1
|
Kunishima H, Ichiki K, Ohge H, Sakamoto F, Sato Y, Suzuki H, Nakamura A, Fujimura S, Matsumoto K, Mikamo H, Mizutani T, Morinaga Y, Mori M, Yamagishi Y, Yoshizawa S. Japanese Society for infection prevention and control guide to Clostridioides difficile infection prevention and control. J Infect Chemother 2024; 30:673-715. [PMID: 38714273 DOI: 10.1016/j.jiac.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Hiroyuki Kunishima
- Department of Infectious Diseases. St. Marianna University School of Medicine, Japan.
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo Medical University Hospital, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Fumie Sakamoto
- Quality Improvement and Safety Center, Itabashi Chuo Medical Center, Japan
| | - Yuka Sato
- Department of Infection Control and Nursing, Graduate School of Nursing, Aichi Medical University, Japan
| | - Hiromichi Suzuki
- Department of Infectious Diseases, University of Tsukuba School of Medicine and Health Sciences, Japan
| | - Atsushi Nakamura
- Department of Infection Prevention and Control, Graduate School of Medical Sciences, Nagoya City University, Japan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases and Chemotherapy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | | | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Minako Mori
- Department of Infection Control, Hiroshima University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Japan
| | - Sadako Yoshizawa
- Department of Laboratory Medicine/Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Japan
| |
Collapse
|
2
|
Mori N, Hirai J, Ohashi W, Asai N, Shibata Y, Mikamo H. Derivation of clinical predictive factors (CHIEF) for first recurrent Clostridioides difficile infection. Am J Infect Control 2024; 52:419-423. [PMID: 37832921 DOI: 10.1016/j.ajic.2023.10.004] [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: 07/30/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Current models for predicting Clostridioides difficile infection (CDI) recurrence rates have a limited capacity to account for important risk factors. This study developed a clinical prediction rule for CDI recurrence. METHODS This retrospective cohort study evaluated 209 patients with CDI at a university hospital in Japan. Logistic regression and receiver operating characteristic curve analyses were performed to identify potential predictors (age, sex, underlying diseases, antibiotic use, acid suppressants, immunosuppressants, CDI history) of CDI recurrence. RESULTS Forty-five patients developed recurrent CDI. Univariate analyses identified several significant recurrence predictors (enteral feeding, inflammatory bowel diseases [IBD], community-onset CDI, severe CDI). Enteral feeding (odds ratio: 3.87, 95% confidence interval: 1.75-8.56) and IBD (odds ratio: 7.08, 95% confidence interval: 1.28-39.06) were significant factors in the multivariate analysis. The CHIEF predictive scoring system was developed using 5 relevant variables (carbapenem use, hematologic malignancy, IBD, enteral feeding, fluoroquinolone use); the area under the receiver operating characteristic curve for the CHIEF score was 0.70. DISCUSSION The CHIEF score incorporates useful, clinically available factors and could help identify patients at risk of recurrent CDI. CONCLUSIONS These findings contribute to the understanding of risk factors associated with CDI recurrence and provide support for the development of prevention strategies.
Collapse
Affiliation(s)
- Nobuaki Mori
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan; Department of Infection Prevention and Control, Aichi Medical University Hospital, Aichi, Japan
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan; Department of Infection Prevention and Control, Aichi Medical University Hospital, Aichi, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Aichi, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan; Department of Infection Prevention and Control, Aichi Medical University Hospital, Aichi, Japan
| | - Yuichi Shibata
- Department of Infection Prevention and Control, Aichi Medical University Hospital, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan; Department of Infection Prevention and Control, Aichi Medical University Hospital, Aichi, Japan.
| |
Collapse
|
3
|
Mpakaniye P, Boven A, Callens S, Engstrand L, Vlieghe E, Brusselaers N. Clostridioides difficile recurrence in individuals with and without cancer: a Swedish population-based cohort study. Infection 2024; 52:649-660. [PMID: 38407777 PMCID: PMC10954957 DOI: 10.1007/s15010-024-02193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Patients with cancer are vulnerable to Clostridioides difficile infection (CDI) due to their disease, treatment and regular hospital contact, yet if CDI-recurrence is more common remains unclear, and differences among cancer types remain unexplored. METHODS This Swedish nationwide population-based cohort included all 43,150 individuals with recorded CDI (2006-2019) to assess CDI-recurrence in individuals with and without cancer, with binary multivariable logistic regression, stratified by anatomical location, and survival status. RESULTS Compared to those without cancer (N = 29,543), ongoing cancer (diagnosis < 12 months; N = 3,882) was associated with reduced recurrence (OR = 0.81, 95% CI 0.73-0.89), while there was no association with cancer history (diagnosis ≥ 12 months; N = 9,725). There was an increased 8-week all-cause mortality (Ongoing cancer: OR = 1.58, 95% CI 1.43-1.74; Cancer history: OR = 1.45, 95% CI 1.36-1.55) compared to those without cancer. Among CDI-survivors, those with ongoing cancer presented with a decreased odds of recurrence (OR = 0.84, 95% CI 0.76-0.94), compared to those without cancer history, with no association for those with cancer history (OR = 1.04, 95% CI 0.97-1.1). Large variations were seen across cancer types, with the highest observed proportion of recurrence in oral and mesothelial cancer, and the lowest for esophageal cancer, although no statistically significant OR were found. CONCLUSION The population-based study indicates that individuals with cancer may have fewerrecurrences than expected, yet variations by cancer type were large, and mortality was high.
Collapse
Affiliation(s)
- Peace Mpakaniye
- Centre for Translational Microbiome Research, Department Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Annelies Boven
- Centre for Translational Microbiome Research, Department Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
- The Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Steven Callens
- General Internal Medicine and Infectious Diseases, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Lars Engstrand
- Centre for Translational Microbiome Research, Department Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Erika Vlieghe
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
- Infectious Diseases, Department of General Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| |
Collapse
|
4
|
Avent ML, Hall L, van Driel M, Dobson A, Deckx L, Galal M, Plejdrup Hansen M, Gilks C. Reducing antibiotic prescribing in general practice in Australia: a cluster randomised controlled trial of a multimodal intervention. Aust J Prim Health 2024; 30:NULL. [PMID: 37844575 DOI: 10.1071/py23024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The health and economic burden of antimicrobial resistance (in Australia is significant. Interventions that help guide and improve appropriate prescribing for acute respiratory tract infections in the community represent an opportunity to slow the spread of resistant bacteria. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. METHODS A cluster randomised trial was conducted comparing two parallel groups of 27 urban general practices in Queensland, Australia: 13 intervention and 14 control practices, with 56 and 54 general practitioners (GPs), respectively. This study evaluated an integrated, multifaceted evidence-based package of interventions implemented over a 6-month period. The evaluation included quantitative and qualitative components, and an economic analysis. RESULTS A multimodal package of interventions resulted in a reduction of 3.81 prescriptions per GP per month. This equates to 1280.16 prescriptions for the 56GPs in the intervention practices over the 6-month period. The cost per prescription avoided was A$148. The qualitative feedback showed that the interventions were well received by the GPs and did not impact on consultation time. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. CONCLUSIONS A multimodal package of interventions to enhance rational prescribing of antibiotics is effective, feasible and acceptable in general practice. Investment in antimicrobial stewardship strategies in primary care may ultimately provide the important returns for public health into the future.
Collapse
Affiliation(s)
- Minyon L Avent
- UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia; and Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Herston, Qld, Australia
| | - Lisa Hall
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Mieke van Driel
- General Practice, Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Annette Dobson
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Laura Deckx
- General Practice, Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Mahmoud Galal
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| | | | - Charles Gilks
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| |
Collapse
|
5
|
Dammling C, Gilmartin EM, Abramowicz S, Kinard B. Indications for Antibiotic Prophylaxis for Dentoalveolar Procedures. Dent Clin North Am 2024; 68:99-111. [PMID: 37951640 DOI: 10.1016/j.cden.2023.07.004] [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] [Indexed: 11/14/2023]
Abstract
Antibiotic prophylaxis is the use of antibiotics perioperatively to prevent infections at the surgical site or distant locations. The decision to provide prophylaxis must balance risks of antibiotic resistance, adverse drug reactions, and increased health care costs with the benefit of decreasing infection. This determination has been studied extensively in patients with specific cardiac conditions and prosthetic joints. Prophylactic antibiotics in healthy patients have been shown to reduce the frequency of alveolar osteitis and decrease the failure rates of dental implants.
Collapse
Affiliation(s)
- Chad Dammling
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South- Room 406, Birmingham, AL 35233, USA.
| | - Evan M Gilmartin
- School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham, AL 35233, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1365 Clifton Road, Building B, Suite 2300, Atlanta 30322, Georgia, USA
| | - Brian Kinard
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South- Room 406, Birmingham, AL 35233, USA
| |
Collapse
|
6
|
Patel N, Gorseth A, Belfiore G, Stornelli N, Lowry C, Thomas L. Fluoroquinolone-associated adverse events of interest among hospitalized veterans affairs patients with community-acquired pneumonia who were treated with a fluoroquinolone: A focus on tendonitis, Clostridioides difficile infection, and aortic aneurysm. Pharmacotherapy 2024; 44:49-60. [PMID: 37699580 DOI: 10.1002/phar.2877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 09/14/2023]
Abstract
STUDY OBJECTIVE The objectives of this study were to (i) quantify the incidence of three concerning fluoroquinolone adverse events of interest (FQAEI, i.e., adverse tendon event (TE), clostridioides difficile infection (CDI), and aortic aneurysm/dissection (AAD)), (ii) identify the patient-level factors that predict these events, and (iii) develop clinical risk scores to estimate the predicted probabilities of each FQAEI based on patient-level covariates available on clinical presentation. DESIGN Retrospective cohort study. SETTING Upstate New York Veterans' Healthcare Administration from 2011 to 2016. PATIENTS Hospitalized patients with community-acquired pneumonia receiving care in the Upstate New York Veterans' Healthcare Administration from 2011 to 2016. INTERVENTION N/A. MEASUREMENTS The outcomes of interest for this study were the occurrence of TE, CDI, and AAD. We also evaluated a composite of these three outcomes, FQAEI. MAIN RESULTS The study population consisted of 1071 patients. The overall incidence of FQAEI, TE, AAD, and CDI was 6.5%, 1.8%, 4.5%, and 0.3%, respectively. For each outcome evaluated, the probability of the event of interest was predicted by the presence of certain comorbidities, previous healthcare exposure, choice of specific FQ antibiotic, or therapy duration. Concomitant steroids, pneumonia in preceding 180 days, and creatinine clearance <30 mL/min predicted FQAEI. CONCLUSIONS Individual frequencies of three important FQAEIs were quantified, and risk scores were developed to estimate the probabilities of experiencing these events to help clinicians individualize treatment decisions for patients and reduce the potential risks of select FQAEIs.
Collapse
Affiliation(s)
- Nimish Patel
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
- Samuel S. Stratton Veteran's Affairs Medical Center, Albany, New York, USA
| | - Allison Gorseth
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
- Department of Pharmacy, Hartford Hospital, Hartford, Connecticut, USA
| | - Gina Belfiore
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Nicholas Stornelli
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
- Department of Pharmacy Services, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA
| | - Colleen Lowry
- Samuel S. Stratton Veteran's Affairs Medical Center, Albany, New York, USA
| | - Lodise Thomas
- Samuel S. Stratton Veteran's Affairs Medical Center, Albany, New York, USA
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| |
Collapse
|
7
|
Gamble KC, Rose DT, Thyagarajan RV, Jaso TC, Reveles KR, Mondy KE. Impact of intensified inpatient clindamycin stewardship initiatives in three phases: a pilot quasi-experimental study. J Hosp Infect 2024; 143:227-228. [PMID: 37783342 DOI: 10.1016/j.jhin.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Affiliation(s)
- K C Gamble
- McLeod Regional Medical Center, Florence, SC, USA.
| | - D T Rose
- Dell Seton Medical Center at the University of Texas, Austin, TX, USA
| | - R V Thyagarajan
- Dell Seton Medical Center at the University of Texas, Austin, TX, USA; Dell Medical School at the University of Texas, Austin, TX, USA
| | - T C Jaso
- Ascension Seton Medical Center Austin, Austin, TX, USA
| | - K R Reveles
- The University of Texas at Austin College of Pharmacy, Austin, TX, USA; UT Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| | - K E Mondy
- Dell Seton Medical Center at the University of Texas, Austin, TX, USA; Dell Medical School at the University of Texas, Austin, TX, USA
| |
Collapse
|
8
|
Bresee LC, Lamont N, Ocampo W, Holroyd-Leduc J, Sabuda D, Leal J, Dalton B, Kaufman J, Missaghi B, Kim J, Larios OE, Henderson E, Raman M, Fletcher JR, Faris P, Kraft S, Shen Y, Louie T, Conly JM. Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection. BMC Health Serv Res 2023; 23:1386. [PMID: 38082421 PMCID: PMC10714625 DOI: 10.1186/s12913-023-10350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +). METHODS We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research. RESULTS A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals. CONCLUSIONS Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
Collapse
Affiliation(s)
- Lauren C Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Nicole Lamont
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Wrechelle Ocampo
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Deana Sabuda
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
| | - Jenine Leal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bruce Dalton
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
| | - Jaime Kaufman
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Bayan Missaghi
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Joseph Kim
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Oscar E Larios
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Elizabeth Henderson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Jared R Fletcher
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Scott Kraft
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Ye Shen
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Thomas Louie
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - John M Conly
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- AGW5 - Special Services Bldg, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, Canada, T2N 2T9.
| |
Collapse
|
9
|
Vintila BI, Arseniu AM, Morgovan C, Butuca A, Sava M, Bîrluțiu V, Rus LL, Ghibu S, Bereanu AS, Roxana Codru I, Gligor FG. A Pharmacovigilance Study Regarding the Risk of Antibiotic-Associated Clostridioides difficile Infection Based on Reports from the EudraVigilance Database: Analysis of Some of the Most Used Antibiotics in Intensive Care Units. Pharmaceuticals (Basel) 2023; 16:1585. [PMID: 38004450 PMCID: PMC10675398 DOI: 10.3390/ph16111585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 10/29/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
The Gram-positive anaerobic bacterium Clostridioides difficile (CD) can produce intense exotoxins, contributing to nosocomial infections, and it is the most common cause of health-care-associated infectious diarrhea. Based on spontaneous Individual Case Safety Reports from EudraVigilance (EV), we conducted a descriptive analysis of Clostridioides difficile infection (CDI) cases that reported a spontaneous adverse reaction related to using ceftriaxone, colistimethate, ciprofloxacin, gentamicin, linezolid, meropenem, and piperacillin/tazobactam. Most ADR reports registered in EV that were related to CDI were associated with ceftriaxone (33%), ciprofloxacin (28%), and piperacillin/tazobactam (21%). Additionally, the disproportionality analysis performed showed that all studied antibiotics had a lower reporting probability when compared to clindamycin. A causal relationship between a drug and the occurrence of an adverse reaction cannot be established from EV data alone because the phenomena of underreporting, overreporting, and reporting bias may affect the results. Based on the analysis of the collected data, this study underlines the importance of surveillance and monitoring programs for the consumption of antibiotics. Furthermore, it is essential to use standardized laboratory tests to define CDI's nature accurately. To prevent this infection, specialists should collaborate and adhere strictly to antibiotic stewardship programs, hygiene practices, and isolation protocols.
Collapse
Affiliation(s)
- Bogdan Ioan Vintila
- Clinical Surgical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (B.I.V.); (A.S.B.); (I.R.C.)
- County Clinical Emergency Hospital, 550245 Sibiu, Romania;
| | - Anca Maria Arseniu
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (C.M.); (A.B.); (L.L.R.); (F.G.G.)
| | - Claudiu Morgovan
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (C.M.); (A.B.); (L.L.R.); (F.G.G.)
| | - Anca Butuca
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (C.M.); (A.B.); (L.L.R.); (F.G.G.)
| | - Mihai Sava
- Clinical Surgical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (B.I.V.); (A.S.B.); (I.R.C.)
- County Clinical Emergency Hospital, 550245 Sibiu, Romania;
| | - Victoria Bîrluțiu
- County Clinical Emergency Hospital, 550245 Sibiu, Romania;
- Clinical Medical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
| | - Luca Liviu Rus
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (C.M.); (A.B.); (L.L.R.); (F.G.G.)
| | - Steliana Ghibu
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Alina Simona Bereanu
- Clinical Surgical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (B.I.V.); (A.S.B.); (I.R.C.)
- County Clinical Emergency Hospital, 550245 Sibiu, Romania;
| | - Ioana Roxana Codru
- Clinical Surgical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (B.I.V.); (A.S.B.); (I.R.C.)
- County Clinical Emergency Hospital, 550245 Sibiu, Romania;
| | - Felicia Gabriela Gligor
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania; (C.M.); (A.B.); (L.L.R.); (F.G.G.)
| |
Collapse
|
10
|
Manzoor F, Manzoor S, Pinto R, Brown K, Langford BJ, Daneman N. Does this patient have Clostridioides difficile infection? A systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:1367-1374. [PMID: 37327874 DOI: 10.1016/j.cmi.2023.06.010] [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: 12/19/2022] [Revised: 05/27/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The clinical features and predictors of Clostridioides difficile infection overlap with many conditions. OBJECTIVES We performed a systematic review to evaluate the diagnostic utility of clinical features (clinical examination, risk factors, laboratory tests, and radiographic findings) associated with C. difficile. METHODS Systematic review and meta-analysis of diagnostic features for C. difficile. DATA SOURCES MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched up to September 2021. STUDY ELIGIBILITY CRITERIA Studies that reported clinical features of C. difficile, a valid reference standard test for confirming diagnosis of C. difficile, and a comparison among patients with a positive and negative test result. PARTICIPANTS Adult and paediatric patients across diverse clinical settings. OUTCOMES Sensitivity, specificity, likelihood ratios. REFERENCE STANDARD Stool nucleic acid amplification tests, enzyme immunoassays, cell cytotoxicity assay, and stool toxigenic culture. ASSESSMENT OF RISK OF BIAS Rational Clinical Examination Series and Quality Assessment of Diagnostic Accuracy Studies-2. METHODS OF DATA SYNTHESIS Univariate and bivariate analyses. RESULTS We screened 11 231 articles of which 40 were included, enabling the evaluation of 66 features for their diagnostic utility for C. difficile (10 clinical examination findings, 4 laboratory tests, 10 radiographic findings, prior exposure to 13 antibiotic types, and 29 clinical risk factors). Of the ten features identified on clinical examination, none were significantly clinically associated with increased likelihood of C. difficile infection. Some features that increased likelihood of C. difficile infection were stool leukocytes (LR+ 5.31, 95% CI 3.29-8.56) and hospital admission in the prior 3 months (LR+ 2.14, 95% CI 1.48-3.11). Several radiographic findings also strongly increased the likelihood of C. difficile infection like ascites (LR+ 2.91, 95% CI 1.89-4.49). DISCUSSION There is limited utility of bedside clinical examination alone in detecting C. difficile infection. Accurate diagnosis of C. difficile infection requires thoughtful clinical assessment for interpretation of microbiologic testing in all suspected cases.
Collapse
Affiliation(s)
- Fizza Manzoor
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Saba Manzoor
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ruxandra Pinto
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kevin Brown
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bradley J Langford
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.
| |
Collapse
|
11
|
Rohde AM, Mischnik A, Behnke M, Dinkelacker A, Eisenbeis S, Falgenhauer J, Gastmeier P, Häcker G, Herold S, Imirzalioglu C, Käding N, Kramme E, Peter S, Piepenbrock E, Rupp J, Schneider C, Schwab F, Seifert H, Steib-Bauert M, Tacconelli E, Trauth J, Vehreschild MJGT, Walker SV, Kern WV, Jazmati N. Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections: an ecological study in five German university hospitals, 2017-2019. J Antimicrob Chemother 2023; 78:2274-2282. [PMID: 37527398 DOI: 10.1093/jac/dkad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES To analyse the influence of antibiotic consumption on healthcare-associated healthcare onset (HAHO) Clostridioides difficile infection (CDI) in a German university hospital setting. METHODS Monthly ward-level antibiotic consumption measured in DDD/100 patient days (pd) and CDI surveillance data from five university hospitals in the period 2017 through 2019 were analysed. Uni- and multivariable analyses were performed with generalized estimating equation models. RESULTS A total of 225 wards with 7347 surveillance months and 4 036 602 pd participated. With 1184 HAHO-CDI cases, there was a median incidence density of 0.17/1000 pd (IQR 0.03-0.43) across all specialties, with substantial differences among specialties. Haematology-oncology wards showed the highest median incidence density (0.67/1000 pd, IQR 0.44-1.01), followed by medical ICUs (0.45/1000 pd, IQR 0.27-0.73) and medical general wards (0.32/1000 pd, IQR 0.18-0.53). Multivariable analysis revealed carbapenem (mostly meropenem) consumption to be the only antibiotic class associated with increased HAHO-CDI incidence density. Each carbapenem DDD/100 pd administered increased the HAHO-CDI incidence density by 1.3% [incidence rate ratio (IRR) 1.013; 95% CI 1.006-1.019]. Specialty-specific analyses showed this influence only to be valid for haematological-oncological wards. Overall, factors like ward specialty (e.g. haematology-oncology ward IRR 2.961, 95% CI 2.203-3.980) or other CDI cases on ward had a stronger influence on HAHO-CDI incidence density (e.g. community-associated CDI or unknown association case in same month IRR 1.476, 95% CI 1.242-1.755) than antibiotic consumption. CONCLUSIONS In the German university hospital setting, monthly ward-level carbapenem consumption seems to increase the HAHO-CDI incidence density predominantly on haematological-oncological wards. Furthermore, other patient-specific factors seem to be equally important to control HAHO-CDI.
Collapse
Affiliation(s)
- Anna M Rohde
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Alexander Mischnik
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Michael Behnke
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Ariane Dinkelacker
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Simone Eisenbeis
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Jane Falgenhauer
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Petra Gastmeier
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Georg Häcker
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Susanne Herold
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- University Hospital Giessen and Marburg, Department of Medicine V (Internal Medicine, Infectious Diseases and Infection Control), Justus-Liebig-University Giessen, Giessen, Germany, member of the German Centre for Lung Research (DZL), member of the German Centre for Infection Research (DZIF) Department of Internal Medicine (Infectiology)
| | - Can Imirzalioglu
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Nadja Käding
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany
| | - Evelyn Kramme
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany
| | - Silke Peter
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Ellen Piepenbrock
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Rupp
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany
| | - Christian Schneider
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frank Schwab
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Harald Seifert
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michaela Steib-Bauert
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Evelina Tacconelli
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Janina Trauth
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- University Hospital Giessen and Marburg, Department of Medicine V (Internal Medicine, Infectious Diseases and Infection Control), Justus-Liebig-University Giessen, Giessen, Germany, member of the German Centre for Lung Research (DZL), member of the German Centre for Infection Research (DZIF) Department of Internal Medicine (Infectiology)
| | - Maria J G T Vehreschild
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, Goethe University, Frankfurt am Main, Germany
| | - Sarah V Walker
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Winfried V Kern
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Nathalie Jazmati
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Labor Dr. Wisplinghoff, Cologne, Germany
| |
Collapse
|
12
|
Yang M, Lu X, Xin L, Luo J, Diao S, Jia Z, Cheng G, Zeng L, Zhang L. Comparative effectiveness and safety of antibiotic prophylaxis during induction chemotherapy in children with acute leukaemia: a systematic review and meta-analysis. J Hosp Infect 2023; 136:20-29. [PMID: 36921630 DOI: 10.1016/j.jhin.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Bacterial infections are common during induction therapy in children and adolescents with acute leukaemia and may cause infection-related mortality. AIM To determine the efficacy and safety of prophylactic antibiotics in paediatric patients with acute leukaemia receiving induction chemotherapy. METHODS From three English databases and four Chinese databases, we searched for randomized controlled trials (RCTs) and cohort studies that compared prophylactic antibiotics to placebo, no prophylaxis, or that compared one antibiotic versus another in paediatric patients with acute leukaemia undergoing induction chemotherapy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias using Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale, and the certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). FINDINGS Two RCTs and ten cohort studies were finally included. For children with acute lymphoblastic leukaemia, antibiotic prophylaxis, including levofloxacin, sulfamethoxazole-trimethoprim, or other antibiotics, probably reduced bacteraemia (risk ratio (RR): 0.44; 95% confidence interval (CI): 0.33-0.60; moderate certainty) without significantly increasing Clostridioides difficile infection (CDI) or invasive fungal infection. Levofloxacin reduced the CDI rate (RR: 0.08; 95% CI: 0.01-0.62; high certainty). Ciprofloxacin prophylaxis probably reduced infection-related mortality (RR: 0.12; 95% CI: 0.01-0.97; moderate certainty). In children with acute myeloid leukaemia, ciprofloxacin plus vancomycin may reduce febrile neutropenia (RR: 0.79; 95% CI: 0.66-0.94; low certainty). Individual studies indicated that prophylaxis increased antibiotic exposure but reduced non-preventive antibiotic exposure. CONCLUSION In children with acute leukaemia undergoing induction therapy, antibiotic prophylaxis may improve the bacterial infection and mortality.
Collapse
Affiliation(s)
- M Yang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - X Lu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Paediatric Haematology and Oncology, West China Second Hospital, Sichuan University, Chengdu, China
| | - L Xin
- Department of Clinical Pharmacy, The Affiliated Hospital of Yunnan University, Kunming, China
| | - J Luo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - S Diao
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Z Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - G Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - L Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
| | - L Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
13
|
Ferre Aracil C, El Hajra Martínez I, Vera Mendoza MS, Ramos Martínez A, Muñez Rubio E, Fernández-Cruz A, Matallana Royo V, García-Maseda S, Sánchez Romero I, Martínez Ruiz R, Calleja Panero JL. Faecal Microbiota Transplantation is a simple, effective and safe treatment in the management of C. difficile infection in daily clinical practice. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:206-210. [PMID: 36681571 DOI: 10.1016/j.eimce.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/19/2022] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Faecal microbiota transplantation (FMT) is a treatment supported by wide scientific evidence and proved to be very effective in the management of Clostridioides difficile infection (CDI). The objective of this study is to analyze its effectiveness and safety in a real clinical practice setting. METHODS Retrospective, single-center and descriptive observational study in which all FMT performed between May 2016 and December 2020 were included. Technical success was defined as the successful administration of the faecal preparation in the patient's gastrointestinal tract and clinical success the disappearance of diarrhoea in the first 72 h after the procedure with no relapse within the following 8 weeks after the therapy was started. RESULTS 15 FMT were performed in 13 patients. Median age was 79 years (range: 40-98 years); being 60% women and 33.3% depedent persons. The indication for FMT was recurrent CDI in 84.6%. All FMTs were performed by colonoscopy and from related donors. With a first procedure, the FMT was effective in 11 of 13 patients (84.61%; 95% CI; 54.55-98.07). Time until resolution of symptoms was less than 48 h in all cases. Post-transplant follow-up was 25.66 ± 17.5 months. No significant short or long-term complications were recorded at follow-up. CONCLUSION TMF is a simple, effective and safe procedure in CD infection, even in elderly patients or those with great comorbidities.
Collapse
Affiliation(s)
- Carlos Ferre Aracil
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - Ismael El Hajra Martínez
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Antonio Ramos Martínez
- Servicio de Medicina Interna - Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Elena Muñez Rubio
- Servicio de Medicina Interna - Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Servicio de Medicina Interna - Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Virginia Matallana Royo
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Sarela García-Maseda
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Isabel Sánchez Romero
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Rocío Martínez Ruiz
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - José Luis Calleja Panero
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| |
Collapse
|
14
|
Mponponsuo K, Brown KA, Fridman DJ, Johnstone J, Langford BJ, Lee SM, MacFadden DR, Patel SN, Schwartz KL, Daneman N. Highly versus less bioavailable oral antibiotics in the treatment of gram-negative bloodstream infections: a propensity-matched cohort analysis. Clin Microbiol Infect 2023; 29:490-497. [PMID: 36216237 DOI: 10.1016/j.cmi.2022.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this study, we evaluated the clinical outcomes associated with the use of highly bioavailable oral antibiotics (fluoroquinolones and trimethoprim-sulfamethoxazole) compared with the less-bioavailable oral antibiotics (β-lactams) in gram-negative bloodstream infections (BSIs). METHODS Among hospitalized older adult patients in Ontario, Canada, discharged home on oral treatment for gram-negative BSI between 1 January 2017 and 31 December 2019, we used a matched cohort design to compare outcomes among those receiving highly versus less-bioavailable agents; hard-matching 1:1 on sex, BSI pathogen (Escherichia coli vs. non-E. coli), and infection source (urinary vs. non-urinary/unknown source) along with a propensity score, incorporating specific pathogen, patient, and infection characteristics. The primary outcome was the composite of 90-day all-cause mortality, recurrent BSI with the same pathogen (genus and species), and re-admission to any Ontario hospital. RESULTS A total of 2012 patients were included in the study (1006 in each bioavailability category). Those who received highly (compared with less) bioavailable antibiotics at discharge had lower rates of the composite outcome (171/1006 [17.0%] vs. 216/1006 [21.5%]), adjusted odds ratio being 0.74 (95% CI, 0.60-0.92). Recurrent BSI at 90 days was the main driver for the composite outcome occurring in 64 (5.4%) and 107 (9.4%) patients of the highly and less-bioavailable groups, respectively (p < 0.001) (adjusted odds ratio, 0.56; 95% CI, 0.40-0.78). DISCUSSION Use of highly (compared with less) bioavailable antibiotics at discharge was associated with significantly better clinical outcomes among patients with gram-negative BSIs.
Collapse
Affiliation(s)
- Kwadwo Mponponsuo
- Institute for Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Kevin A Brown
- Public Health Ontario, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Daniel J Fridman
- Institute for Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jennie Johnstone
- Infection Prevention and Control, Sinai Health and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J Langford
- Public Health Ontario, Hotel Dieu Shaver Health and Rehabilitation Center, Toronto, Ontario, Canada
| | - Samantha M Lee
- Institute for Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Samir N Patel
- Public Health Ontario, University of Toronto Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Institute for Clinical Evaluative Sciences, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
| |
Collapse
|
15
|
Jaber RH, Beahm NP. Daptomycin for the treatment of acute bacterial meningitis: a narrative review. Int J Antimicrob Agents 2023; 61:106770. [PMID: 36870402 DOI: 10.1016/j.ijantimicag.2023.106770] [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: 07/07/2022] [Revised: 01/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND There is a growing interest in the utilization of daptomycin for the treatment of multi-drug resistant, Gram-positive infections. Pharmacokinetic studies suggest that daptomycin could penetrate into the cerebrospinal fluid, albeit to a small extent. The objective of this review was to evaluate the available clinical evidence for daptomycin use in acute bacterial meningitis of both pediatric and adult patients. METHODS Electronic databases were searched up to June 2022 for studies published on the topic. The inclusion criteria were met if the study reported the use of intravenous daptomycin (more than a single dose) for the treatment of diagnosed acute bacterial meningitis. RESULTS A total of 21 case reports were identified that met the inclusion criteria. These suggest that daptomycin could be safe and effective alternative in achieving clinical cure of meningitis. In these studies, daptomycin was used in the event of treatment failure, patient intolerance, or bacterial resistance to first-line agents. CONCLUSIONS Daptomycin has potential to be an alternative to standard care for meningitis caused by Gram-positive bacteria in the future; however, more robust research is required to establish an optimal dosing regimen, duration of therapy, and place in therapy for the management of meningitis.
Collapse
Affiliation(s)
- Rami H Jaber
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nathan P Beahm
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
16
|
Butters C, Thursky K, Hanna DT, Cole T, Davidson A, Buttery J, Haeusler G. Adverse effects of antibiotics in children with cancer: are short-course antibiotics for febrile neutropenia part of the solution? Expert Rev Anti Infect Ther 2023; 21:267-279. [PMID: 36694289 DOI: 10.1080/14787210.2023.2171987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Febrile neutropenia is a common complication experienced by children with cancer or those undergoing hematopoietic stem cell transplantation. Repeated episodes of febrile neutropenia result in cumulative exposure to broad-spectrum antibiotics with potential for a range of serious adverse effects. Short-course antibiotics, even in patients with high-risk febrile neutropenia, may offer a solution. AREAS COVERED This review addresses the known broad effects of antibiotics, highlights developments in understanding the relationship between cancer, antibiotics, and the gut microbiome, and discusses emerging evidence regarding long-term adverse antibiotic effects. The authors consider available evidence to guide the duration of empiric antibiotics in pediatric febrile neutropenia and directions for future research. EXPERT OPINION Broad-spectrum antibiotics are associated with antimicrobial resistance, Clostridioides difficile infection, invasive candidiasis, significant disturbance of the gut microbiome and may seriously impact outcomes in children with cancer or undergoing allogenic hematopoietic stem cell transplant. Short-course empiric antibiotics are likely safe in most children with febrile neutropenia and present a valuable opportunity to reduce the risks of antibiotic exposure.
Collapse
Affiliation(s)
- Coen Butters
- Department of General Paediatrics and Adolescent Medicine, John Hunter Children's Hospital, Newcastle, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, Australia.,Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Diane T Hanna
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Theresa Cole
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Andrew Davidson
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Anaesthesia, Royal Children's Hospital, Parkville, Australia.,Department of Critical Care, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia.,Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Australia
| | - Jim Buttery
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia.,Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia.,Health Informatics Group and SAEFVIC, Murdoch Children's Research Institute, Parkville, Australia
| | - Gabrielle Haeusler
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia
| |
Collapse
|
17
|
Stebliankin V, Sazal M, Valdes C, Mathee K, Narasimhan G. A novel approach for combining the metagenome, metaresistome, metareplicome and causal inference to determine the microbes and their antibiotic resistance gene repertoire that contribute to dysbiosis. Microb Genom 2022; 8:mgen000899. [PMID: 36748547 PMCID: PMC9837561 DOI: 10.1099/mgen.0.000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 09/11/2022] [Indexed: 12/24/2022] Open
Abstract
The use of whole metagenomic data to infer the relative abundance of all its microbes is well established. The same data can be used to determine the replication rate of all eubacterial taxa with circular chromosomes. Despite their availability, the replication rate profiles (metareplicome) have not been fully exploited in microbiome analyses. Another relatively new approach is the application of causal inferencing to analyse microbiome data that goes beyond correlational studies. A novel scalable pipeline called MeRRCI (Metagenome, metaResistome, and metaReplicome for Causal Inferencing) was developed. MeRRCI combines efficient computation of the metagenome (bacterial relative abundance), metaresistome (antimicrobial gene abundance) and metareplicome (replication rates), and integrates environmental variables (metadata) for causality analysis using Bayesian networks. MeRRCI was applied to an infant gut microbiome data set to investigate the microbial community's response to antibiotics. Our analysis suggests that the current treatment stratagem contributes to preterm infant gut dysbiosis, allowing a proliferation of pathobionts. The study highlights the specific antibacterial resistance genes that may contribute to exponential cell division in the presence of antibiotics for various pathogens, namely Klebsiella pneumoniae, Citrobacter freundii, Staphylococcus epidermidis, Veilonella parvula and Clostridium perfringens. These organisms often contribute to the harmful long-term sequelae seen in these young infants.
Collapse
Affiliation(s)
- Vitalii Stebliankin
- Bioinformatics Research Group (BioRG), Knight Foundation School of Computing and Information Sciences, Florida International University, Miami, FL, USA
| | - Musfiqur Sazal
- Bioinformatics Research Group (BioRG), Knight Foundation School of Computing and Information Sciences, Florida International University, Miami, FL, USA
- Present address: Microsoft Corporation, GA, Atlanta, USA
| | - Camilo Valdes
- Bioinformatics Research Group (BioRG), Knight Foundation School of Computing and Information Sciences, Florida International University, Miami, FL, USA
- Present address: Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94550, USA
| | - Kalai Mathee
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Biomolecular Sciences Institute, Florida International University, Miami, FL, USA
| | - Giri Narasimhan
- Bioinformatics Research Group (BioRG), Knight Foundation School of Computing and Information Sciences, Florida International University, Miami, FL, USA
- Biomolecular Sciences Institute, Florida International University, Miami, FL, USA
| |
Collapse
|
18
|
Swingler EA, Song M, Moore SE, Bohn BC, Schulz PS, Junkins AD, Wilde AM. Fluoroquinolone stewardship at a community health system: A decade in review. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e186. [PMID: 36425222 PMCID: PMC9679733 DOI: 10.1017/ash.2022.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe inpatient fluoroquinolone use and susceptibility data over a 10-year period after the implementation of an antimicrobial stewardship program (ASP) led by an infectious diseases pharmacist starting in 2011. DESIGN Retrospective surveillance study. SETTING Large community health system. METHODS Fluoroquinolone use was quantified by days of therapy (DOT) per 1,000 patient days (PD) and reported quarterly. Use data are reported for inpatients from 2016 to 2020. Levofloxacin susceptibility is reported for Pseudomonas aeruginosa and Escherichia coli for inpatients from 2011 to 2020 at a 4 adult-hospital health system. RESULTS Inpatient fluoroquinolone use decreased by 74% over a 5-year period, with an average decrease of 3.45 DOT per 1,000 PD per quarter (P < .001). Over a 10-year period, inpatient levofloxacin susceptibility increased by 57% for P. aeruginosa and by 15% for E. coli. P. aeruginosa susceptibility to levofloxacin increased by an average of 2.73% per year (P < .001) and had a strong negative correlation with fluoroquinolone use, r = -0.99 (P = .002). E. coli susceptibility to levofloxacin increased by an average of 1.33% per year (P < .001) and had a strong negative correlation with fluoroquinolone use, r = -0.95 (P = .015). CONCLUSIONS A substantial decrease in fluoroquinolone use and increase in P. aeruginosa and E. coli levofloxacin susceptibility was observed after implementation of an antimicrobial stewardship program. These results demonstrate the value of stewardship services and highlight the effectiveness of an infectious diseases pharmacist led antimicrobial stewardship program.
Collapse
Affiliation(s)
- Elena A. Swingler
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Matthew Song
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Sarah E. Moore
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Brian C. Bohn
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Paul S. Schulz
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Alan D. Junkins
- Department of Microbiology, Norton Healthcare, Louisville, Kentucky
| | - Ashley M. Wilde
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| |
Collapse
|
19
|
Motzer AR, Holaday E, Axelrod P, Mishkin A. Effects of reported beta‐lactam allergies on pneumonia outcomes in lung transplant recipients. Transpl Infect Dis 2022; 24:e13906. [DOI: 10.1111/tid.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/03/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew R. Motzer
- Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Eric Holaday
- Virtua Medical Group Mount Laurel New Jersey USA
| | - Peter Axelrod
- Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Aaron Mishkin
- Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| |
Collapse
|
20
|
Kobayashi H, Shindo Y, Kobayashi D, Sakakibara T, Murakami Y, Yagi M, Matsuura A, Sato K, Matsui K, Emoto R, Yagi T, Saka H, Matsui S, Hasegawa Y. Extended-Spectrum Antibiotics for Community-Acquired Pneumonia with a Low Risk of Drug-Resistant Pathogens. Int J Infect Dis 2022; 124:124-132. [PMID: 36116670 DOI: 10.1016/j.ijid.2022.09.015] [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: 07/03/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The potential hazards of extended-spectrum antibiotic therapy for patients with community-acquired pneumonia (CAP) with low risk of drug-resistant pathogens (DRPs) remains unclear, although risk assessment for DRPs is essential to determine the initial antibiotics to be administered. The study objective is to assess the effect of unnecessary extended-spectrum therapy on mortality of such patients. METHODS A post-hoc analysis was conducted after a prospective multicenter observational study for CAP. Multivariable logistic regression analysis was performed to assess the effect of extended-spectrum therapy on 30-day mortality. Three sensitivity analyses, including propensity score analysis to confirm the robustness of findings, were also performed. RESULTS Among 750 patients with CAP, 416 with CAP with a low risk of DRPs were analyzed; of these, 257 underwent standard therapy and 159 underwent extended-spectrum therapy. The 30-day mortality was 3.9% and 13.8% in the standard and extended-spectrum therapy groups, respectively. Primary analysis revealed that extended-spectrum therapy was associated with increased 30-day mortality compared with standard therapy (adjusted odds ratio, 2.82; 95% confidence interval, 1.20-6.66). The results of the sensitivity analyses were consistent with those of the primary analysis. CONCLUSIONS Physicians should assess the risk of DRPs when determining the empirical antibiotic therapy and should refrain from administering unnecessary extended-spectrum antibiotics for patients with CAP with a low risk of DRPs.
Collapse
Affiliation(s)
- Hironori Kobayashi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Daisuke Kobayashi
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Toshihiro Sakakibara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Yasushi Murakami
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Mitsuaki Yagi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Akinobu Matsuura
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Kenta Sato
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Kota Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Ryo Emoto
- Department of Biostatistics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Hideo Saka
- Department of Respiratory Medicine, Matsunami General Hospital, 185-1 Dendai, Kasamatsu, Hashima District, Gifu 501-6062, Japan; National Hospital Organization, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; National Hospital Organization, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| |
Collapse
|
21
|
Wells DA, Johnson AJ, Lukas JG, Mason D, Cleveland KO, Bissell A, Hobbs ALV. Criteria Restricting Inappropriate Meropenem Empiricism (CRIME): a quasi-experimental carbapenem restriction pilot at a large academic medical centre. Int J Antimicrob Agents 2022; 60:106661. [PMID: 35988667 DOI: 10.1016/j.ijantimicag.2022.106661] [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: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
The broad-spectrum activity of carbapenems makes them appealing for empirical use; however, they are associated with development of Clostridioides difficile infection (CDI) and multidrug resistance. Selective carbapenem use is vital in maintaining their effectiveness. We examined the impact of meropenem restriction criteria on utilisation and patient outcomes. This quasi-experimental study was conducted at a single academic medical centre after medication use evaluation found frequent inappropriate meropenem utilisation. Antimicrobial stewardship-led restriction criteria were developed and implemented in February 2022. Investigators aimed to determine how restriction criteria affected meropenem utilisation across 8 weeks in the pre- (February-April 2020) versus post-implementation period (February-April 2022). The primary outcome was inappropriateness of meropenem utilisation. Secondary outcomes included days of therapy per 1000 patient-days (DOT/1000 PD), hospital length of stay (LOS), CDI Standardized Infection Ratio (SIR), and acquisition cost. Across the 8-week timeframes, reductions in inappropriate meropenem use (64.5% vs. 12.8%; P < 0.001), duration of therapy [5.8 (3.2-7.3) vs. 2.4 (1.0-5.5) days; P < 0.001] and utilisation (30.5 vs. 8.3 DOT/1000 PD; P < 0.001) pre- versus post-implementation were observed. Total meropenem orders decreased by 65% (P < 0.001). Median hospital LOS also decreased between periods [11.9 (7.8-20.4) vs. 9.2 (5.4-15.2) days], although not statistically significant (P = 0.051). There was no difference in CDI SIR (0.1 vs. 0.1; P = 0.99). Projected annual cost savings were ∼US$57 300. Implementation of antimicrobial stewardship-initiated restriction criteria can reduce inappropriate meropenem utilisation, overall number of orders, and total duration of therapy.
Collapse
Affiliation(s)
- Drew A Wells
- Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA.
| | - Asia J Johnson
- Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
| | - Jack G Lukas
- Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
| | - Darius Mason
- Information Technology, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
| | - Kerry O Cleveland
- Infectious Diseases, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA; Division of Infectious Diseases, University of Tennessee Health Science Center, 1325 Eastmoreland Avenue, Suite 460, Memphis, TN, 38104, USA
| | - Aaron Bissell
- Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
| | - Athena L V Hobbs
- Cardinal Health Innovative Delivery Solutions, 13651 Dublin Court, Stafford, TX, 77477, USA
| |
Collapse
|
22
|
Tashiro S, Mihara T, Sasaki M, Shimamura C, Shimamura R, Suzuki S, Yoshikawa M, Hasegawa T, Enoki Y, Taguchi K, Matsumoto K, Ohge H, Suzuki H, Nakamura A, Mori N, Morinaga Y, Yamagishi Y, Yoshizawa S, Yanagihara K, Mikamo H, Kunishima H. Oral fidaxomicin versus vancomycin for the treatment of Clostridioides difficile infection: A systematic review and meta-analysis of randomized controlled trials. J Infect Chemother 2022; 28:1536-1545. [PMID: 35964806 DOI: 10.1016/j.jiac.2022.08.008] [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: 07/06/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fidaxomicin (FDX) has received considerable attention as a novel therapeutic alternative agent to vancomycin (VCM) for Clostridioides difficile infection (CDI). However, the superiority and efficacy profile of FDX are not sufficiently determined by high-quality evidence. This study aimed to clarify the superiority of FDX for CDI treatment through a systematic review and meta-analysis. METHODS We conducted a meta-analysis of randomized controlled trials (RCTs) which evaluated the efficacy and safety of FDX and VCM in patients with CDI. Electronic databases (PubMed, Cochrane Library, Web of Science, and Clinicaltrials.gov) were searched for studies published until October 15, 2021. The primary endpoint was global cure. The secondary endpoints were clinical cure, recurrence, and adverse event. Risk ratios (RRs), risk differences (RDs), and 95% confidence intervals were calculated using Mantel-Haenszel random-effects model. The risk of bias was assessed using Cochrane Handbook for Systematic Reviews of Interventions and Assessment Criteria. RESULTS Six RCTs were included in this meta-analysis. Compared to VCM, FDX was associated with significantly higher global cure rates (RR = 1.18, P < 0.00001; RD = 0.11, 95% CI = 0.07-0.16). In addition, clinical cure rates were comparable between FDX and VCM (P = 0.31). FDX was associated with significantly lower recurrence rates compared to VCM (RR = 0.59, P < 0.0001). In addition, adverse event rates were not significantly different between the drugs (P = 0.41). CONCLUSION FDX achieves significantly higher global cure rates and lower recurrence rates and is comparable to VCM in clinical cure rates and adverse event rates in patients with CDI. Collectively, FDX is superior to VCM as a therapeutic agent for CDI.
Collapse
Affiliation(s)
- Sho Tashiro
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Takayuki Mihara
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Moe Sasaki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Chiaki Shimamura
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Rina Shimamura
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Shiho Suzuki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Maiko Yoshikawa
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Tatsuki Hasegawa
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan.
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiromichi Suzuki
- Department of Infectious Diseases, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Atsushi Nakamura
- Department of Infection Prevention and Control, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Nobuaki Mori
- Department of General Internal Medicine and Infectious Diseases, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Kochi Medical School, Kochi, Japan
| | - Sadako Yoshizawa
- Department of Clinical Laboratory / Department of Microbiology and Infectious Diseases, Toho University Faculty of Medicine, Tokyo, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, Kanagawa, Japan
| |
Collapse
|
23
|
Diluted Fecal Community Transplant Restores Clostridioides difficile Colonization Resistance to Antibiotic-Perturbed Murine Communities. mBio 2022; 13:e0136422. [PMID: 35913161 PMCID: PMC9426422 DOI: 10.1128/mbio.01364-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fecal communities transplanted into individuals can eliminate recurrent Clostridioides difficile infection (CDI) with high efficacy. However, this treatment is only used once CDI becomes resistant to antibiotics or has recurred multiple times. We sought to investigate whether a fecal community transplant (FCT) pretreatment could be used to prevent CDI altogether. We treated male C57BL/6 mice with either clindamycin, cefoperazone, or streptomycin and then inoculated them with the microbial community from untreated mice before challenge with C. difficile. We measured colonization and sequenced the V4 region of the 16S rRNA gene to understand the dynamics of the murine fecal community in response to the FCT and C. difficile challenge. Clindamycin-treated mice became colonized with C. difficile but cleared it naturally and did not benefit from the FCT. Cefoperazone-treated mice became colonized by C. difficile, but the FCT enabled clearance of C. difficile. In streptomycin-treated mice, the FCT was able to prevent C. difficile from colonizing. We then diluted the FCT and repeated the experiments. Cefoperazone-treated mice no longer cleared C. difficile. However, streptomycin-treated mice colonized with 1:102 dilutions resisted C. difficile colonization. Streptomycin-treated mice that received an FCT diluted 1:103 became colonized with C. difficile but later cleared the infection. In streptomycin-treated mice, inhibition of C. difficile was associated with increased relative abundance of a group of bacteria related to Porphyromonadaceae and Lachnospiraceae. These data demonstrate that C. difficile colonization resistance can be restored to a susceptible community with an FCT as long as it complements the missing populations.
Collapse
|
24
|
Kunishima H, Ohge H, Suzuki H, Nakamura A, Matsumoto K, Mikamo H, Mori N, Morinaga Y, Yanagihara K, Yamagishi Y, Yoshizawa S. Japanese Clinical Practice Guidelines for Management of Clostridioides (Clostridium) difficile infection. J Infect Chemother 2022; 28:1045-1083. [PMID: 35618618 DOI: 10.1016/j.jiac.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, Japan.
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Hiromichi Suzuki
- Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Japan
| | - Atsushi Nakamura
- Division of Infection Control and Prevention, Nagoya City University Hospital, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Japan
| | - Hiroshige Mikamo
- Clinical Infectious Diseases, Graduate School of Medicine, Aichi Medical University, Japan
| | - Nobuaki Mori
- Division of General Internal Medicine and Infectious Diseases, National Hospital Organization Tokyo Medical Center, Japan
| | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yuka Yamagishi
- Clinical Infectious Diseases, Graduate School of Medicine, Aichi Medical University, Japan
| | - Sadako Yoshizawa
- Department of Clinical Laboratory/Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan
| |
Collapse
|
25
|
Umemura T, Mutoh Y, Maeda M, Hagihara M, Ohta A, Mizuno T, Kato H, Sukawa M, Yamada T, Ikeda Y, Mikamo H, Ichihara T. Impact of Hospital Environmental Cleaning with a Potassium Peroxymonosulphate-Based Environmental Disinfectant and Antimicrobial Stewardship on the Reduction of Hospital-Onset Clostridioides difficile Infections. J Hosp Infect 2022; 129:181-188. [PMID: 35820556 DOI: 10.1016/j.jhin.2022.06.018] [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: 04/25/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND A 1% potassium peroxymonosulphate-based environmental disinfectant (PPED) produces sodium hypochlorite when combined with sodium chloride, which functions as a disinfectant. However, little is known about the impact of hospital cleaning with PPED on hospital-onset Clostridioides difficile infection (HO-CDI). AIM To reduce HO-CDI, we promote antimicrobial stewardship and hospital ward cleaning with PPED. This study was conducted to evaluate their impact. METHODS We began a promotion of post-prescription review with feedback for broad-spectrum antimicrobials and hospital ward cleaning with PPED. We reviewed the ratio of HO-CDI, PPED consumption, and days of therapy (DOT) of broad-spectrum antimicrobials between July 2014 and March 2018, dividing this time into the pre-promotion (July 2014 to June 2015) and post-promotion periods (July 2015 to March 2018). FINDINGS Using interrupted time series analysis, an immediate significant change in HO-CDI was observed after intervention (P = 0.03), although a downward trend was not observed over this period (P = 0.19). Trends in PPED consumption significantly changed over this period (P = 0.02). DOT of carbapenems decreased immediately after the intervention began (P < 0.01). A Poisson regression analysis showed that PPED consumption and DOT of carbapenems were independent factors affecting HO-CDI (P = 0.039 and 0.016, respectively). CONCLUSION We revealed that DOT of carbapenems and use of PPED were associated with the HO-CDI ratio and that both interventions reduced the rate of HO-CDI. This is the first report on the impact of hospital ward cleaning with PPED on the reduction of HO-CDI.
Collapse
Affiliation(s)
- T Umemura
- Department of Infection and Prevention, Tosei General Hospital, Aichi, Japan; Department of Clinical Infectious Diseases, Aichi Medical University, Japan; Department of Pharmacy, Tosei General Hospital, Aichi, Japan; College of Pharmacy, Kinjo Gakuin University, Nagoya, Aichi, Japan.
| | - Y Mutoh
- Department of Infection and Prevention, Tosei General Hospital, Aichi, Japan
| | - M Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan
| | - M Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | - A Ohta
- Department of Pharmacy, Tosei General Hospital, Aichi, Japan
| | - T Mizuno
- Department of Pharmacy, Tosei General Hospital, Aichi, Japan
| | - H Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | - M Sukawa
- Department of Infection and Prevention, Tosei General Hospital, Aichi, Japan
| | - T Yamada
- Department of Pharmacy, Tosei General Hospital, Aichi, Japan
| | - Y Ikeda
- College of Pharmacy, Kinjo Gakuin University, Nagoya, Aichi, Japan
| | - H Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | - T Ichihara
- Department of Infection and Prevention, Tosei General Hospital, Aichi, Japan
| |
Collapse
|
26
|
Shahbazi F, Shojaei L, Farvadi F, Kadivarian S. Antimicrobial safety considerations in critically ill patients: part II: focused on anti-microbial toxicities. Expert Rev Clin Pharmacol 2022; 15:563-573. [PMID: 35734938 DOI: 10.1080/17512433.2022.2093716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Antibiotic prescription is a challenging issue in critical care settings. Different pharmacokinetic and pharmacodynamic properties, polypharmacy, drug interactions, and high incidence of multidrug-resistant microorganisms in this population can influence the selection, safety, and efficacy of prescribed antibiotics. AREAS COVERED In the current article we searched PubMed, Scopus and Google Scholar for neurotoxicities, hematologic toxicity and fluid stewardship in intensive care units. EXPERT OPINION Critically ill patients who receive antimicrobial agents should be monitored for neurological, hematologic toxicities especially seizure, thrombocytopenia, and clostridioides infections. Other toxicities including QTc prolongation, electrolyte disturbances, liver enzyme elevation, and infusion-related reactions were being considered. Other changes, including fluid overload, hypoalbuminemia, augmented renal clearance, increased cardiac outputs in septic shock, and acute kidney injury, may influence treatment efficiency and patient outcome.
Collapse
Affiliation(s)
- Foroud Shahbazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Lida Shojaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fakhrossadat Farvadi
- Center for nanotechnology in drug delivery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Kadivarian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
27
|
Cruz KCP, Enekegho LO, Stuart DT. Bioengineered Probiotics: Synthetic Biology Can Provide Live Cell Therapeutics for the Treatment of Foodborne Diseases. Front Bioeng Biotechnol 2022; 10:890479. [PMID: 35656199 PMCID: PMC9152101 DOI: 10.3389/fbioe.2022.890479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
The rising prevalence of antibiotic resistant microbial pathogens presents an ominous health and economic challenge to modern society. The discovery and large-scale development of antibiotic drugs in previous decades was transformational, providing cheap, effective treatment for what would previously have been a lethal infection. As microbial strains resistant to many or even all antibiotic drug treatments have evolved, there is an urgent need for new drugs or antimicrobial treatments to control these pathogens. The ability to sequence and mine the genomes of an increasing number of microbial strains from previously unexplored environments has the potential to identify new natural product antibiotic biosynthesis pathways. This coupled with the power of synthetic biology to generate new production chassis, biosensors and “weaponized” live cell therapeutics may provide new means to combat the rapidly evolving threat of drug resistant microbial pathogens. This review focuses on the application of synthetic biology to construct probiotic strains that have been endowed with functionalities allowing them to identify, compete with and in some cases kill microbial pathogens as well as stimulate host immunity. Weaponized probiotics may have the greatest potential for use against pathogens that infect the gastrointestinal tract: Vibrio cholerae, Staphylococcus aureus, Clostridium perfringens and Clostridioides difficile. The potential benefits of engineered probiotics are highlighted along with the challenges that must still be met before these intriguing and exciting new therapeutic tools can be widely deployed.
Collapse
|
28
|
Farshidfar N, Hamedani S, Amiri MA, Tovani‐Palone MR, Nemati S. Modifications to the 2021 American Heart Association guideline for antibiotic prophylaxis prior to invasive dental procedures: Strengths and pitfalls. SPECIAL CARE IN DENTISTRY 2022; 42:203-205. [DOI: https:/doi.org/10.1111/scd.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 08/30/2023]
Affiliation(s)
- Nima Farshidfar
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | - Shahram Hamedani
- Oral and Dental Disease Research Center, School of Dentistry Shiraz University of Medical Sciences Shiraz Iran
| | - Mohammad Amin Amiri
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | | | - Saeed Nemati
- Books and Journals Group Shiraz University of Medical Sciences Shiraz Iran
| |
Collapse
|
29
|
Ferre-Aracil C, El Hajra Martínez I, Vera Mendoza MI, Ramos Martínez A, Muñez Rubio E, Fernández-Cruz A, Matallana Royo V, García-Maseda S, Sánchez Romero I, Martínez Ruiz R, Calleja Panero JL. El trasplante de microbiota fecal es un tratamiento sencillo, efectivo y seguro en el manejo de la infección por C. difficile en la práctica clínica diaria. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
30
|
Cantón R, Barberán J, Linares M, Molero JM, Rodríguez-González-Moro JM, Salavert M, González Del Castillo J. Decalogue for the selection of oral antibiotics for lower respiratory tract infections. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:16-29. [PMID: 35041328 PMCID: PMC8790641 DOI: 10.37201/req/172.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/12/2022] [Indexed: 12/28/2022]
Abstract
Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options beta-lactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected.
Collapse
Affiliation(s)
- R Cantón
- Rafael Cantón. Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid. Spain.
| | | | | | | | | | | | - J González Del Castillo
- Juan Gonzalez del Castillo. Servicio de Urgencias, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| |
Collapse
|
31
|
Phanchana M, Harnvoravongchai P, Wongkuna S, Phetruen T, Phothichaisri W, Panturat S, Pipatthana M, Charoensutthivarakul S, Chankhamhaengdecha S, Janvilisri T. Frontiers in antibiotic alternatives for Clostridioides difficile infection. World J Gastroenterol 2021; 27:7210-7232. [PMID: 34876784 PMCID: PMC8611198 DOI: 10.3748/wjg.v27.i42.7210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/12/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Clostridioides difficile (C. difficile) is a gram-positive, anaerobic spore-forming bacterium and a major cause of antibiotic-associated diarrhea. Humans are naturally resistant to C. difficile infection (CDI) owing to the protection provided by healthy gut microbiota. When the gut microbiota is disturbed, C. difficile can colonize, produce toxins, and manifest clinical symptoms, ranging from asymptomatic diarrhea and colitis to death. Despite the steady-if not rising-prevalence of CDI, it will certainly become more problematic in a world of antibiotic overuse and the post-antibiotic era. C. difficile is naturally resistant to most of the currently used antibiotics as it uses multiple resistance mechanisms. Therefore, current CDI treatment regimens are extremely limited to only a few antibiotics, which include vancomycin, fidaxomicin, and metronidazole. Therefore, one of the main challenges experienced by the scientific community is the development of alternative approaches to control and treat CDI. In this Frontier article, we collectively summarize recent advances in alternative treatment approaches for CDI. Over the past few years, several studies have reported on natural product-derived compounds, drug repurposing, high-throughput library screening, phage therapy, and fecal microbiota transplantation. We also include an update on vaccine development, pre- and pro-biotics for CDI, and toxin antidote approaches. These measures tackle CDI at every stage of disease pathology via multiple mechanisms. We also discuss the gaps and concerns in these developments. The next epidemic of CDI is not a matter of if but a matter of when. Therefore, being well-equipped with a collection of alternative therapeutics is necessary and should be prioritized.
Collapse
Affiliation(s)
- Matthew Phanchana
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | | | - Supapit Wongkuna
- Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Tanaporn Phetruen
- Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Wichuda Phothichaisri
- Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Supakan Panturat
- Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Methinee Pipatthana
- Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Sitthivut Charoensutthivarakul
- School of Bioinnovation and Bio-based Product Intelligence, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | | | - Tavan Janvilisri
- Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| |
Collapse
|
32
|
Abstract
Fluoroquinolones are broad-spectrum antibiotics with good oral bioavailability. They are used for the treatment of a wide variety of infections, but there are restrictions on prescribing these drugs. Epidemiological studies have reported an increased risk of rare adverse effects. These include tendinopathy and tendon rupture, peripheral neuropathy and aortic aneurysm. Safe prescribing of fluroquinolones requires recognition of patients with risk factors for toxicity. Prompt drug discontinuation is recommended in the event of an adverse reaction. Practising antimicrobial stewardship by prescribing fluoroquinolones only when alternative drugs are unavailable is also key to limiting adverse events and antibiotic resistance.
Collapse
Affiliation(s)
- Diva Baggio
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Health.,General Medicine Unit, Alfred Health.,Central Clinical School, Monash University.,Melbourne
| | - Michelle R Ananda-Rajah
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Health.,General Medicine Unit, Alfred Health.,Central Clinical School, Monash University.,Melbourne
| |
Collapse
|
33
|
Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing. Infect Control Hosp Epidemiol 2021; 42:1361-1368. [PMID: 33843527 PMCID: PMC9999290 DOI: 10.1017/ice.2021.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. METHODS Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. RESULTS Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were "completely" accepted had lower fluoroquinolone rates than sites where it was "moderately" accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) "would" or "may" be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. CONCLUSIONS PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.
Collapse
|
34
|
Uda A, Onuma K, Shigemura K, Kitagawa K, Yan Y, Osawa K, Yano I, Miyara T. Impact of Cefazolin Shortage on Clinical Outcomes of Adult Patients with Bacteremia Caused by Methicillin-Susceptible Staphylococcus aureus in a Tertiary Care University Hospital. Antibiotics (Basel) 2021; 10:antibiotics10101247. [PMID: 34680827 PMCID: PMC8532967 DOI: 10.3390/antibiotics10101247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
Cefazolin is an essential antibiotic used for treating bacteremia; in particular, it is recommended as a first-line agent for infections caused by methicillin-susceptible Staphylococcusaureus (MSSA). In March 2019, problems with a major antibiotic supplier caused a critical shortage of cefazolin in Japan; however, the impact of the cefazolin shortage on clinical outcomes remains unknown. This study aimed to evaluate the effect of the cefazolin shortage in patients with MSSA bacteremia. Data from 75 patients were compared between the pre-shortage (March 2018–January 2019, n = 39) and post-shortage (March 2019–January 2020, n = 36) periods. There were no significant differences in the demographic characteristics between the two groups, and the cefazolin shortage did not worsen clinical outcomes such as adverse drug reactions, treatment failure, and 30-day mortality. In the post-shortage group, ampicillin/sulbactam and benzylpenicillin were more frequently administered as alternative antibiotics for empirical and definitive therapy (10% vs. 31%, p = 0.042; 0% vs. 19%, p = 0.004, respectively). Multivariate analysis revealed that the broad-spectrum antibiotics for definitive therapy, such as antipseudomonal penicillin, were associated with treatment failure in patients with MSSA bacteremia (OR = 17, p = 0.003). Hence, narrow-spectrum antibiotics should be prescribed for MSSA bacteremia as alternatives during a cefazolin shortage.
Collapse
Affiliation(s)
- Atsushi Uda
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan;
- Correspondence: ; Tel.: +81-78-382-5111
| | - Kenichiro Onuma
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Department of Clinical Laboratory, Kobe University Hospital, Kobe 650-0017, Japan
| | - Katsumi Shigemura
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Koichi Kitagawa
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Division of Advanced Medical Science, Kobe University Graduate School of Science, Technology and Innovation, Kobe 657-8501, Japan
| | - Yonmin Yan
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Kayo Osawa
- Department of Medical Technology, Kobe Tokiwa University, Kobe 653-0838, Japan;
| | - Ikuko Yano
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan;
| | - Takayuki Miyara
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
| |
Collapse
|
35
|
Potential Cost Savings Associated with Targeted Substitution of Current Guideline-Concordant Inpatient Agents with Omadacycline for the Treatment of Adult Hospitalized Patients with Community-Acquired Bacterial Pneumonia at High Risk for Clostridioides difficile Infections: Results of Healthcare-Decision Analytic Model from the United States Hospital Perspective. Antibiotics (Basel) 2021; 10:antibiotics10101195. [PMID: 34680776 PMCID: PMC8532985 DOI: 10.3390/antibiotics10101195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Approximately 3% of hospitalized patients with community-acquired bacterial pneumonia (CABP) develop healthcare-associated Clostridioides difficile infection (HCA-CDI). The validated Davis risk score (DRS) indicates that patients with a DRS ≥ 6 are at an increased risk of 30-day HCA-CDI. In the phase 3 OPTIC CABP study, 14% of CABP patients with DRS ≥ 6 who received moxifloxacin developed CDI vs. 0% for omadacycline. This study assessed the potential economic impact of substituting current guideline-concordant CABP inpatient treatments with omadacycline in hospitalized CABP patients with a DRS ≥ 6 across US hospitals. Methods: A deterministic healthcare-decision analytic model was developed. The model population was hospitalized adult CABP patients with a DRS ≥ 6 across US hospitals (100,000 patients). In the guideline-concordant arm, 14% of CABP patients with DRS ≥ 6 were assumed to develop an HCA-CDI, each costing USD 20,100. In the omadacycline arm, 5 days of therapy was calculated for the entire model population. Results: The use of omadacycline in place of guideline-concordant CABP inpatient treatments for CABP patients with DRS ≥ 6 was estimated to result in cost savings of USD 55.4 million annually across US hospitals. Conclusion: The findings of this simulated model suggest that prioritizing the use of omadacycline over current CABP treatments in hospitalized CABP with a DRS ≥ 6 may potentially reduce attributable HCA-CDI costs. The findings are not unique to omadacycline and could be applied to any antibiotic that confers a lower risk of HCA-CDI relative to current CABP inpatient treatments.
Collapse
|
36
|
Farshidfar N, Hamedani S, Amiri MA, Tovani-Palone MR, Nemati S. Modifications to the 2021 American Heart Association guideline for antibiotic prophylaxis prior to invasive dental procedures: Strengths and pitfalls. SPECIAL CARE IN DENTISTRY 2021; 42:203-205. [PMID: 34591993 DOI: 10.1111/scd.12655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Nima Farshidfar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Hamedani
- Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Amiri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Saeed Nemati
- Books and Journals Group, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
37
|
Farshidfar N, Hamedani S, Amiri MA, Tovani‐Palone MR, Nemati S. Modifications to the 2021 American Heart Association guideline for antibiotic prophylaxis prior to invasive dental procedures: Strengths and pitfalls. SPECIAL CARE IN DENTISTRY 2021. [DOI: https://doi.org/10.1111/scd.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nima Farshidfar
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | - Shahram Hamedani
- Oral and Dental Disease Research Center, School of Dentistry Shiraz University of Medical Sciences Shiraz Iran
| | - Mohammad Amin Amiri
- Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | | | - Saeed Nemati
- Books and Journals Group Shiraz University of Medical Sciences Shiraz Iran
| |
Collapse
|
38
|
Koo H, Morrow CD. Incongruence between dominant commensal donor microbes in recipient feces post fecal transplant and response to anti-PD-1 immunotherapy. BMC Microbiol 2021; 21:251. [PMID: 34544375 PMCID: PMC8454007 DOI: 10.1186/s12866-021-02312-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background To understand inter-individual variability of fecal microbe transplantation (FMT) to enhance anti-PD-1 immunotherapy (IT) for melanoma, we analyzed the data sets from two recent publications with a microbial strain-tracking tool to determine if donor strains were dominant in the recipient feces following FMT. Results Analysis of the Baruch et al. data set found that the presence of commensal donor microbes in recipient feces post-FMT did not correlate with the patient response to IT. From the Davar et al., data set, we found 4 patients that responded to IT had donor’s related strain post-FMT, while 2 patients that did not respond to the IT also had donor’s strain post-FMT. Importantly, we identified no donor microbes in the feces in one recipient post-FMT that responded to IT. Furthermore, in depth analysis from two patients who responded to IT revealed both donor and recipient strains at different times post-FMT. Colonization of the gastrointestinal tract niches is important for the interaction with the host immune system. Using a separate data set, we show that mucosa from the cecum, transverse colon, and sigmoid colon share strains, providing a large reservoir of niches containing recipient microbes. Conclusions We demonstrated using strain-tracking analysis individual variation with the respect to the presence of fecal dominant donor microbes in the recipient following FMT that did not correlate with the response to anti-PD-1 immunotherapy. The inter-individual differences of FMT to enhance IT might be explained by the variability of the donor microbes to occupy and outcompete recipient microbes for the gastrointestinal niches. The result from our study supports the use of new approaches to clear the niches in the gastrointestinal tract to promote donor colonization to reduce inter-individual variability of IT for melanoma and potentially other cancers. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-021-02312-0.
Collapse
Affiliation(s)
- Hyunmin Koo
- Department of Genetics Hugh Kaul Personalized Medicine Institute, University of Alabama at Birmingham, Alabama, Birmingham, USA.
| | - Casey D Morrow
- Department of Cell, Developmental and Integrative Biology Hugh Kaul Personalized Medicine Institute, University of Alabama at Birmingham, Alabama, Birmingham, USA.
| |
Collapse
|
39
|
Schechner V, Fallach N, Braun T, Temkin E, Carmeli Y. Antibiotic exposure and the risk of hospital-acquired diarrhoea and Clostridioides difficile infection: a cohort study. J Antimicrob Chemother 2021; 76:2182-2185. [PMID: 33969419 DOI: 10.1093/jac/dkab151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospital-acquired diarrhoea (HAD) and Clostridioides difficile infection (CDI) may be triggered by antibiotic use. OBJECTIVES To determine the effect of specific antibiotic agents and duration of therapy on the risk of HAD and CDI. PATIENTS AND METHODS A single-centre retrospective cohort study was conducted between May 2012 and December 2014 in the internal medicine division. HAD was defined based on documentation of diarrhoea in the medical record or an uncancelled C. difficile test in the laboratory database. CDI was diagnosed using a two-step test (initial glutamate dehydrogenase and toxin A/B EIA, with PCR for discrepant results). Outcomes first occurred on hospital Day 4 or later. Treatment with antibiotics and days of therapy were modelled. RESULTS In 29 063 hospitalizations there were 970 HAD events [incidence rate per 10 000 patient days (IR) = 38.5] and 105 CDI events (IR = 3.9). Any antibiotic treatment increased the risk of HAD [adjusted relative risk (aRR) 2.79; 95% CI 2.27-3.43] and CDI (aRR 5.31; 95% CI 2.23-12.69). Each day of β-lactam/β-lactamase inhibitors (βL/βLIs), carbapenems, IV glycopeptides and metronidazole increased the risk of HAD. Each day of βL/βLIs, third- and fourth-generation cephalosporins and carbapenems increased the risk of CDI by over 2%. CONCLUSIONS Preventing HAD and CDI should focus on reducing the overall use of antibiotics and shortening antibiotic exposure, rather than focusing on specific agents.
Collapse
Affiliation(s)
- Vered Schechner
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Noga Fallach
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Tali Braun
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Yehuda Carmeli
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| |
Collapse
|
40
|
Macy E. Why Was There Ever a Warning Not to Use Cephalosporins in the Setting of a Penicillin "Allergy"? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3929-3933. [PMID: 34303019 DOI: 10.1016/j.jaip.2021.06.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022]
Abstract
It is now well-established that avoiding β-lactam antibiotics, when they are the drugs of choice, results in significantly worse long-term global outcomes for patients. Much of this avoidable morbidity has been caused by widespread warnings in electronic health care record systems not to use cephalosporins in the setting of penicillin allergy. High rates, up to 1000-fold higher than now seen, of immunologically mediated reactions were associated with early impure penicillin preparations. This instilled a rational fear of β-lactam-associated anaphylaxis in generations of physicians. In the late 1970s, several editorial comments regarding a potential increased risk to patients given cephalosporins who had a history of a penicillin allergy resulted in the warning that became imbedded in the culture of medicine. Over the past 40 years, compelling data have been developed that refute this warning and showed that the risks of avoiding cephalosporins outweighed the benefits. In late 2017, Kaiser Permanente Southern California completely removed all warnings not to use cephalosporins in the setting of a penicillin allergy. The results have recently been published in JAMA Network Open. This Rostrum article provides some of the backstory on the establishment and removal of this warning for physicians who trained over the past 30 years.
Collapse
Affiliation(s)
- Eric Macy
- Allergy Department, Kaiser San Diego Medical Center, Permanente Southern California, San Diego, Calif.
| |
Collapse
|
41
|
Mason JD, Terwilliger DW, Pote AR, Myers AG. Practical Gram-Scale Synthesis of Iboxamycin, a Potent Antibiotic Candidate. J Am Chem Soc 2021; 143:11019-11025. [PMID: 34264649 DOI: 10.1021/jacs.1c03529] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A gram-scale synthesis of iboxamycin, an antibiotic candidate bearing a fused bicyclic amino acid residue, is presented. A pivotal transformation in the route involves an intramolecular hydrosilylation-oxidation sequence to set the ring-fusion stereocenters of the bicyclic scaffold. Other notable features of the synthesis include a high-yielding, highly diastereoselective alkylation of a pseudoephenamine amide, a convergent sp3-sp2 Negishi coupling, and a one-pot transacetalization-reduction reaction to form the target compound's oxepane ring. Implementation of this synthetic strategy has provided ample quantities of iboxamycin to allow for its in vivo profiling in murine models of infection.
Collapse
Affiliation(s)
- Jeremy D Mason
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Daniel W Terwilliger
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Aditya R Pote
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Andrew G Myers
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| |
Collapse
|
42
|
Safety of administering cefazolin versus other antibiotics in penicillin-allergic patients for surgical prophylaxis at a major Canadian teaching hospital. Surgery 2021; 170:783-789. [PMID: 33894984 DOI: 10.1016/j.surg.2021.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/10/2021] [Accepted: 03/06/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cefazolin surgical prophylaxis is associated with better patient outcomes; however, its use in penicillin-allergic patients is controversial. We evaluated the safety of cefazolin as surgical prophylaxis in penicillin-allergic patients, including those with anaphylaxis histories. METHODS We conducted a pre and postintervention quality improvement evaluation of an institution-wide policy change at a tertiary-care hospital, before (October 2017-January 2018), during (February 2018-September 2018), and after (October 2018-October 2019) transition to routine cefazolin prophylaxis for penicillin-allergic patients, including those with anaphylaxis histories but excluding severe delayed reactions (eg, Stevens-Johnson syndrome). Retrospective data was collected on all surgical prophylaxis patients with penicillin-anaphylactic histories between October 2017 and September 2018. From October 2018, we prospectively reviewed adverse events with cefazolin. Primary outcome was adverse events in penicillin-allergic patients receiving cefazolin perioperatively. RESULTS From October 2017 to October 2019, 27,467 operations were performed. Of 220 patients with penicillin-anaphylactic histories reviewed prior to the full policy change, no statistically significant differences were reported in allergic reactions (P = .70), surgical site infections (P = 1.00), or adverse events (P = .32) with cefazolin compared to other antibiotics. Postpolicy implementation, cefazolin usage increased 18.2%, while vancomycin and clindamycin decreased by 11.4% and 62.0%, respectively. No anaphylaxis was documented in penicillin-allergic patients receiving cefazolin in either the review or quality assurance follow-up after the change. Of 3 patients developing reactions to cefazolin, none had histories of penicillin allergy. Surgical site infection rates were similar between pre and postpolicy time periods (P = .842). CONCLUSION Administration of cefazolin in penicillin-anaphylactic patients for surgical prophylaxis appears to be safe.
Collapse
|
43
|
Berkell M, Mysara M, Xavier BB, van Werkhoven CH, Monsieurs P, Lammens C, Ducher A, Vehreschild MJGT, Goossens H, de Gunzburg J, Bonten MJM, Malhotra-Kumar S. Microbiota-based markers predictive of development of Clostridioides difficile infection. Nat Commun 2021; 12:2241. [PMID: 33854066 PMCID: PMC8047037 DOI: 10.1038/s41467-021-22302-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Antibiotic-induced modulation of the intestinal microbiota can lead to Clostridioides difficile infection (CDI), which is associated with considerable morbidity, mortality, and healthcare-costs globally. Therefore, identification of markers predictive of CDI could substantially contribute to guiding therapy and decreasing the infection burden. Here, we analyze the intestinal microbiota of hospitalized patients at increased CDI risk in a prospective, 90-day cohort-study before and after antibiotic treatment and at diarrhea onset. We show that patients developing CDI already exhibit significantly lower diversity before antibiotic treatment and a distinct microbiota enriched in Enterococcus and depleted of Ruminococcus, Blautia, Prevotella and Bifidobacterium compared to non-CDI patients. We find that antibiotic treatment-induced dysbiosis is class-specific with beta-lactams further increasing enterococcal abundance. Our findings, validated in an independent prospective patient cohort developing CDI, can be exploited to enrich for high-risk patients in prospective clinical trials, and to develop predictive microbiota-based diagnostics for management of patients at risk for CDI.
Collapse
Affiliation(s)
- Matilda Berkell
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Mohamed Mysara
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
- Microbiology Unit, Interdisciplinary Biosciences, Belgian Nuclear Research Centre, SCK-CEN, Mol, Belgium
| | - Basil Britto Xavier
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Cornelis H van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Pieter Monsieurs
- Microbiology Unit, Interdisciplinary Biosciences, Belgian Nuclear Research Centre, SCK-CEN, Mol, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christine Lammens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | | | - Maria J G T Vehreschild
- Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | | | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium.
| |
Collapse
|
44
|
Mizusawa M, Carroll KC. Advances and required improvements in methods to diagnosing Clostridioides difficile infections in the healthcare setting. Expert Rev Mol Diagn 2021; 21:311-321. [PMID: 33682564 DOI: 10.1080/14737159.2021.1900737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Clostrididioides difficile is associated with adverse clinical outcomes and increased morbidity, mortality, length of hospital stay, and health-care costs.Areas Covered: We searched relevant papers in PubMed for the last 10 years. In major papers, we scanned the bibliographies to ensure that important articles were included. This review addresses the evolving epidemiology of Clostridioides difficile infection (CDI) and discusses novel methods/approaches for improving the diagnosis of this important disease. EXPERT OPINION No single diagnostic test to date has demonstrated optimum sensitivity and specificity for detection of CDI. Many institutions have developed multi-step algorithms consistent with guidelines established by various professional societies. Some institutions have successfully tried to improve the pretest probability of molecular assays by implementing appropriate sample rejection criteria and establishing best practice alerts at the time of electronic order entry. Others have established PCR cycle threshold cutoffs to attempt to differentiate symptomatic patients from asymptomatic carriers or to make predictions about severity of disease with variable success. As research advances our understanding of C. difficile pathogenesis and pathophysiology, more information on CDI specific biomarkers is emerging. Finally, assessments of the microbiome and metabolome may expand the diagnostic armamentarium with advances in mass spectrometry and sequencing technologies.
Collapse
Affiliation(s)
- Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri, Kansas City, Missouri, Kansas City, MO, USA
| | - Karen C Carroll
- Director Division of Medical Microbiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
45
|
Goff DA, Mangino JE, Glassman AH, Goff D, Larsen P, Scheetz R. Review of Guidelines for Dental Antibiotic Prophylaxis for Prevention of Endocarditis and Prosthetic Joint Infections and Need for Dental Stewardship. Clin Infect Dis 2021; 71:455-462. [PMID: 31728507 DOI: 10.1093/cid/ciz1118] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
Dentists prescribe 10% of all outpatient antibiotic prescriptions, writing more than 25.7 million prescriptions per year. Many are for prophylaxis in patients with prosthetic joint replacements; the American Dental Society states that "in general," prophylactic antibiotics are not recommended to prevent prosthetic joint infections. Orthopedic surgeons are concerned with the risk of implant infections following a dental procedure and, therefore, see high value and low risk in recommending prophylaxis. Patients are "stuck in the middle," with conflicting recommendations from orthopedic surgeons (OS) and dentists. Unnecessary prophylaxis and fear of lawsuits amongst private practice dentists and OS has not been addressed. We review The American Heart Association/American College of Cardiology, American Dental Association, and American Association of Orthopedic Surgeons' guidelines on dental antibiotic prophylaxis for the prevention of endocarditis and prosthetic joint infections. We provide experience on how to engage private-practice dentists and OS in dental stewardship using a community-based program.
Collapse
Affiliation(s)
- Debra A Goff
- The Ohio State University Wexner Medical Center, The Ohio State University College of Pharmacy, Columbus, Ohio, USA
| | - Julie E Mangino
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrew H Glassman
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Douglas Goff
- Drs. Gilbert and Goff Prosthodontists, Columbus, Ohio, USA
| | - Peter Larsen
- Division of Oral and Maxillofacial Surgery and Dental Anesthesiology, The Ohio State University College of Dentistry, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Scheetz
- Drs. Scheetz and Rekos Oral and Facial Surgeons of Ohio, Dublin, Ohio, USA
| |
Collapse
|
46
|
Meryk A, Kropshofer G, Bargehr C, Knoll M, Hetzer B, Lass-Flörl C, Crazzolara R. Which Type of Empiric Antibiotic Therapy is Appropriate? A 20-Year Retrospective Study of Bloodstream Infections in Childhood Cancer. Infect Dis Ther 2021; 10:789-800. [PMID: 33704685 PMCID: PMC8116419 DOI: 10.1007/s40121-021-00427-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Sufficient empirical antimicrobial therapy in febrile patients with cancer is challenging, owing to the limited arsenal of available antibiotics in an era of growing resistance. Because of the emergence of gram-negative bacteria resistant to ceftazidime and piperacillin, a combination antibiotic therapy was employed that uses meropenem combined with gentamicin and/or vancomycin if the patient further deteriorates. METHODS A retrospective cohort analysis was performed including all patients with catheter-associated bloodstream infections (BSIs) and treated for childhood cancer in a tertiary single centre between 1 January 2000 and 31 June 2018. We calculated the prevalence and the risk for BSIs and compared the in vitro susceptibility to various antimicrobial agents. RESULTS Of 653 patients with childhood cancer, 113 patients (17.3%) were identified with a total of 139 BSIs, most of them occurring in patients with leukaemia (n = 90, 64.7%) and were associated with gram-positive bacteria (60.5%). In our cohort, all BSIs with gram-negative bacteria exhibited in vitro susceptibility against meropenem alone without any signs of resistance development. The antibiotic coverage of our meropenem-based combination therapy was also highly effective for gram-positive and non-fermenting bacteria. Thus, BSI-related mortality in all 139 BSI episodes was 1.4%. Clostridium difficile infections (CDIs), as main adverse event of carbapenem usage, occurred in only 16 (2.5%) patients. CONCLUSION Our meropenem-based combination therapy showed sufficient empirical antibiotic coverage in the majority of BSIs (96.4%) and did not result in an increased rate of unwanted side effects or development of antibiotic resistance.
Collapse
Affiliation(s)
- Andreas Meryk
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Caroline Bargehr
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Miriam Knoll
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Hetzer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
| |
Collapse
|
47
|
Engineered Phage Endolysin Eliminates Gardnerella Biofilm without Damaging Beneficial Bacteria in Bacterial Vaginosis Ex Vivo. Pathogens 2021; 10:pathogens10010054. [PMID: 33435575 PMCID: PMC7830407 DOI: 10.3390/pathogens10010054] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
Bacterial vaginosis is characterized by an imbalance of the vaginal microbiome and a characteristic biofilm formed on the vaginal epithelium, which is initiated and dominated by Gardnerella bacteria, and is frequently refractory to antibiotic treatment. We investigated endolysins of the type 1,4-beta-N-acetylmuramidase encoded on Gardnerella prophages as an alternative treatment. When recombinantly expressed, these proteins demonstrated strong bactericidal activity against four different Gardnerella species. By domain shuffling, we generated several engineered endolysins with 10-fold higher bactericidal activity than any wild-type enzyme. When tested against a panel of 20 Gardnerella strains, the most active endolysin, called PM-477, showed minimum inhibitory concentrations of 0.13–8 µg/mL. PM-477 had no effect on beneficial lactobacilli or other species of vaginal bacteria. Furthermore, the efficacy of PM-477 was tested by fluorescence in situ hybridization on vaginal samples of fifteen patients with either first time or recurring bacterial vaginosis. In thirteen cases, PM-477 killed the Gardnerella bacteria and physically dissolved the biofilms without affecting the remaining vaginal microbiome. The high selectivity and effectiveness in eliminating Gardnerella, both in cultures of isolated strains as well as in clinically derived samples of natural polymicrobial biofilms, makes PM-477 a promising alternative to antibiotics for the treatment of bacterial vaginosis, especially in patients with frequent recurrence.
Collapse
|
48
|
Knežević D, Petković M. Faecal transplantation and Clostridioides difficile infection. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-32752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Faecal microbiota transplantation (FMT), known equally well as faecal transplantation or faecal bacteriotherapy, is the process of implanting the faecal suspension containing balanced microbiota from a healthy donor to the colon of a recipient patient. Excessive growth of Clostridioides difficile (C difficile) in the intestinal microbiota resulting from antibiotic consumption is currently a rising threat to public health. FMT is one of the most important, newer approaches to treating C difficile infections. Since C difficile is regarded as an opportunistic bacterium triggering disease in conditions of disturbed homeostasis of the intestinal microbiota, restoration of healthy intestinal microflora facilitates suppression of toxic strain of C difficile by anaerobic bacteria of normal intestinal microflora with concomitant cure. Nurses have important role in caring for patients after faecal transplantation.
Collapse
|
49
|
Gu SL, Gong Y, Zhang J, Chen Y, Wu Z, Xu Q, Fang Y, Wang J, Tang LL. Effect of the Short-Term Use of Fluoroquinolone and β-Lactam Antibiotics on Mouse Gut Microbiota. Infect Drug Resist 2020; 13:4547-4558. [PMID: 33376361 PMCID: PMC7762438 DOI: 10.2147/idr.s281274] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Antibiotics play an important role in the treatment of infectious diseases. However, the overuse of antibiotics increases the spread of drug-resistant bacteria and causes dysbiosis of the intestinal microbiota. Few studies have addressed the longitudinal effects of antibiotics on the microbiome and host immunity. MATERIALS AND METHODS In this study, the short-term effect of fluoroquinolone (levofloxacin) and β-lactam antibiotics (meropenem, cefoperazone/sulbactam, and aztreonam) on the gut microbiota of mice was evaluated by 16S rRNA gene sequencing. The susceptibility of Bifidobacterium longum, Lactobacillus lactis, Enterococcus faecium, and Clostridium butyricum to these antimicrobial agents was assessed using the disc diffusion method. RESULTS Our results showed that 4-day antibiotic exposure significantly reduced the alpha and beta diversity of gut bacteria and increased serum inflammatory cytokines, and these changes persisted long after antibiotic withdrawal and did not return to pre-treatment levels. Nonetheless, the bacterial community composition tended to return to pre-treatment levels after discontinuing treatment. The tested probiotic strains were resistant to aztreonam but were sensitive to meropenem and cefoperazone/sulbactam. CONCLUSION Short-term antibiotic treatment led to significant changes in the intestinal flora with a tendency to recover. The antibiotics had different effects on the intestinal microbial community and probiotic strains. This study provides guidance for the concomitant use of probiotics and antibiotics, and the results emphasize the importance of using broad-spectrum antibiotics responsibly to prevent the long-term disruption of the native microbiota.
Collapse
Affiliation(s)
- Si-Lan Gu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou310003, People’s Republic of China
| | - Yiwen Gong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou310003, People’s Republic of China
| | - Jiaying Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou310003, People’s Republic of China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou310003, People’s Republic of China
| | - Zhengjie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou310003, People’s Republic of China
| | - Qiaomai Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou310003, People’s Republic of China
| | - Yunhui Fang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou310003, People’s Republic of China
| | - Jingxia Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou310003, People’s Republic of China
| | - Ling-Ling Tang
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Hangzhou310000, People’s Republic of China
| |
Collapse
|
50
|
Vedamurthy A, Rajendran I, Manian F. Things We Do for No Reason™: Routine Coverage of Anaerobes in Aspiration Pneumonia. J Hosp Med 2020; 15:754-756. [PMID: 32966204 DOI: 10.12788/jhm.3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 03/25/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Amar Vedamurthy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Iniya Rajendran
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Farrin Manian
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|