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Piddock LJV, Alimi Y, Anderson J, de Felice D, Moore CE, Røttingen JA, Skinner H, Beyer P. Advancing global antibiotic research, development and access. Nat Med 2024; 30:2432-2443. [PMID: 39227444 DOI: 10.1038/s41591-024-03218-w] [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: 03/27/2024] [Accepted: 07/30/2024] [Indexed: 09/05/2024]
Abstract
The pipeline of new antibiotics is insufficient to keep pace with the growing global burden of drug-resistant infections. Substantial economic challenges discourage private investment in antibiotic research and development (R&D), with a decline in the number of companies and researchers working in the field. Compounding these issues, many countries (from low income to high income) face a growing crisis of antibiotic shortages and inequitable access to existing and emerging treatments. This has led to an increasing role for public and philanthropic funding in supporting antibiotic R&D via the creation of nonprofit public-private partnerships, including Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) and the Global Antibiotic Research and Development Partnership (GARDP), industry support for the AMR Action Fund, and pilot schemes to evaluate and reimburse antibiotics in innovative ways. Now is the time to raise the urgency, ambition and commitments of the world's leaders to fully support the antibiotic R&D ecosystem, incentivizing all sectors to conduct public health-driven antibiotic R&D and make effective antibiotics accessible to all who need them.
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Affiliation(s)
- Laura J V Piddock
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland.
| | - Yewande Alimi
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - James Anderson
- International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), Geneva, Switzerland
| | | | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, St George's, University of London, London, UK
| | | | | | - Peter Beyer
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
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2
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Calcagno A, Coppola N, Sarmati L, Tadolini M, Parrella R, Matteelli A, Riccardi N, Trezzi M, Di Biagio A, Pirriatore V, Russo A, Gualano G, Pontali E, Surace L, Falbo E, Mencarini J, Palmieri F, Gori A, Schiuma M, Lapadula G, Goletti D. Drugs for treating infections caused by non-tubercular mycobacteria: a narrative review from the study group on mycobacteria of the Italian Society of Infectious Diseases and Tropical Medicine. Infection 2024; 52:737-765. [PMID: 38329686 PMCID: PMC11142973 DOI: 10.1007/s15010-024-02183-3] [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: 10/30/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) are generally free-living organism, widely distributed in the environment, with sporadic potential to infect. In recent years, there has been a significant increase in the global incidence of NTM-related disease, spanning across all continents and an increased mortality after the diagnosis has been reported. The decisions on whether to treat or not and which drugs to use are complex and require a multidisciplinary approach as well as patients' involvement in the decision process. METHODS AND RESULTS This review aims at describing the drugs used for treating NTM-associated diseases emphasizing the efficacy, tolerability, optimization strategies as well as possible drugs that might be used in case of intolerance or resistance. We also reviewed data on newer compounds highlighting the lack of randomised clinical trials for many drugs but also encouraging preliminary data for others. We also focused on non-pharmacological interventions that need to be adopted during care of individuals with NTM-associated diseases CONCLUSIONS: Despite insufficient efficacy and poor tolerability this review emphasizes the improvement in patients' care and the needs for future studies in the field of anti-NTM treatments.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.
- Stop TB Italy, Milan, Italy.
| | - N Coppola
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - L Sarmati
- Department of System Medicine, Tor Vergata University and Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - M Tadolini
- Stop TB Italy, Milan, Italy
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - R Parrella
- Stop TB Italy, Milan, Italy
- Respiratory Infectious Diseases Unit, Cotugno Hospital, A. O. R. N. dei Colli, Naples, Italy
| | - A Matteelli
- Institute of Infectious and Tropical Diseases, WHO Collaborating Centre for TB Prevention, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - N Riccardi
- Stop TB Italy, Milan, Italy
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - M Trezzi
- Stop TB Italy, Milan, Italy
- Infectious and Tropical Diseases Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - A Di Biagio
- Infectious Diseases Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - V Pirriatore
- Stop TB Italy, Milan, Italy
- Unit of Infectious Diseases, "DivisioneA", Ospedale Amedeo di Savoia, ASL CIttà di Torino, Turin, Italy
| | - A Russo
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Gualano
- Stop TB Italy, Milan, Italy
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - E Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - L Surace
- Stop TB Italy, Milan, Italy
- Dipartimento Di Prevenzione, Azienda Sanitaria Provinciale di Catanzaro, Centro di Medicina del Viaggiatore e delle Migrazioni, P. O. Giovanni Paolo II, Lamezia Terme, CZ, Italy
| | - E Falbo
- Stop TB Italy, Milan, Italy
- Dipartimento Di Prevenzione, Azienda Sanitaria Provinciale di Catanzaro, Centro di Medicina del Viaggiatore e delle Migrazioni, P. O. Giovanni Paolo II, Lamezia Terme, CZ, Italy
| | - J Mencarini
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - F Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - A Gori
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, ASST Fatebenefratelli Sacco-Ospedale Luigi Sacco-Polo Universitario and Università Degli Studi di Milano, Milano, Italy
| | - M Schiuma
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, ASST Fatebenefratelli Sacco-Ospedale Luigi Sacco-Polo Universitario and Università Degli Studi di Milano, Milano, Italy
| | - G Lapadula
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - D Goletti
- Stop TB Italy, Milan, Italy
- Translational Research Unit, Epidemiology Department, National Institute for Infectious Diseases-IRCCS L. Spallanzani, Rome, Italy
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Mittal N, Mittal R, Singh S, Godara S. The Availability of Essential Antimicrobials in Public and Private Sector Facilities: A Cross-Sectional Survey in a District of North India. Antibiotics (Basel) 2024; 13:131. [PMID: 38391517 PMCID: PMC10886159 DOI: 10.3390/antibiotics13020131] [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: 11/25/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024] Open
Abstract
(1) Background: There is a need to assess the availability of essential antimicrobials, as the availability of an antimicrobial is a critical element of its rational use. We aimed to assess the availability of antimicrobials listed in the National List of Essential Medicines 2015, India (primary list), and a selected (secondary) list comprised of agents indicated for commonly encountered infectious illnesses in various healthcare settings and to identify the reasons for their non-availability. (2) Methods: A cross-sectional survey of 25 public, private, and other sector pharmacies was carried out in Rohtak, a district of the North Indian state of Haryana, from April to June 2022. (3) Results: Most of the antimicrobials surveyed were optimally available in various sector pharmacies with the exception of benzathine benzylpenicillin, benzylpenicillin, cloxacillin, cefazolin, cefuroxime, cefadroxil, amphotericin B, and antimalarials. The most frequent reasons for limited availability were low demand, no prescriptions, and the non-listing of drugs in the state's essential medicine list. (4) Conclusions: Enough evidence needs to be generated with respect to the status of availability of essential antimicrobials from different regions of India as well as other lower-middle-income countries to devise measures for ascertaining better availability of these agents, especially antibiotics at regional, national, and global scales.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Rakesh Mittal
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Sukhbir Singh
- Department of Hospital Administration, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Sushila Godara
- Health Department, Government of Haryana, Panchkula 134109, Haryana, India
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Mittal N, Goel P, Goel K, Sharma R, Nath B, Singh S, Thangaraju P, Mittal R, Kahkasha K, Mithra P, Sahu R, Priyadarshini RP, Sharma N, Pala S, Rohilla SK, Kaushal J, Sah S, Rustagi S, Sah R, Barboza JJ. Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India. Antibiotics (Basel) 2023; 12:1496. [PMID: 37887197 DOI: 10.3390/antibiotics12101496] [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: 08/26/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Understanding the physicians' knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Parul Goel
- Department of Biochemistry, Shri Atal Bihari Vajpayee Government Medical College, Chhainsa, Faridabad 121004, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rashmi Sharma
- Department of Community Medicine, GMERS Medical College Sola, Ahmedabad 380060, India
| | - Bhola Nath
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raebareli 229405, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur 342001, India
| | | | - Rakesh Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Kahkasha Kahkasha
- Department of Biochemistry, All India Institute of Medical Sciences, Deoghar 814152, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal 575001, India
| | - Rajesh Sahu
- Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Raman P Priyadarshini
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal 609602, India
| | - Nikita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bilaspur 174037, India
| | - Star Pala
- Department of Community Medicine, NEIGRIHMS, Shillong 793018, India
| | - Suneel Kumar Rohilla
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Jyoti Kaushal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Sanjit Sah
- Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha 442001, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun 248007, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu 46000, Nepal
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Wu S, Tannous E, Haldane V, Ellen ME, Wei X. Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research. Implement Sci 2022; 17:30. [PMID: 35550169 PMCID: PMC9096759 DOI: 10.1186/s13012-022-01209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Behavior change interventions that aim to improve rational antibiotic use in prescribers and users have been widely conducted in both high- and LMICs. However, currently, no review has systematically examined challenges unique to LMICs and offered insights into the underlying contextual factors that influence these interventions. We adopted an implementation research perspective to systematically synthesize the implementation barriers and facilitators in LMICs. Methods We conducted literature searches in five electronic databases and identified studies that involved the implementation of behavior change interventions to improve appropriate antibiotic use in prescribers and users in LMICs and reported implementation barriers and facilitators. Behavior change interventions were defined using the behavior change wheel, and the coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research (CFIR). Results We identified 52 eligible studies, with the majority targeting prescribers practicing at tertiary facilities (N=39, 75%). The most commonly reported factors influencing implementation were found in the inner setting domain of the CFIR framework, particularly related to constraints in resources and the infrastructure of the facilities where interventions were implemented. Barriers related to the external policy environment (e.g., lack of national initiatives and policies on antibiotic use), and individual characteristics of target populations (e.g., reluctance to change prescribing behaviors) were also common, as well as facilitators related to intervention characteristics (e.g., embedding interventions in routine practice) and process (e.g., stakeholder engagement). We also provided insights into the interrelationships between these factors and the underlying causes contributing to the implementation challenges in LMICs. Conclusion We presented a comprehensive overview of the barriers and facilitators of implementing behavior change interventions to promote rational antibiotic use in LMICs. Our findings suggest that facilitating the implementation of interventions to improve rational antibiotic use needs comprehensive efforts to address challenges at policy, organizational, and implementation levels. Specific strategies include (1) strengthening political commitment to prompt mobilization of domestic resources and formulation of a sustainable national strategy on AMR, (2) improving the infrastructure of health facilities that allow prescribers to make evidence-based clinical decisions, and (3) engaging local stakeholders to improve their buy-in and facilitate contextualizing interventions. Trial registration PROSPERO: CRD42021252715. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01209-4.
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Affiliation(s)
- Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elias Tannous
- Faculty of Health Sciences, Department of Clinical Biochemistry and Pharmacology, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Pharmacy services, Hillel Yaffe Medical Center, Hadera, Israel
| | - Victoria Haldane
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Moriah E Ellen
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Clinical management of severe infections caused by carbapenem-resistant gram-negative bacteria: a worldwide cross-sectional survey addressing the use of antibiotic combinations. Clin Microbiol Infect 2021; 28:66-72. [PMID: 33975010 DOI: 10.1016/j.cmi.2021.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Optimal treatment of carbapenem-resistant Gram-negative bacteria (CR-GNB) infections is uncertain because of the lack of good-quality evidence and the limited effectiveness of available antibiotics. The aim of this survey was to investigate clinicians' prescribing strategies for treating CR-GNB infections worldwide. METHODS A 36-item questionnaire was developed addressing the following aspects of antibiotic prescribing: respondent's background, diagnostic and therapeutic availability, preferred antibiotic strategies and rationale for selecting combination therapy. Prescribers were recruited following the snowball sampling approach, and a post-stratification correction with inverse proportional weights was used to adjust the sample's representativeness. RESULTS A total of 1012 respondents from 95 countries participated in the survey. Overall, 298 (30%) of the respondents had local guidelines for treating CR-GNB at their facility and 702 (71%) had access to Infectious Diseases consultation, with significant discrepancies according to country economic status: 85% (390/502) in high-income countries versus 59% (194/283) in upper-medium-income countries and 30% (118/196) in lower-middle-income countries/lower-income-countries). Targeted regimens varied widely, ranging from 40 regimens for CR-Acinetobacter spp. to more than 100 regimens for CR-Enterobacteriaceae. Although the majority of respondents acknowledged the lack of evidence behind this choice, dual combination was the preferred treatment scheme and carbapenem-polymyxin was the most prescribed regimen, irrespective of pathogen and infection source. Respondents noticeably disagreed around the meaning of 'combination therapy' with 20% (150/783) indicating the simple addition of multiple compounds, 42% (321/783) requiring the presence of in vitro activity and 38% (290/783) requiring in vitro synergism. CONCLUSIONS Management of CR-GNB infections is far from being standardized. Strategic public health focused randomized controlled trials are urgently required to inform evidence-based treatment guidelines.
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Honda H, Murakami S, Tokuda Y, Tagashira Y, Takamatsu A. Critical National Shortage of Cefazolin in Japan: Management Strategies. Clin Infect Dis 2021; 71:1783-1789. [PMID: 32133482 DOI: 10.1093/cid/ciaa216] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/28/2020] [Indexed: 12/13/2022] Open
Abstract
The shortage of antimicrobials poses a global health threat. In Japan, for instance, the current, critical shortage of cefazolin, a first-line agent for the treatment of common infectious diseases and surgical antimicrobial prophylaxis, has had a substantial impact on inpatient care. A shortage of essential antimicrobial agents like cefazolin leads to increased consumption of alternative antimicrobial agents with broad-spectrum activity, with the unintended consequence of militating against antimicrobial stewardship efforts in inpatient settings and potentially promoting antimicrobial resistance. Although there is global awareness of the shortage of crucial antimicrobials, action to resolve this problem, especially with a view to preventing antimicrobial resistance and promoting antimicrobial stewardship, has been slow, possibly due to the failure to appreciate the urgency of the dilemma. A comprehensive plan for stabilizing antimicrobial access and international collaboration to secure a continuous supply of essential antimicrobials are urgently needed.
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Affiliation(s)
- Hitoshi Honda
- Division of Infectious Diseases and Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Shutaro Murakami
- Division of Infectious Diseases and Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yasuharu Tokuda
- Muribushi Project for Teaching Hospitals, Iso, Urasoe, Okinawa, Japan
| | - Yasuaki Tagashira
- Division of Infectious Diseases and Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Akane Takamatsu
- Division of Infectious Diseases and Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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Blisse M, Idelevich EA, Becker K. Investigation of In-Vitro Adaptation toward Sodium Bituminosulfonate in Staphylococcus aureus. Microorganisms 2020; 8:microorganisms8121962. [PMID: 33322073 PMCID: PMC7763802 DOI: 10.3390/microorganisms8121962] [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: 11/10/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/04/2022] Open
Abstract
The global increase in antimicrobial resistance has revived the interest in “old” substances with antimicrobial activity such as sodium bituminosulfonate. However, for those “old” compounds, scientific studies are still sparse and the ones available do not mostly meet the current standards. Since this compound is used for topical applications, investigation of a potential increase in minimal inhibitory concentrations (MICs) is of particular importance. For selection of phenotypes with decreased susceptibility, a collection of 30 genetically diverse methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) strains were cultured on bi-layered linear gradient agar plates containing sub-inhibitory concentrations of the active agents. The stability of phenotypes with increased MICs was determined by serial passage on agent-free medium. Within 10 passages, only slight and, in most cases, reversible increases in MSSA and MRSA MIC levels toward sodium bituminosulfonate were obtained. Fusidic acid, used as a control, showed exponential expansions in MIC based on mutations in the fusA gene (elongation factor G or EF-G) with no reduction during the recovery phase. The only marginal and largely reversible changes of S. aureus MICs after exposition to sodium bituminosulfonate indicate a low potential for resistance development.
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Affiliation(s)
- Marko Blisse
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (M.B.); (E.A.I.)
| | - Evgeny A. Idelevich
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (M.B.); (E.A.I.)
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (M.B.); (E.A.I.)
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-3834-86-5560
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de Arriba-Fernández A, Molina-Cabrillana MJ, Hernández-Aceituno A, García-López FJ. [Evaluation of training on the programs to optimize antimicrobial use in medical residents of the province of Las Palmas]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:399-409. [PMID: 32781824 PMCID: PMC7712345 DOI: 10.37201/req/066.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Antibiotic resistance is a threat to global public health. This situation makes essential to establish programs to optimize antimicrobial use (PROA). Training needs are identified in the PROA of resident physicians and the results of the analysis of the associations between study variables and training in the rational and prudent use of antibiotics are presented in this analysis. METHODS Cross-sectional and analytical study through a self-administered questionnaire to a group of 506 medical residents of the province of Las Palmas. The association between resident's characteristics and PROA training was calculated through logistic regression. RESULTS The associations between response variance and speciality were observed in most of the core component analysis (opportunity p=0.003, training p=0.007, motivation p=0.055 and hand hygiene p=0.044), followed by variance according to sex (capacity p=0.028, theoretical knowledge p=0.013, hand hygiene p=0.002). Very few differences were associated with age (capacity p=0.051 and hand hygiene p=0.054) or the year of expertise (hand hygiene p=0.032). CONCLUSIONS The main training needs of resident physicians include one health, motivation, training, hand hygiene and information. The type of speciality followed by sex are the most important determinants on antibiotic use and resistance for resident physicians.
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Affiliation(s)
- A de Arriba-Fernández
- Alejandro de Arriba-Fernández, Servicio de Medicina Preventiva, Hospital Insular de Gran Canaria, Avenida Marítima s/n, 35016. Las Palmas Gran Canaria. Spain.
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Idelevich EA, Becker K. In Vitro Activity of Sodium Bituminosulfonate: Susceptibility Data for the Revival of an Old Antimicrobial. Microb Drug Resist 2020; 26:1405-1409. [PMID: 32182162 DOI: 10.1089/mdr.2019.0390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Revival of old antibiotic compounds is a promising strategy to strengthen the antimicrobial armamentarium in the era of increasing resistance and limited development pipelines. To exploit their full potential, their reinvestigation using current standards is needed. We aimed to investigate the in vitro activity of the old antimicrobial agent sodium bituminosulfonate in accordance with the current recommendations for antimicrobial susceptibility testing (AST) and to generate susceptibility data reflecting the current epidemiological situation. The in vitro activity of sodium bituminosulfonate was tested on consecutive clinical isolates, including 12 methicillin-resistant Staphylococcus aureus (MRSA) and 12 methicillin-susceptible S. aureus (MSSA), 24 coagulase-negative staphylococci (CoNS), 60 streptococci, 12 Enterococcus faecalis, 12 Enterococcus faecium (including two vancomycin-resistant strains), 12 Enterobacterales, 12 nonfermenting Gram-negative bacilli, and 12 Cutibacterium [Propionibacterium] acnes. AST of sodium bituminosulfonate was performed using broth microdilution method for Gram-positive cocci and Gram-negative rods and by agar dilution method for C. acnes. Sodium bituminosulfonate demonstrated activity against Gram-positive pathogens with minimal inhibitory concentration 90 (MIC90) values (g/L) for MRSA 0.25, MSSA 1, CoNS 16, Streptococcus pyogenes 0.03, Streptococcus agalactiae 0.125, Streptococcus dysgalactiae ≤0.015, Streptococcus pneumoniae ≤0.015, viridans streptococci 0.03, E. faecalis 0.25, E. faecium 0.5, and C. acnes 0.03 (without blood supplement). MIC values for Gram-negative bacteria were considerably higher. Blood-supplemented media proved to be unsuitable for activity testing of this agent. Sodium bituminosulfonate may represent an alternative to classical antibiotics for topical use. Although it has been clinically used for many decades, well-designed randomized trials are needed for the effective revival of this old antimicrobial.
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Affiliation(s)
- Evgeny A Idelevich
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.,Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
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11
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Hillock NT, Karnon J, Turnidge J, Merlin TL. Estimating the utilisation of unregistered antimicrobials in Australia. Infect Dis Health 2020; 25:82-91. [PMID: 31911133 DOI: 10.1016/j.idh.2019.12.001] [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: 09/19/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify and estimate the usage of unregistered antimicrobial drugs in Australian clinical practice. METHODS A descriptive pharmaco-epidemiological study, utilising three data sources: analysis of Special Access Scheme (SAS) applications for unregistered antimicrobials included in clinical guidelines over a five year period, analysis of antimicrobials dispensed from South Australian public hospital pharmacy departments over a two year period and analysis of National Antimicrobial Utilisation Surveillance Program (NAUSP) data for reported inpatient usage of unregistered antimicrobials in Australian hospitals over the last 5 years. RESULTS 59 unregistered antimicrobials were identified using the mixed methods. 18,362 Special Access Scheme applications were submitted between May 2012 and April 2017 to access the 20 unregistered antimicrobials identified in the Therapeutic Guidelines® (eTG complete); 51.4% were determined by the prescriber to be for life-threatening indications. Annual applications more than doubled over the five years. 34 unregistered antimicrobials were dispensed from South Australian public hospitals between July 2015 and June 2017. On average, 1.1% of total antimicrobial usage (Defined Daily Doses) per month was accessed via the SAS, of which 87.7% were for outpatients or discharged patients. 34 unregistered antimicrobials for systemic use identified in the NAUSP database were used in Australian hospitals between 2013 and 2018. CONCLUSION The use of unregistered antimicrobials in Australian clinical practice is not uncommon. With increasing antimicrobial resistance, there will be a continued reliance on older less-used antimicrobial agents and an increasing need for novel drugs, therefore regulatory pathways need to facilitate security of supply and assurance of medicine quality and safety.
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Affiliation(s)
- Nadine T Hillock
- School of Public Health, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia.
| | - John Turnidge
- School of Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Tracy L Merlin
- School of Public Health, University of Adelaide, Adelaide, SA, 5000, Australia.
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12
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Resman F. Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy. Part II: Ten questions reflecting knowledge gaps and issues of controversy in the field of antimicrobial stewardship. Ther Adv Infect Dis 2020; 7:2049936120945083. [PMID: 32913648 PMCID: PMC7443983 DOI: 10.1177/2049936120945083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023] Open
Abstract
Regardless of one's opinion on antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and include aspects not only of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name but a few. This review aims to take several of these aspects and the scientific evidence from antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? and Which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale? This narrative review is written in two separate parts aiming to provide answers to the two questions. The first part, published separately, is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps; (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. This second part formulates 10 critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.
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Affiliation(s)
- Fredrik Resman
- Clinical Infection Medicine, Department of
Translational Medicine, Lund University, Rut Lundskogs gata 3, plan 6, Malmö,
20502, Sweden
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13
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Sustained-release microparticle dry powders of chloramphenicol palmitate or thiamphenicol palmitate prodrugs for lung delivery as aerosols. Eur J Pharm Sci 2019; 138:105028. [DOI: 10.1016/j.ejps.2019.105028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022]
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14
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Tebano G, Li G, Beovic B, Bielicki J, Brink A, Enani MA, Godman B, Hinrichsen SL, Kibuule D, Gabriel LH, Oduyebo O, Sharland M, Singh S, Wertheim HFL, Nathwani D, Pulcini C. Essential and forgotten antibiotics: An inventory in low- and middle-income countries. Int J Antimicrob Agents 2019; 54:273-282. [PMID: 31260741 DOI: 10.1016/j.ijantimicag.2019.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/21/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The World Health Organization Essential Medicines List (WHO-EML) includes 'access' antibiotics, judged essential to treat common infections. The European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship defined a list of 'forgotten' antibiotics, some old and often off-patent antibiotics, which have particular value for specific indications. OBJECTIVE To investigate which WHO-EML 'access' and 'forgotten' antibiotics are approved at national level in a sample of low- to middle-income countries (LMICs). METHODS The Scientific Committee used a consensus procedure to select 26 WHO-EML 'access' and 15 'forgotten' antibiotics. Paediatric formulations were explored for 14 antibiotics. An internet-based questionnaire was circulated to 40 LMIC representatives. Antibiotics were defined as approved if an official drug regulatory agency and/or the national ministry of health licensed their use, making them, at least theoretically, available on the market. RESULTS Twenty-eight LMICs (11 in Africa, 11 in Asia and six in America) were surveyed. Nine WHO-EML 'access' antibiotics (amoxicillin, ampicillin, benzylpenicillin, ceftriaxone, clarithromycin, ciprofloxacin, doxycycline, gentamicin and metronidazole) were approved in all countries, and all 26 'access' antibiotics were approved in more than two-thirds of countries. Among the 15 'forgotten' antibiotics, only one was approved in more than two-thirds of countries. The median number of approved antibiotics per country was 30 (interquartile range 23-35). Six of 14 paediatric formulations (amoxicillin, amoxicillin-clavulanic acid, oral antistaphylococcal penicillin, cotrimoxazole, erythromycin and metronidazole) were approved in more than two-thirds of countries. CONCLUSIONS WHO-EML 'access' antibiotics and the most frequently used formulations for paediatrics were approved in the vast majority of the 28 surveyed LMICs. This was not the case for many of the 'forgotten' antibiotics, despite their important role, particularly in areas with high prevalence of multi-drug-resistant bacteria.
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Affiliation(s)
- Gianpiero Tebano
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, AP-PH, Paris, France; Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
| | - Grace Li
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Bojana Beovic
- University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Julia Bielicki
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK; Paediatric Pharmacology Group, University of Basel Children's Hospital, Basel, Switzerland
| | - Adrian Brink
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, South Africa; Department of Clinical Microbiology, Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa
| | - Mushira A Enani
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Brian Godman
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK; Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Sylvia Lemos Hinrichsen
- Division of Tropical Medicine, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Brasil Stewardship de Antimicrobianos, Instituto Brasileiro de Segurança do Paciente, São Paulo, São Paulo, Brasil
| | - Dan Kibuule
- School of Pharmacy, University of Namibia, Namibia
| | - Levy-Hara Gabriel
- Unit of Infectious Diseases, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Oyinlola Oduyebo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Sanjeev Singh
- Infectious Diseases, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India
| | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi, Vietnam; Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, UK; Department of Medical Microbiology and Radboudumc Centre for Infectious Diseases, Radboudumc, Radboud University, Nijmegen, The Netherlands
| | - Dilip Nathwani
- Infection Unit, Ninewells Hospital and Medical School, Dundee, UK; Academic Health Sciences Partnership in Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Céline Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
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15
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Malmros K, Huttner BD, McNulty C, Rodríguez-Baño J, Pulcini C, Tängdén T. Comparison of antibiotic treatment guidelines for urinary tract infections in 15 European countries: Results of an online survey. Int J Antimicrob Agents 2019; 54:478-486. [PMID: 31229671 DOI: 10.1016/j.ijantimicag.2019.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/04/2019] [Accepted: 06/15/2019] [Indexed: 11/17/2022]
Abstract
Appropriate antibiotic use for urinary tract infections (UTIs) is important in order to provide effective and safe treatment while minimising the risk of antimicrobial resistance development. This survey was carried out to compare existing national guidelines for UTIs in Europe. Experts in 37 European countries were asked to participate. An electronic questionnaire was used to obtain information on treatment recommendations, factors considered important when setting guidelines, acceptable resistance rates for empirical therapy, evidence grading, and existing resistance surveillance for uropathogens. Treatment guidelines and antimicrobial susceptibility data were collected. In total, 22 experts (59%) responded to the survey. National guidelines were missing in four countries and data were incomplete in three cases. Fifteen national guidelines published between 2004 and 2017 were included in the analysis. Great variability was found between guidelines in the selection of antibiotics, dosing regimens and treatment duration. For example, 10 different antibiotics were recommended as first-line therapy for uncomplicated cystitis. National surveillance data on antimicrobial susceptibility of uropathogens were available in 13 of 15 countries. Resistance epidemiology could not explain the observed differences between guidelines, and comparison of resistance rates was hampered by variations in methods. This study revealed major differences in treatment guidelines for UTIs within Europe, indicating that there are opportunities for improvement. More clinical research and a more systematic and stratified approach to resistance surveillance, including also antibiotics that are currently not available in all countries, is needed.
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Affiliation(s)
- Karin Malmros
- ReAct Europe, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Benedikt D Huttner
- Division of Infectious Diseases and Infection Control Program, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; ESCMID Study Group for Antimicrobial Stewardship (ESGAP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
| | | | - Jesús Rodríguez-Baño
- ESCMID Study Group for Antimicrobial Stewardship (ESGAP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID); Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - Céline Pulcini
- ESCMID Study Group for Antimicrobial Stewardship (ESGAP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID); Université de Lorraine, APEMAC and Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - Thomas Tängdén
- ReAct Europe, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; ESCMID Study Group for Antimicrobial Stewardship (ESGAP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).
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16
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Baron SA, Cassir N, Mékidèche T, Mlaga KD, Brouqui P, Rolain JM. Successful treatment and digestive decolonisation of a patient with osteitis caused by a carbapenemase-producing Klebsiella pneumoniae isolate harbouring both NDM-1 and OXA-48 enzymes. J Glob Antimicrob Resist 2019; 18:225-229. [PMID: 31201994 DOI: 10.1016/j.jgar.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Carbapenem resistance in Klebsiella pneumoniae is an increasing problem worldwide and infections caused by this bacterium can be difficult to treat. This study reported the case of a patient from Romania, who was hospitalised in Bulgaria after an accident trauma. He then came to France for treatment of an osteitis caused by a Klebsiella pneumoniae carrying both blaNDM-1 and blaOXA-48. METHOD The resistome of this extremely drug-resistant bacterium was analysed both with phenotypic (large antibiotic susceptibility testing) and genomic methods (genome sequencing). The genetic environment of the two carbapenemases was studied. RESULTS Klebsiella pneumoniae ST307 carrying both a blaNDM-1 and blaOXA-48 gene was located on two different plasmids: Inc L/M and IncFII. The patient was successfully treated by a combination of intravenous colistin (9 MUI, then 4.5 MUI bd), intravenous fosfomycin (4g tds) and oral doxycycline (100mg bd) for 3 months. Faecal microbiota transplantation was successfully conducted for stool carriage. CONCLUSION The ST307 type is becoming endemic in hospital environments and is frequently associated with carbapenem resistance. Treatment of infection caused by multidrug-resistant bacteria is a clinical challenge, and the use of old antibiotics associated with screening and decolonisation of the reservoirs can be an efficient therapeutic alternative.
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Affiliation(s)
- Sophie Alexandra Baron
- Aix Marseille Université, IRD, MEPHI, Faculté de Médecine et de Pharmacie, Marseille, France; IHU Méditerranée Infection, Marseille, France; Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Nadim Cassir
- Aix Marseille Université, IRD, MEPHI, Faculté de Médecine et de Pharmacie, Marseille, France; IHU Méditerranée Infection, Marseille, France; Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Thibaut Mékidèche
- Aix Marseille Université, IRD, MEPHI, Faculté de Médecine et de Pharmacie, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - Kodjovi Dodji Mlaga
- Aix Marseille Université, IRD, MEPHI, Faculté de Médecine et de Pharmacie, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - Philippe Brouqui
- IHU Méditerranée Infection, Marseille, France; Assistance Publique des Hôpitaux de Marseille, Marseille, France; Aix Marseille Université, IRD, VITROME, Faculté de Médecine et de Pharmacie, Marseille, France
| | - Jean-Marc Rolain
- Aix Marseille Université, IRD, MEPHI, Faculté de Médecine et de Pharmacie, Marseille, France; IHU Méditerranée Infection, Marseille, France; Assistance Publique des Hôpitaux de Marseille, Marseille, France.
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17
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Kakkar AK, Shafiq N, Malhotra S. Ensuring access to ‘access’ antibiotics: an imminent consideration for sustainable antimicrobial stewardship in the developing world. Infect Dis (Lond) 2019; 51:395-398. [DOI: 10.1080/23744235.2019.1574978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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18
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Tängdén T, Pulcini C, Aagaard H, Balasegaram M, Hara GL, Nathwani D, Sharland M, Theuretzbacher U, Cars O. Unavailability of old antibiotics threatens effective treatment for common bacterial infections. THE LANCET. INFECTIOUS DISEASES 2019; 18:242-244. [PMID: 29485082 DOI: 10.1016/s1473-3099(18)30075-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Thomas Tängdén
- Department of Medical Sciences, Uppsala University, SE 751 85, Uppsala, Sweden
| | | | - Helle Aagaard
- Department of Medical Sciences, Uppsala University, SE 751 85, Uppsala, Sweden
| | - Manica Balasegaram
- Global Antibiotic R&D Partnership, Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Gabriel Levy Hara
- Unit of Infectious Diseases, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Dilip Nathwani
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George's University, London, UK
| | | | - Otto Cars
- Department of Medical Sciences, Uppsala University, SE 751 85, Uppsala, Sweden.
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19
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Gardiner BJ, Stewardson AJ, Abbott IJ, Peleg AY. Nitrofurantoin and fosfomycin for resistant urinary tract infections: old drugs for emerging problems. Aust Prescr 2019; 42:14-19. [PMID: 30765904 DOI: 10.18773/austprescr.2019.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Uncomplicated urinary tract infection is one of the most common indications for antibiotic use in the community However the Gram-negative organisms that can cause the infection are becoming more resistant to antibiotics Many multidrug resistant organisms retain susceptibility to two old antibiotics nitrofurantoin and fosfomycin Advantages over newer drugs include their high urinary concentrations and minimal toxicity Fosfomycin is a potential treatment option for patients with uncomplicated urinary tract infection due to resistant organisms Nitrofurantoin may be more effective and can be used for urinary infections in pregnant women
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Affiliation(s)
- Bradley J Gardiner
- Department of Infectious Disease, Alfred Health and Central Clinical School, Monash University, Melbourne.,Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands.,Biomedicine Discovery Institute, Department of Microbiology, Monash University, Melbourne
| | - Andrew J Stewardson
- Department of Infectious Disease, Alfred Health and Central Clinical School, Monash University, Melbourne.,Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands.,Biomedicine Discovery Institute, Department of Microbiology, Monash University, Melbourne
| | - Iain J Abbott
- Department of Infectious Disease, Alfred Health and Central Clinical School, Monash University, Melbourne.,Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands.,Biomedicine Discovery Institute, Department of Microbiology, Monash University, Melbourne
| | - Anton Y Peleg
- Department of Infectious Disease, Alfred Health and Central Clinical School, Monash University, Melbourne.,Department of Medical Microbiology and Infectious Diseases, Research and Development Unit, Erasmus Medical Centre, Rotterdam, The Netherlands.,Biomedicine Discovery Institute, Department of Microbiology, Monash University, Melbourne
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20
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Le Page S, Dubourg G, Baron SA, Rolain JM, Raoult D. No global increase in resistance to antibiotics: a snapshot of resistance from 2001 to 2016 in Marseille, France. Eur J Clin Microbiol Infect Dis 2018; 38:395-407. [PMID: 30515637 DOI: 10.1007/s10096-018-3439-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/21/2018] [Indexed: 12/15/2022]
Abstract
Since effective empirical antibiotic therapy is a key factor for survival, local antibiotic resistance epidemiology is critical. We aimed to identify current trends in antibiotic resistance for key antibiotics obtained over 16 years (2001-2016) for invasive infections corresponding to empirical treatment in a large hospital centre in Marseille, France.From January 2014 to December 2016, we have collected all data on antibiotic susceptibility from public laboratory hospitals, and a retrospective analysis was performed on key antibiotics in blood cultures since 2001. A total of 99,932 antibiotic susceptibility testings (ASTs) were analysed, and proportion of pan-drug resistant (PDR = resistant to all antibiotics tested) and extensively drug-resistant (XDR = resistant to all except for two classes) strains were < 0.03 and 0.5%, respectively. Between 2001 and 2016, we found an increase of resistance to third-generation cephalosporins for E. coli invasive strains (0% vs 17.8%; p < 10-5) and K. pneumoniae (8% vs 35.4%; p = 0.001) along with a decrease of methicillin-resistant S. aureus strains (31% vs 19.8%; p = 0.006). Moreover, during the 3-year period, a significant increase of wild-type strains, susceptible to all antibiotics tested, was observed in invasive infections. Regarding bacteraemia involving Enterobacteriaceae and S. aureus, empirical therapy is effective in > 99% cases. Active epidemiological surveillance is necessary because antibiotic resistance remains unpredictable.
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Affiliation(s)
| | | | | | | | - Didier Raoult
- IRD, AP-HM, MEPHI, Aix Marseille Univ, Marseille, France.
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21
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Peyclit L, Baron SA, Yousfi H, Rolain JM. Zidovudine: A salvage therapy for mcr-1 plasmid-mediated colistin-resistant bacterial infections? Int J Antimicrob Agents 2018; 52:11-13. [DOI: 10.1016/j.ijantimicag.2018.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 12/18/2022]
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22
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Abat C, Fournier PE, Jimeno MT, Rolain JM, Raoult D. Extremely and pandrug-resistant bacteria extra-deaths: myth or reality? Eur J Clin Microbiol Infect Dis 2018; 37:1687-1697. [PMID: 29956024 DOI: 10.1007/s10096-018-3300-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 06/06/2018] [Indexed: 12/16/2022]
Abstract
In 2009, the European Centre for Disease Prevention and Control (ECDC) estimated that multidrug-resistant (MDR) bacterial infections were responsible for 25,000 extra-deaths per year. In 2015, another report estimated that 12,500 extra-deaths were attributable to MDR bacteria every year in France. Recently, the United Nations claimed that resistance to antimicrobials was a global scourge, forecasting 10 million deaths in 2050. Surprisingly, our antibiotic resistance surveillance system in Marseille, France, did not allowed us to observe similar trends. We herein compared our data on extremely drug-resistant (XDR)/pandrug-resistant (PDR) patient extra-deaths to evaluations and predictions from these reports. First, we retrospectively collect and analyze antibiotic resistance data produced by our settings between November 2009 and March 2015 to look for 30-day deaths attributable to XDR/PDR strains belonging to 11 bacterial species/genus. In parallel, we performed a PubMed literature search to look for articles published prior to July 2016 and describing human deaths due to PDR strains. Overall, 35,723 patients were infected by at least one bacterial species/genus of interest and 85 by XDR/PDR strains. Of these patients, only one death was attributable to a XDR bacterial infection in a patient with strong comorbidities and two consecutive septic shocks. Our literature review shows that only four articles described human deaths due to PDR bacteria. All together, these data allowed us to conclude that there is a large discrepancy between the real count of deaths attributable to XDR/PDR bacteria and alarmist predictions.
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Affiliation(s)
- Cédric Abat
- IRD, MEPHI, AP-HM, IHU-Méditerranée-Infection, Aix-Marseille University, Marseille, France
| | - Pierre-Edouard Fournier
- IRD, VITROME, AP-HM, SSA, IHU-Méditerranée-Infection, Aix-Marseille University, Marseille, France
| | - Marie-Thérèse Jimeno
- IRD, VITROME, AP-HM, SSA, IHU-Méditerranée-Infection, Aix-Marseille University, Marseille, France
| | - Jean-Marc Rolain
- IRD, MEPHI, AP-HM, IHU-Méditerranée-Infection, Aix-Marseille University, Marseille, France.
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, 27 boulevard Jean Moulin, 13385, Marseille CEDEX 5, France.
| | - Didier Raoult
- IRD, MEPHI, AP-HM, IHU-Méditerranée-Infection, Aix-Marseille University, Marseille, France.
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, 27 boulevard Jean Moulin, 13385, Marseille CEDEX 5, France.
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23
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Pulcini C. Antibiotic stewardship: a European perspective. FEMS Microbiol Lett 2018; 364:4582261. [PMID: 29092037 DOI: 10.1093/femsle/fnx230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/27/2017] [Indexed: 12/31/2022] Open
Abstract
Antibiotic stewardship programmes, which are a set of interventions aiming at prescribing antibiotics appropriately and responsibly, are one of the key strategies to tackle the current worldwide bacterial resistance crisis. We will present here some examples of international and national initiatives, with a focus on Europe, discuss the role of clinical microbiologists, and present some perspectives and future developments.
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Affiliation(s)
- Céline Pulcini
- Nancy University Hospital, Infectious Diseases Department, 54000 Nancy, France.,Lorraine University, EA 4360 APEMAC, 54000 Nancy, France
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24
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Abat C, Raoult D, Rolain JM. Are we living in an antibiotic resistance nightmare? Clin Microbiol Infect 2018; 24:568-569. [PMID: 29337254 PMCID: PMC7129525 DOI: 10.1016/j.cmi.2018.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/30/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022]
Affiliation(s)
- C Abat
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 boulevard Jean Moulin, 13005 Marseille, France
| | - D Raoult
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 boulevard Jean Moulin, 13005 Marseille, France
| | - J-M Rolain
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 boulevard Jean Moulin, 13005 Marseille, France.
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25
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Sharland M, Pulcini C, Harbarth S, Zeng M, Gandra S, Mathur S, Magrini N. Classifying antibiotics in the WHO Essential Medicines List for optimal use-be AWaRe. THE LANCET. INFECTIOUS DISEASES 2017; 18:18-20. [PMID: 29303731 DOI: 10.1016/s1473-3099(17)30724-7] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/03/2017] [Accepted: 11/21/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Celine Pulcini
- EA 4360 APEMAC, University of Lorraine, Nancy, France; Department of Infectious Diseases, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, Nancy, France
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland; Department of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Sumanth Gandra
- Centre for Disease Dynamics, Economics & Policy, New Delhi, India
| | - Shrey Mathur
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Nicola Magrini
- Department of Essential Medicines and Health Products, World Health Organization, 1211 Geneva 27, Switzerland.
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26
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Hu D, Su H, Chen Z, Cui Y, Ran C, Xu J, Xiao T, Li X, Wang H, Tian Y, Ren N. Performance evaluation and microbial community dynamics in a novel AnMBR for treating antibiotic solvent wastewater. BIORESOURCE TECHNOLOGY 2017; 243:218-227. [PMID: 28668560 DOI: 10.1016/j.biortech.2017.06.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/16/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
This study aims at evaluating the performance and microbial community dynamics of anaerobic membrane bioreactor (AnMBR) treating antibiotic solvent wastewater at improved influent quality period. The whole process was divided into five phases according to the influent COD concentration with a fluctuated volume loading rate (VLR) ranging from 3.9 to 12.7kgCOD/(m3·d). After 249days of operation, the average COD and THF removal efficiency were 93.6% and 98.7%, respectively. The accumulation of VFA, relatively low pH, decline of biogas production and methane content were discovered at higher VLR (>10kgCOD/(m3·d)). Methanomicrobiales are the major population throughout the whole running period. Methanosaetaceae showed a minor relative abundance compared both of them, while Methanobacteriales remained a minimum value. Results showed that the reactor performed an excellent pollutants removal effect because of the function of membranes even at high VLR conditions.
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Affiliation(s)
- Dongxue Hu
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China; State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Haiyan Su
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China
| | - Zhaobo Chen
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China.
| | - Yubo Cui
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China
| | - Chunqiu Ran
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China
| | - Jiao Xu
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China
| | - Tingting Xiao
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China
| | - Xue Li
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China
| | - Haixu Wang
- College of Environment and Resources, Dalian Minzu University, 18 Liaohe West Road, Dalian 116600, China
| | - Yu Tian
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Nanqi Ren
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, Harbin 150090, China
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27
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Pulcini C. Antibiotic stewardship: update and perspectives. Clin Microbiol Infect 2017; 23:791-792. [DOI: 10.1016/j.cmi.2017.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/31/2022]
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28
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Castan B, Lesprit P, Alfandari S, Bonnet E, Diamantis S, Gauzit R, Kerneis S, Leroy J, Lescure X, Meyssonnier V, Mondain V, Pavese P, Rabaud C, Stahl JP, Tattevin P, Roblot F, Pulcini C. [Antibiotic stewardship: A 2017 update]. Med Mal Infect 2017; 47:439-442. [PMID: 28781198 DOI: 10.1016/j.medmal.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, CH Ajaccio, 20303 Ajaccio, France
| | - P Lesprit
- Infectiologie transversale, service de biologie clinique, hôpital Foch, 92151 Suresnes, France
| | - S Alfandari
- Service de réanimation et maladies infectieuses, CH de Tourcoing, 59200 Tourcoing, France
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - S Diamantis
- Service des maladies infectieuses et tropicales, CH Sud Île-de-France, 77011 Melun, France
| | - R Gauzit
- Équipe mobile d'infectiologie, AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, 75014 Paris, France
| | - S Kerneis
- Équipe mobile d'infectiologie, AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, 75014 Paris, France
| | - J Leroy
- ARLIN BFC/PRIMAIR, service d'hygiène hospitalière et service de maladies infectieuses, CHRU de Besançon, 25030 Besançon, France
| | - X Lescure
- IAME UMR 1137 Inserm, service de maladies infectieuses et tropicales, AP-HP, hôpital Bichat-Claude Bernard, faculté Paris Diderot, 75018 Paris, France
| | - V Meyssonnier
- CRIOAC, médecine interne, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020 Paris, France
| | - V Mondain
- Service des maladies infectieuses, CHU de Nice, Nice, France
| | - P Pavese
- Infectiologie, CHU, université Grenoble Alpes, 38700 Grenoble, France
| | - C Rabaud
- EA 4360 APEMAC, service de maladies infectieuses, CHRU de Nancy, université de Lorraine, 54000 Nancy, France
| | - J P Stahl
- Infectiologie, CHU, université Grenoble Alpes, 38700 Grenoble, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, CHU de Rennes, hôpital Pontchaillou, 35033 Rennes, France
| | - F Roblot
- Service de médecine interne, maladies infectieuses et tropicales et Inserm U1070, CHU de Poitiers, 86021 Poitiers, France
| | - C Pulcini
- EA 4360 APEMAC, service de maladies infectieuses, CHRU de Nancy, université de Lorraine, 54000 Nancy, France.
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29
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Pulcini C, Beovic B, Béraud G, Carlet J, Cars O, Howard P, Levy-Hara G, Li G, Nathwani D, Roblot F, Sharland M. Ensuring universal access to old antibiotics: a critical but neglected priority. Clin Microbiol Infect 2017; 23:590-592. [PMID: 28522030 DOI: 10.1016/j.cmi.2017.04.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 12/31/2022]
Affiliation(s)
- C Pulcini
- Lorraine University, EA 4360 APEMAC, Nancy, France; Nancy University Hospital, Infectious Diseases Department, Nancy, France; ESCMID Study Group for Antimicrobial stewardshiP (ESGAP), Basel, Switzerland.
| | - B Beovic
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP), Basel, Switzerland; University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - G Béraud
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP), Basel, Switzerland; Centre Hospitalier Universitaire de Poitiers, Department of Infectious Diseases, Université de Poitiers, Poitiers, France; Université Droit et Santé Lille 2, EA2694, Lille, France; Hasselt University, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt, Belgium; World Alliance Against Antibiotic Resistance (WAAAR), Paris, France
| | - J Carlet
- World Alliance Against Antibiotic Resistance (WAAAR), Paris, France
| | - O Cars
- ReAct - Action on Antibiotic Resistance, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Howard
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP), Basel, Switzerland; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G Levy-Hara
- ISC (International Society of Chemotherapy) Antimicrobial Stewardship Working Group, UK; Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - G Li
- Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - D Nathwani
- British Society for Antimicrobial Chemotherapy (BSAC), Birmingham, UK
| | - F Roblot
- Centre Hospitalier Universitaire de Poitiers, Department of Infectious Diseases, Université de Poitiers, Poitiers, France; Société de Pathologie Infectieuse de Langue Française (SPILF, French Infectious Diseases Society), Paris, France
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
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30
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Daikos G, Lagier JC. Editorial: the resurrection of old antibiotics. Int J Antimicrob Agents 2017; 49:525. [DOI: 10.1016/j.ijantimicag.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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