydrobutyric acid and valinol is 2-amino-3-methyl-1-butanol) has a molecular mass of 1,583.0794 Da and contains three modified amino acid residues: α,β-didehydrobutyric acid, ornithine, and valinol. The compound, designated brevibacillin, was determined to be a member of a cationic lipopeptide antibiotic family. In addition to its potency against drug-resistant bacteria, brevibacillin also exhibited low MICs (1 to 8 μg/ml) against selected foodborne pathogenic and spoilage bacteria, such as Listeria monocytogenes,Bacillus cereus, and Alicyclobacillus acidoterrestris Purified brevibacillin showed no sign of degradation when it was held at 80 °C for 60 min, and it retained at least 50% of its antimicrobial activity when it was held for 22 h under acidic or alkaline conditions. On the basis of these findings, brevibacillin is a potent antimicrobial lipopeptide which is potentially useful to combat drug-resistant bacterial pathogens and foodborne pathogenic and spoilage bacteria.

Phytochemical analysis, antibacterial, and antifungal assessment of aerial parts of Polygonatumverticillatum

The current study was designed to assess the phytochemical profile, antibacterial, and antifungal activities of the crude methanol extract of the aerial parts of Polygonatum verticillatum (PA) and its various subsequent solvent fractions using agar well diffusion, agar tube dilution, and microdilution methods. Phytochemical analysis showed positive for different chemical groups and also contained marked quantity of saponin and flavonoid contents. Significant antibacterial activity was observed against various tested pathogenic bacteria. The only susceptible Gram-positive bacterium was Bacillus subtilis and their minimum inhibitory concentrations (MICs) measured ranged from 11–50 µg/ml. The sensitive Gram-negative bacteria were Salmonella typhi and Shigella flexeneri. The estimated MICs were in the range of 2–7 µg/ml and 8–50 µg/ml for S. typhi and S. flexeneri, respectively. However, the antifungal activity of the plant was limited to Microsporum canis and their MICs ranged from 60 to 250 µg/ml. Our study confirmed significant antibacterial potential of the plant and substantiated its folk use in dysentery and pyrexia of multiple origins.

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists.

Resistant patterns of bacteria isolated from bloodstream infections at a university hospital in Delhi

Background:

The choice of antimicrobial therapy for bloodstream infections is often empirical and based on the knowledge of local antimicrobial activity profiles of the most common bacteria causing such infections.

Aims:

The present study was aimed to investigate frequency of bacterial pathogens causing septicemia and their antimicrobial resistant pattern in hospital admitted patients.

Settings and Design:

It was a prospective study, conducted at Majeedia Hospital, Hamdard University, New Delhi, India.

Material and Methods:

We examined prospectively, 168 bacterial strains isolated from 186 clinically diagnosed septicemia cases admitted at a University Hospital in New Delhi, over a period of six months from July 2009 to December 2009. Antimicrobial susceptibility was performed according to Clinical and Laboratory Standards Institute (CLSI, USA) guidelines.

Results:

The most frequently identified Gram-positive bacteria were coagulase-negative staphylococci 63.5%, Staphylococcus aureus 23.1%, enterococci 5.8% and alpha-haemolytic streptococci 5.8%. The most frequently Gram-negative bacteria identified were Acinetobacter species 31%, Salmonella typhi 24.1%, Escherichia coli 23.3% and Pseudomonas aeruginosa 13.8%. Coagulase-negative staphylococci showed maximum resistance to cefaclor 57.1% and ampicillin 46.9%. Staphylococcus aureus showed maximum resistance to amoxicillin 100% and ampicillin 91.7%. Acinetobacter species showed maximum resistance to amoxicillin 89.7%, amoxiclav 87.1% and ampicillin 85.7%. Salmonella typhi, Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae showed maximum resistance to ampicillin, 46.4%, 92%, 93.8% and 100%, respectively.

Conclusions:

Gram-negative pathogens predominated in bloodstream infections. Resistance to most of the antimicrobial agents for a number of pathogens implicated in bloodstream infections, especially in Gram-negative bacteria, has reached worrisome levels and continues to increase.

Ocular penetration of topically applied 1% daptomycin in a rabbit model

PURPOSE

To evaluate the ocular penetration of daptomycin, a new antibiotic agent targeted against Gram-positive organisms.

METHODS

Thirty-two New Zealand white rabbits were divided into 4 equal groups. One drop of 50 μL 1% daptomycin was administered to group 1. In group 2, 1 drop of 1% daptomycin was administered after the corneal epithelium was scraped. In group 3, 1 drop of 1% daptomycin was administered every 15 min for 1 h (keratitis protocol). In group 4, the keratitis protocol was applied after the corneal epithelium was scraped. In groups 1 and 2, aqueous humor samples were collected 30 min, 1 h, and 2 h after the single drop under general anesthesia. All the animals in groups 3 and 4 were humanely killed. Cornea, aqueous humor, and vitreous samples were collected 1 and 2 h after the last drop. Daptomycin concentrations were measured by high-performance liquid chromatography.

RESULTS

Each group comprised 8 rabbits. Daptomycin was not detected in the aqueous humor in groups 1 and 2. In group 3, the mean values at 1 h in the aqueous humor and cornea, respectively, were 1.90±0.15 μg/mL and 3.93±0.67 μg/g, and at 2 h were 1.71±0.42 μg/mL and 4.13±0.46 μg/g. In group 4, the mean values at 1 h were 5.19±0.50 μg/mL and 7.10±0.35 μg/g, and at 2 h were 4.96±0.47 μg/mL and 7.22±0.34 μg/g. Daptomycin was not detected in vitreous samples in groups 3 and 4.

CONCLUSIONS

Single-drop administration does not yield a detectable daptomycin concentration in aqueous humor in neither nonscraped nor scraped group. In the multiple-drop regimen, daptomycin seems to penetrate well into the aqueous humor and cornea both in nonscraped and scraped groups. However, this concentration may not cover the minimum inhibitory concentration (MIC) of organisms such as Enterococcus fecalis.

Novel polymyxin derivatives are less cytotoxic than polymyxin B to renal proximal tubular cells

The emergence of very multiresistant Gram-negative bacterial strains has reinstated polymyxins (polymyxin B, colistin), pentacationic lipopeptides, in the therapy, in spite of their nephrotoxicity. Extensive tubular reabsorption concentrates polymyxin in proximal tubular cells. The novel polymyxin derivatives NAB739, NAB7061 and NAB741 have their cyclic part identical to that of polymyxin B, but their side chain consists of uncharged octanoyl-threonyl-d-serinyl, octanoyl-threonyl-aminobutyryl, and acetyl-threonyl-D-serinyl respectively. In this study, we compared the toxicities of NAB739, NAB7061 and NAB741 with that of polymyxin B by using the porcine renal proximal tubular cell line LLC-PK1 electroporated or incubated with the selected compound. Both the ability to cause cell necrosis (quantified as the leakage of lactate dehydrogenase) and the ability to cause apoptosis (as quantified by counting apoptotic nuclei) were assessed. In electroporated cells, polymyxin B induced total (>85%) necrosis of the cells at 0.016 mM, whereas an approx. 8-fold concentration of NAB739 and NAB7961 and an approx. 32-fold concentration of NAB741 was required for the same effect. In cells treated without electroporation (incubated), polymyxin B elicited a marked degree (approx. 50%) of necrosis at 0.5mM, whereas the NAB compounds were inert even at 1mM. Neither polymyxin B nor the NAB compounds induced apoptosis.

Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis

BACKGROUND

Multidrug resistance among bacteria increases the need for new antimicrobial drugs with high potency and stability. Tigecycline is one candidate drug, and a previous meta-analysis of only published randomised controlled trials suggested that it might as effective as comparator treatments; we did a meta-analysis to include new and unpublished trials to assess its efficacy for the treatment of adult patients with serious bacterial infection.

METHODS

We searched PubMed, Cochrane Central Register, and Embase up to March 30, 2011, to identify published studies, and we searched clinical trial registries to identify completed unpublished studies, the results of which were obtained through the manufacturer. Eligible studies were randomised trials assessing the clinical efficacy, safety, and eradication efficiency of tigecycline versus other antimicrobial agents for any bacterial infection. The primary outcome was treatment success in patients who received at least one dose of the study drug, had clinical evidence of disease, and had complete follow-up (the clinically assessable population). Meta-analysis was done with random-effects models because of heterogeneity across the trials.

FINDINGS

14 randomised trials, comprising about 7400 patients, were included. Treatment success was lower with tigecycline than with control antibiotic agents, but the difference was not significant (odds ratio 0·87, 95% CI 0·74-1·02). Adverse events were more frequent in the tigecycline group than in the control groups (1·45, 1·11-1·88), with significantly more vomiting and nausea. All-cause mortality was higher in the tigecycline group than in the comparator groups, but the difference was not significant (1·28, 0·97-1·69). Eradication efficiency did not differ between tigecycline and control regimens, but the sample size for these comparisons was small.

INTERPRETATION

Tigecycline is not better than standard antimicrobial agents for the treatment of serious infections. Our findings show that assessment with unpublished studies is needed to make appropriate decisions about new agents.

FUNDING

None.

Prevalence and epidemiology of microbial pathogens causing bloodstream infections: results of the OASIS multicenter study

Beginning on April 2007, a prospective multicenter study was performed to investigate prevalence and epidemiology of microbial pathogens causing bloodstream infections (BSIs). Twenty microbiology laboratories participated to the survey over a 1-year period. A total of 11,638 episodes of BSI occurred in 11 202 patients, with 8.5% (n=985) of episodes being polymicrobial. Of 12 781 causative organisms, aerobic Gram-negative bacteria were 47.4% (n=6058), whereas Gram-positives accounted for 43.9% (n=5608). The remaining organisms included fungal species (n=924, 7.2%) and anaerobes (n=191, 1.5%). The most prevalent agents were Escherichia coli (21.7%), Staphylococcus aureus (14.9%), Staphylococcus epidermidis (8.2%), Pseudomonas aeruginosa (7.0%), and Enterococcus faecalis (6.3%). Isolates recovered from patients admitted to medical, surgical, and intensive care units accounted for 62.9%, 17.7%, and 19.4% of cases, respectively. BSIs were classified as hospital-acquired in 67.2% of cases. Compared with previous studies, our data show an increasing role of Gram-negative bacteria among both hospital- and community-acquired blood isolates.

Confronting multidrug-resistant Acinetobacter baumannii: a review

Multidrug-resistant Acinetobacter baumannii (MDR-AB) infections are difficult to treat owing to the extremely limited armamentarium. The present review reports all available treatment options against MDR-AB, including single molecules, combination schemes, and alternative modes of antimicrobial administration. Additionally, a group of recently reported peptides with anti-MDR-AB activity is described.

S-thanatin enhances the efficacy of tigecycline in an experimental rat model of polymicrobial peritonitis

We investigated the efficacy of the peptide s-thanatin alone and in combination with tigecycline in an animal model of sepsis induced by cecal ligation and puncture. Adult male Wistar rats were randomized to receive intravenously isotonic sodium chloride solution, 5mg/kg s-thanatin, 2mg/kg tigecycline, 5mg/kg s-thanatin combined with 2mg/kg tigecycline. The experiment was also performed with administration of the drugs 360 min after the surgical procedure to better investigate the clinical situation where there is an interval between the onset of sepsis and the initiation of therapy. Lethality, bacterial growth in blood, peritoneum, spleen and liver, and NO indices were evaluated. All compounds reduced the lethality when compared to control. In all experiments, the compounds reduced significantly bacterial growth and lethality compared with saline treatment. Treatment with s-thanatin resulted in significant decrease in plasma NO levels compared to tigecycline and control group. The combination between s-thanatin and tigecycline proved to be the most effective treatment in reducing all variables measured. S-thanatin may have potential therapeutic usefulness alone and when associated to tigecycline in polymicrobial peritonitis.