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Rivetti S, Romano A, Mastrangelo S, Attinà G, Maurizi P, Ruggiero A. Aminoglycosides-Related Ototoxicity: Mechanisms, Risk Factors, and Prevention in Pediatric Patients. Pharmaceuticals (Basel) 2023; 16:1353. [PMID: 37895824 PMCID: PMC10610175 DOI: 10.3390/ph16101353] [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: 07/08/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Aminoglycosides are broad-spectrum antibiotics largely used in children, but they have potential toxic side effects, including ototoxicity. Ototoxicity from aminoglycosides is permanent and is a consequence of its action on the inner ear cells via multiple mechanisms. Both uncontrollable risk factors and controllable risk factors are involved in the pathogenesis of aminoglycoside-related ototoxicity and, because of the irreversibility of ototoxicity, an important undertaking for preventing ototoxicity includes antibiotic stewardship to limit the use of aminoglycosides. Aminoglycosides are fundamental in the treatment of numerous infectious conditions at neonatal and pediatric age. In childhood, normal auditory function ensures adequate neurocognitive and social development. Hearing damage from aminoglycosides can therefore strongly affect the normal growth of the child. This review describes the molecular mechanisms of aminoglycoside-related ototoxicity and analyzes the risk factors and the potential otoprotective strategies in pediatric patients.
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Affiliation(s)
- Serena Rivetti
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (S.R.); (A.R.); (S.M.); (G.A.); (P.M.)
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (S.R.); (A.R.); (S.M.); (G.A.); (P.M.)
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (S.R.); (A.R.); (S.M.); (G.A.); (P.M.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (S.R.); (A.R.); (S.M.); (G.A.); (P.M.)
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (S.R.); (A.R.); (S.M.); (G.A.); (P.M.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (S.R.); (A.R.); (S.M.); (G.A.); (P.M.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Ricci MF, Shah PS, Moddemann D, Alvaro R, Ng E, Lee SK, Synnes A. Neurodevelopmental Outcomes of Infants at <29 Weeks of Gestation Born in Canada Between 2009 and 2016. J Pediatr 2022; 247:60-66.e1. [PMID: 35561804 DOI: 10.1016/j.jpeds.2022.04.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/14/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate changes in mortality or significant neurodevelopmental impairment (NDI) in children born at <29 weeks of gestation in association with national quality improvement initiatives. STUDY DESIGN This longitudinal cohort study included children born at 220/7 to 286/7 weeks of gestation who were admitted to Canadian neonatal intensive care units between 2009 and 2016. The primary outcome was a composite rate of death or significant NDI (Bayley Scales of Infant and Toddler Development, Third Edition score <70, severe cerebral palsy, blindness, or deafness requiring amplification) at 18-24 months corrected age. To evaluate temporal changes, outcomes were compared between epoch 1 (2009-2012) and epoch 2 (2013-2016). aORs were calculated for differences between the 2 epochs accounting for differences in patient characteristics. RESULTS The 4426 children included 1895 (43%) born in epoch 1 and 2531 (57%) born in epoch 2. Compared with epoch 1, in epoch 2 more mothers received magnesium sulfate (56% vs 28%), antibiotics (69% vs 65%), and delayed cord clamping (37% vs 31%) and fewer infants had a Score for Neonatal Acute Physiology, version II >20 (31% vs 35%) and late-onset sepsis (23% vs 27%). Death or significant NDI occurred in 30% of children in epoch 2 versus 32% of children in epoch 1 (aOR, 0.86; 95% CI, 0.75-0.99). In epoch 2, there were reductions in the need for hearing aids or cochlear implants (1.4% vs 2.6%; aOR, 0.50; 95% CI, 0.31-0.82) and in blindness (0.6% vs.1.4%; aOR, 0.38; 95% CI, 0.18-0.80). CONCLUSIONS Among preterm infants born at <29 weeks of gestation, composite rates of death or significant NDI and rates of visual and hearing impairment were significantly lower in 2013-2016 compared with 2009-2012.
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Affiliation(s)
- M Florencia Ricci
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Diane Moddemann
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruben Alvaro
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eugene Ng
- Newborn & Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Chen B, Chen S, Duan L, Zhang M, Liu X, Duan Y. Effects of ambient air pollution, fresh fruit and vegetable intakes as well as maternal psychosocial stress on the outcome of newborn otoacoustic emission hearing screening. BMC Pediatr 2022; 22:269. [PMID: 35549697 PMCID: PMC9097425 DOI: 10.1186/s12887-022-03328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Newborn hearing screening results indicated that more than 40% of the detected infants had no recognized risk factors. To determine whether maternal exposure to ambient air pollutants and experience of stressful life event, as well as lack of fresh fruit and vegetable during pregnancy are associated with the abnormal hearing development among newborns. METHODS A total of 1193 newborns and their mothers were recruited in this study. Personal information and covariates were collected by face to face interview. Medical examination results of newborns and their mothers were extracted from medical record. We estimated personal air pollutant exposure level through inverse distance weighted method based on data from air quality monitoring stations and assessed the auditory development of newborns via distortion product otoacoustic emission (DPOAE). Unconditional logistic regression model was used to estimate the relationship between DPOAE screening result and the potential influential factors as well as the combined effect. RESULTS The results indicated that PM10 exposure during the second trimester and stressful life event during the third trimester could increase the risk of not passing DPOAE test among newborns. However, frequent intakes of fruit and vegetable significantly reduced the risk. There was a synergetic interaction between PM10 exposure and stressful life event on neonatal hearing development. CONCLUSIONS To alleviate abnormal auditory development among fetus, pregnant woman should decrease the exposures to ambient air pollutant and negative life event and at the same time, intake sufficient fresh fruit and vegetable.
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Affiliation(s)
- Bingzhi Chen
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Shaoyi Chen
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Lidan Duan
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Muyang Zhang
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Xiaoqun Liu
- Department of Children and Maternal Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Yanying Duan
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China.
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McDermott JH, Wolf J, Hoshitsuki K, Huddart R, Caudle KE, Whirl-Carrillo M, Steyger PS, Smith RJH, Cody N, Rodriguez-Antona C, Klein TE, Newman WG. Clinical Pharmacogenetics Implementation Consortium Guideline for the Use of Aminoglycosides Based on MT-RNR1 Genotype. Clin Pharmacol Ther 2022; 111:366-372. [PMID: 34032273 PMCID: PMC8613315 DOI: 10.1002/cpt.2309] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
Aminoglycosides are widely used antibiotics with notable side effects, such as nephrotoxicity, vestibulotoxicity, and sensorineural hearing loss (cochleotoxicity). MT-RNR1 is a gene that encodes the 12s rRNA subunit and is the mitochondrial homologue of the prokaryotic 16s rRNA. Some MT-RNR1 variants (i.e., m.1095T>C; m.1494C>T; m.1555A>G) more closely resemble the bacterial 16s rRNA subunit and result in increased risk of aminoglycoside-induced hearing loss. Use of aminoglycosides should be avoided in individuals with an MT-RNR1 variant associated with an increased risk of aminoglycoside-induced hearing loss unless the high risk of permanent hearing loss is outweighed by the severity of infection and safe or effective alternative therapies are not available. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for the use of aminoglycosides based on MT-RNR1 genotype (updates at https://cpicpgx.org/guidelines/ and www.pharmgkb.org).
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Affiliation(s)
- John Henry McDermott
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Keito Hoshitsuki
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel Huddart
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Kelly E. Caudle
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | - Peter S. Steyger
- Translational Hearing Center, Biomedical Sciences, Creighton University, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA
| | - Richard J. H. Smith
- Molecular Otolaryngology and Renal Research Laboratories, Department of Otolaryngology, Internal Medicine (Nephrology), Pediatrics and Molecular Physiology & Biophysics, University of Iowa, Iowa City, Iowa, USA
| | - Neal Cody
- Department of Genetics and Genomic Sciences, Ichan School of Medicine at Mount Sinai, New York, New York, USA
- Sema4, Stamford, Connecticut, USA
| | - Cristina Rodriguez-Antona
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Teri E. Klein
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
- Department of Medicine, Stanford University, Stanford, California, USA
| | - William G. Newman
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
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Abstract
Ototoxicity refers to damage to the inner ear that leads to functional hearing loss or vestibular disorders by selected pharmacotherapeutics as well as a variety of environmental exposures (eg, lead, cadmium, solvents). This article reviews the fundamental mechanisms underlying ototoxicity by clinically relevant, hospital-prescribed medications (ie, aminoglycoside antibiotics or cisplatin, as illustrative examples). Also reviewed are current strategies to prevent prescribed medication-induced ototoxicity, with several clinical or candidate interventional strategies being discussed.
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Affiliation(s)
- Peter S Steyger
- Translational Hearing Center, Biomedical Sciences, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
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Steyger PS. Mechanisms of Aminoglycoside- and Cisplatin-Induced Ototoxicity. Am J Audiol 2021; 30:887-900. [PMID: 34415784 PMCID: PMC9126111 DOI: 10.1044/2021_aja-21-00006] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/30/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose This review article summarizes our current understanding of the mechanisms underlying acquired hearing loss from hospital-prescribed medications that affects as many as 1 million people each year in Western Europe and North America. Yet, there are currently no federally approved drugs to prevent or treat the debilitating and permanent hearing loss caused by the life-saving platinum-based anticancer drugs or the bactericidal aminoglycoside antibiotics. Hearing loss has long-term impacts on quality-of-life measures, especially in young children and older adults. This review article also highlights some of the current knowledge gaps regarding iatrogenic causes of hearing loss. Conclusion Further research is urgently needed to further refine clinical practice and better ameliorate iatrogenic drug-induced hearing loss.
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Affiliation(s)
- Peter S. Steyger
- Translational Hearing Center, Creighton University, Omaha, NE
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
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Coffin AB, Boney R, Hill J, Tian C, Steyger PS. Detecting Novel Ototoxins and Potentiation of Ototoxicity by Disease Settings. Front Neurol 2021; 12:725566. [PMID: 34489859 PMCID: PMC8418111 DOI: 10.3389/fneur.2021.725566] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Over 100 drugs and chemicals are associated with permanent hearing loss, tinnitus, and vestibular deficits, collectively known as ototoxicity. The ototoxic potential of drugs is rarely assessed in pre-clinical drug development or during clinical trials, so this debilitating side-effect is often discovered as patients begin to report hearing loss. Furthermore, drug-induced ototoxicity in adults, and particularly in elderly patients, may go unrecognized due to hearing loss from a variety of etiologies because of a lack of baseline assessments immediately prior to novel therapeutic treatment. During the current pandemic, there is an intense effort to identify new drugs or repurpose FDA-approved drugs to treat COVID-19. Several potential COVID-19 therapeutics are known ototoxins, including chloroquine (CQ) and lopinavir-ritonavir, demonstrating the necessity to identify ototoxic potential in existing and novel medicines. Furthermore, several factors are emerging as potentiators of ototoxicity, such as inflammation (a hallmark of COVID-19), genetic polymorphisms, and ototoxic synergy with co-therapeutics, increasing the necessity to evaluate a drug's potential to induce ototoxicity under varying conditions. Here, we review the potential of COVID-19 therapies to induce ototoxicity and factors that may compound their ototoxic effects. We then discuss two models for rapidly detecting the potential for ototoxicity: mammalian auditory cell lines and the larval zebrafish lateral line. These models offer considerable value for pre-clinical drug development, including development of COVID-19 therapies. Finally, we show the validity of in silico screening for ototoxic potential using a computational model that compares structural similarity of compounds of interest with a database of known ototoxins and non-ototoxins. Preclinical screening at in silico, in vitro, and in vivo levels can provide an earlier indication of the potential for ototoxicity and identify the subset of candidate therapeutics for treating COVID-19 that need to be monitored for ototoxicity as for other widely-used clinical therapeutics, like aminoglycosides and cisplatin.
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Affiliation(s)
| | | | - Jordan Hill
- Washington State University Vancouver, Vancouver, WA, United States
| | - Cong Tian
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
| | - Peter S. Steyger
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
- National Center for Rehabilitative Auditory Research, Portland, OR, United States
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Toll-like Receptor 4 Signaling and Downstream Neutrophilic Inflammation Mediate Endotoxemia-Enhanced Blood-Labyrinth Barrier Trafficking. Otol Neurotol 2020; 41:123-132. [PMID: 31568132 DOI: 10.1097/mao.0000000000002447] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
HYPOTHESIS Both toll-like receptor 4 (TLR4) and downstream neutrophil activity are required for endotoxemia-enhanced blood-labyrinth barrier (BLB) trafficking. BACKGROUND Aminoglycoside and cisplatin are valuable clinical therapies; however, these drugs often cause life-long hearing loss. Endotoxemia enhances the ototoxicity of aminoglycosides and cisplatin in a TLR4 dependent mechanism for which downstream proinflammatory signaling orchestrates effector immune cells including neutrophils. Neutrophil-mediated vascular injury (NMVI) can enhance molecular trafficking across endothelial barriers and may contribute to endotoxemia-enhanced drug-induced ototoxicity. METHODS Lipopolysaccharide (LPS) hypo-responsive TLR4-KO mice and congenitally neutropenic granulocyte colony-stimulating factor (GCSF) GCSF-KO mice were studied to investigate the relative contributions of TLR4 signaling and downstream neutrophil activity to endotoxemia-enhanced BLB trafficking. C57Bl/6 wild-type mice were used as a positive control. Mice were treated with LPS and 24 hours later cochleae were analyzed for gene transcription of innate inflammatory cytokine/chemokine signaling molecules, neutrophil recruitment, and vascular trafficking of the paracellular tracer biocytin-TMR. RESULTS Cochlear transcription of innate proinflammatory cytokines/chemokines was increased in endotoxemic C57Bl/6 and GCSF-KO, but not in TLR4-KO mice. More neutrophils were recruited to endotoxemic C57Bl/6 cochleae compared with both TLR4 and GCSF-KO cochleae. Endotoxemia enhanced BLB trafficking of biocytin-TMR in endotoxemic C57Bl/6 cochleae and this was attenuated in both TLR4 and GCSF-KO mice. CONCLUSION Together these results suggest that TLR4-mediated innate immunity cytokine/chemokine signaling alone is not sufficient for endotoxemia-enhanced trafficking of biocytin-TMR and that downstream neutrophil activity is required to enhance BLB trafficking. Clinically, targeting neutrophilic inflammation could protect hearing during aminoglycoside, cisplatin, or other ototoxic drug therapies.
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Arora V, Strunk D, Furqan SH, Schweig L, Lefaiver C, George J, Prazad P. Optimizing antibiotic use for early onset sepsis: A tertiary NICU experience. J Neonatal Perinatal Med 2020; 12:301-312. [PMID: 30932898 DOI: 10.3233/npm-180075] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neonatal antibiotic use is associated with a greater risk of nosocomial infection, necrotizing enterocolitis, and mortality. It can induce drug-resistant pathogens that contribute to increased neonatal morbidity/mortality, healthcare costs, and length of stay. Prior to the antibiotic stewardship program, decisions to obtain blood cultures and empiric antibiotics for possible Early-onset Sepsis (EOS) in late preterm and term infants upon NICU admission were provider-dependent rather than algorithm-based. We aimed to decrease empiric antibiotic prescription from 70% to 56% (20% decrease) in infants ≥34 weeks gestation admitted to the NICU. METHODS The stewardship initiative comprised the following practice changes: (1) use of the Neonatal Sepsis Risk Calculator (SRC); and (2) a 36-hour time-out for prescribed empiric antibiotics. Data was retrospectively collected and analyzed for inborn infants pre-intervention (January 2015-December 2015; n = 263) and post-intervention (August 2016-September 2017; n = 279). Data regarding compliance with the new antibiotic guideline were collected and disseminated to the team every week. Overlap between CDC guidelines and calculator recommendations were studied. RESULTS Pre-and post-intervention outcomes were analyzed using chi-square tests. There was a significant post-intervention reduction in the rate of both antibiotic prescriptions (29.4% decline; 70.3% vs. 49.6%; p < 0.001) and sepsis evaluations (24.3% decline; 90.9% vs. 68.8%; p < 0.001). No difference (p = 0.271) in culture-positive EOS cases was observed. There was 92% overlap in blood culture recommendations and 95% overlap between antibiotic recommendations when current CDC guidelines were compared to the SRC. CONCLUSION A significant reduction in antibiotic use and sepsis evaluations was achieved for late preterm and term infants upon NICU admission. No clinical deterioration occurred in post-intervention infants who did not receive antibiotics. There is significant overlap between CDC guidelines and SRC recommendations.
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Affiliation(s)
- V Arora
- Department of Pediatrics, Division of Neonatology, Advocate Children's Hospital, Park Ridge, IL, USA
| | - D Strunk
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - S H Furqan
- Department of Research, Advocate Children's Hospital, Park Ridge, IL, USA
| | - L Schweig
- Department of Research, Advocate Children's Hospital, Park Ridge, IL, USA
| | - C Lefaiver
- Department of Research, Advocate Children's Hospital, Park Ridge, IL, USA
| | - J George
- Department of Pediatrics, Division of Neonatology, Advocate Children's Hospital, Park Ridge, IL, USA
| | - P Prazad
- Department of Pediatrics, Division of Neonatology, Advocate Children's Hospital, Park Ridge, IL, USA
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Hemmingsen D, Mikalsen C, Hansen AR, Fjalstad JW, Stenklev NC, Klingenberg C. Hearing in Schoolchildren After Neonatal Exposure to a High-Dose Gentamicin Regimen. Pediatrics 2020; 145:peds.2019-2373. [PMID: 31915192 DOI: 10.1542/peds.2019-2373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the association between gentamicin exposure in the neonatal period and hearing in school age. METHODS This study included children exposed to a high-dose (6 mg/kg) gentamicin regimen as neonates (2004-2012), invited for follow-up at school age, and a healthy age-matched control group. We assessed hearing with pure tone audiometry including the extended high-frequency (EHF) range. Outcomes were average hearing thresholds in the midfrequencies (0.5-4 kHz) and the EHFs (9-16 kHz). The measures of gentamicin exposure were cumulative dose and highest trough plasma concentration. We used linear regression models to assess the impact of gentamicin exposure, and other peri- and postnatal morbidities, on hearing thresholds. RESULTS A total of 219 gentamicin-exposed and 33 healthy-control children were included in the audiological analysis. In the gentamicin cohort, 39 (17%) had a birth weight <1500 g. Median cumulative doses and trough plasma concentrations were 30 (interquartile range 24-42) mg/kg and 1.0 (interquartile range 0.7-1.2) mg/L, respectively. Median hearing thresholds for the midfrequencies and the EHFs were 2.5 (0 to 6.3) dB hearing level and -1.7 (-5.0 to 5.0) dB hearing level, both of which were within the normal range. In an adjusted analysis, increasing hearing thresholds were associated with lower birth weight and postnatal middle-ear disease but not level of gentamicin exposure. After adjusting for birth weight, there was no difference in hearing threshold between the gentamicin-exposed cohort and healthy controls. CONCLUSIONS Exposure to a high-dose gentamicin regimen in the neonatal period was not associated with an increase in hearing thresholds in schoolchildren being able to complete audiometry.
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Affiliation(s)
- Dagny Hemmingsen
- Departments of Otorhinolaryngology and Head and Neck Surgery and.,Paediatric Research Group, Faculty of Health Sciences, Univeristy of Tromsø-Arctic University of Norway, Tromsø, Norway; and
| | - Camilla Mikalsen
- Departments of Otorhinolaryngology and Head and Neck Surgery and
| | | | - Jon Widding Fjalstad
- Paediatric Research Group, Faculty of Health Sciences, Univeristy of Tromsø-Arctic University of Norway, Tromsø, Norway; and
| | | | - Claus Klingenberg
- Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway; .,Paediatric Research Group, Faculty of Health Sciences, Univeristy of Tromsø-Arctic University of Norway, Tromsø, Norway; and
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Ciorba A, Hatzopoulos S, Corazzi V, Cogliandolo C, Aimoni C, Bianchini C, Stomeo F, Pelucchi S. Newborn hearing screening at the Neonatal Intensive Care Unit and Auditory Brainstem Maturation in preterm infants. Int J Pediatr Otorhinolaryngol 2019; 123:110-115. [PMID: 31096068 DOI: 10.1016/j.ijporl.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/31/2019] [Accepted: 05/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Aim of this study is to report and discuss the results of 4 years of Newborn hearing screening (NHS) program at the Neonatal Intensive Care Unit (NICU), particularly evaluating the clinical ABR results. METHODS Retrospective study. NHS data from NICU newborns, admitted for ≥5 days, in the period from January 1st, 2013 and December 31st, 2016, were retrieved and analyzed. NHS results were classified as following: (i) "pass" when both ears for both the a-TEOAE (automated Transient-Evoked Otoacoustic Emissions) and the a-ABR (automated Auditory Brainstem Response) protocol resulted as "pass"; (ii) "fail" when one ear, at either one of the two performed tests resulted as "fail"; (iii) "missing" when the newborns were not tested with both protocols. All "fail" and "missing" newborns were retested (with both tests): in the case of a second "fail" result, a clinical ABR was performed within a period of 3 months. RESULTS A total of 1191 newborns were screened. From those, 1044/1191 resulted as "pass", 108/1191 as "fail", and 39/1191 as "missing". During the re-testing of these 147 newborns, 43 were assigned as "missing", 63 were assigned as "pass" (showing bilaterally a wave V identifiable within 30 dB nHL) and 25 failed the retest and/or did not present an identifiable wave V within 30 dB nHL. Among the 147 retested infants, we identified a group of 16 subjects who resulted as NHS "refer" and who, during the audiological follow-up, showed either: (i) a unilateral or bilateral wave V identifiable over 30 dB nHL, at the first clinical ABR assessment; or (ii) a bilateral wave V identifiable within 30 dB nHL, in a following clinical ABR test during the first year of life. These 16 subjects were defined to have an 'Auditory Brainstem Maturation' issue. CONCLUSIONS A possible "maturation" of the ABR response (and therefore of the auditory pathway) has been hypothesised in 16 out of 1191 infants (1.3%). A delay of the auditory pathway maturation in preterm babies compared to term newborns has already been suggested in the literature. A possible delay of the NHS retest could be considered, in selected cases, with significant savings in economic resources and parental anxiety.
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Affiliation(s)
- Andrea Ciorba
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy.
| | - Stavros Hatzopoulos
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Virginia Corazzi
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Cristina Cogliandolo
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Claudia Aimoni
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Chiara Bianchini
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Francesco Stomeo
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
| | - Stefano Pelucchi
- ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy
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Jiang M, Li H, Johnson A, Karasawa T, Zhang Y, Meier WB, Taghizadeh F, Kachelmeier A, Steyger PS. Inflammation up-regulates cochlear expression of TRPV1 to potentiate drug-induced hearing loss. SCIENCE ADVANCES 2019; 5:eaaw1836. [PMID: 31328162 PMCID: PMC6636990 DOI: 10.1126/sciadv.aaw1836] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/13/2019] [Indexed: 05/26/2023]
Abstract
Aminoglycoside antibiotics are essential for treating life-threatening bacterial infections, despite the risk of lifelong hearing loss. Infections induce inflammation and up-regulate expression of candidate aminoglycoside-permeant cation channels, including transient receptor potential vanilloid-1 (TRPV1). Heterologous expression of TRPV1 facilitated cellular uptake of (fluorescently tagged) gentamicin that was enhanced by agonists, and diminished by antagonists, of TRPV1. Cochlear TRPV1 was immunolocalized near the apical membranes of sensory hair cells, adjacent supporting cells, and marginal cells in the stria vascularis. Exposure to immunostimulatory lipopolysaccharides, to simulate of bacterial infections, increased cochlear expression of TRPV1 and hair cell uptake of gentamicin. Lipopolysaccharide exposure exacerbated aminoglycoside-induced auditory threshold shifts and loss of cochlear hair cells in wild-type, but not in heterozygous Trpv1+/- or Trpv1 knockout, mice. Thus, TRPV1 facilitates cochlear uptake of aminoglycosides, and bacteriogenic stimulation upregulates TRPV1 expression to exacerbate cochleotoxicity. Furthermore, loss-of-function polymorphisms in Trpv1 can protect against immunogenic exacerbation of aminoglycoside-induced cochleotoxicity.
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Affiliation(s)
- Meiyan Jiang
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Hongzhe Li
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Anastasiya Johnson
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Takatoshi Karasawa
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Yuan Zhang
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - William B. Meier
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Farshid Taghizadeh
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Allan Kachelmeier
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Peter S. Steyger
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR 97239, USA
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13
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Puia-Dumitrescu M, Bretzius OM, Brown N, Fitz-Henley JA, Ssengonzi R, Wechsler CS, Gray KD, Benjamin DK, Smith PB, Clark RH, Gonzalez D, Hornik CP. Evaluation of Gentamicin Exposure in the Neonatal Intensive Care Unit and Hearing Function at Discharge. J Pediatr 2018; 203:131-136. [PMID: 30244991 PMCID: PMC6361629 DOI: 10.1016/j.jpeds.2018.07.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/25/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the association between gentamicin dosing, duration of treatment, and ototoxicity in hospitalized infants. STUDY DESIGN This retrospective cohort study conducted at 330 neonatal intensive care units (2002-2014) included inborn infants exposed to gentamicin with available hearing screen results, and excluded infants with incomplete dosing data and major congenital anomalies. Our primary outcome was the final hearing screen result performed during hospitalization: abnormal (failed or referred for further testing in one or both ears) or normal (bilateral passed). The 4 measures of gentamicin exposure were highest daily dose, average daily dose, cumulative dose, and cumulative duration of exposure. We fitted separate multivariable logistic regression models adjusted for demographics, comorbidities, and other clinical events. RESULTS A total of 84 808 infants met inclusion/exclusion criteria; median (25th, 75th percentile) gestational age and birth weight were 35 weeks (33, 38) and 2480 g (1890, 3184), respectively. Failed hearing screens occurred in 3238 (3.8%) infants; failed screens were more likely in infants of lower gestational age and birth weight, who had longer hospital lengths of stay, higher rates of morbidities, and were small for gestational age. Median highest daily dose, average daily dose, and cumulative dose were 4.0 mg/kg/day (3.0, 4.0), 3.8 mg/kg/day (3.0, 4.0), and 12.1 mg/kg (9.1, 20.5), respectively. Median cumulative duration of exposure was 3 days (3, 6). In adjusted analysis, gentamicin dose and duration of therapy were not associated with hearing screen failure. CONCLUSIONS Gentamicin dosing and duration of treatment were not associated with increased odds of failed hearing screen at the time of discharge from initial neonatal intensive care unit stay.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Nia Brown
- Duke Clinical Research Institute, Durham, NC
| | | | | | | | - Keyaria D Gray
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | | | - P Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Daniel Gonzalez
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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14
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Konrad-Martin D, Poling GL, Garinis AC, Ortiz CE, Hopper J, Bennett KO, Dille MF. Applying U.S. national guidelines for ototoxicity monitoring in adult patients: perspectives on patient populations, service gaps, barriers and solutions. Int J Audiol 2018; 57:S3-S18. [PMID: 29157038 PMCID: PMC6450095 DOI: 10.1080/14992027.2017.1398421] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To promote establishment of effective ototoxicity monitoring programs (OMPs), this report reviews the U.S. national audiology guidelines in relation to "real world" OMP application. Background is provided on the mechanisms, risks and clinical presentation of hearing loss associated with major classes of ototoxic medications. DESIGN This is a non-systematic review using PubMed, national and international agency websites, personal communications between ototoxicity experts, and results of unpublished research. Examples are provided of OMPs in various healthcare settings within the U.S. civilian sector, Department of Defense (DoD), and Department of Veterans Affairs (VA). STUDY SAMPLE The five OMPs compared in this report represent a convenience sample of the programs with which the authors are affiliated. Their opinions were elicited via two semi-structured teleconferences on barriers and facilitators of OMP, followed by a self-administered questionnaire on OMP characteristics and practices, with responses synthesized herein. Preliminary results are provided from an ongoing VA clinical trial at one of these OMP sites. Participants were 40 VA patients who received cisplatin chemotherapy in 2014-2017. The study arms contrast access to care for OMP delivered on the treatment unit versus usual care as provided in the audiology clinic. RESULTS Protocols of the OMPs examined varied, reflecting their diverse settings. Service delivery concerns included baseline tests missed or completed after the initial treatment, and monitoring tests done infrequently or only after cessation of treatment. Perceived barriers involved logistics related to accessing and testing patients, such as a lack of processes to help patients enter programs, patients' time and scheduling constraints, and inconvenient audiology clinic locations. Use of abbreviated or screening methods facilitated monitoring. CONCLUSIONS The most effective OMPs integrated audiological management into care pathways of the clinical specialties that prescribe ototoxic medications. More OMP guidance is needed to inform evaluation schedules, outcome reporting, and determination of actionable ototoxic changes. Guidance is also lacking on the use of hearing conservation approaches suitable for the mass testing needed to support large-scale OMP efforts. Guideline adherence might improve with formal endorsement from organizations governing the medical specialty stakeholders in OMP such as oncologists, pulmonologists, infectious disease specialists, ototolaryngologists and pharmacists.
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Affiliation(s)
- Dawn Konrad-Martin
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Gayla L. Poling
- Mayo Clinic, Department of Otorhinolaryngology, Division of Audiology, Rochester, MN
| | - Angela C. Garinis
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Candice E. Ortiz
- Walter Reed National Military Medical Center, National Military Audiology and Speech Pathology Center, Bethesda, MD
| | - Jennifer Hopper
- Department of Otolaryngology, Yale University School of Medicine, New Haven, CT
| | - Keri O’Connell Bennett
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Marilyn F. Dille
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
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15
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Sequi Canet JM, Angelats Romero CM, Sequi Sabater JM, Miralles Torres A, Boronat Garcia M, Gomez Delgado M. Otoacoustic Emissions in Children Treated With Gentamicin in a Secondary Hospital. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Reis FMFDS, Gonçalves CGDO, Conto JD, Iantas M, Lüders D, Marques J. Hearing Assessment of Neonates at Risk for Hearing Loss at a Hearing Health High Complexity Service: An Electrophysiological Assessment. Int Arch Otorhinolaryngol 2018; 23:157-164. [PMID: 30956699 PMCID: PMC6449126 DOI: 10.1055/s-0038-1648217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/18/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction
Hearing is the main sensory access in the first years of life. Therefore, early detection and intervention of hearing impairment must begin before the first year of age.
Objective
To analyze the results of the electrophysiological hearing assessment of children at risk for hearing loss as part of the newborn hearing screening (NHS).
Methods
This is a cross-sectional study held at a hearing health public service clinic located in Brazil, with 104 babies at risks factors for hearing loss referred by public hospitals. A questionnaire was applied to parents, and the auditory brainstem response (ABR) test was held, identifying those with alterations in the results. The outcome of the NHS was also analyzed regarding risk factor, gestational age and gender.
Results
Among the 104 subjects, most of them were male (53.85%), and the main risk factor found was the admission to the neonatal intensive care unit (NICU) for a period longer than 5 days (50.93%). Eighty-five (81.73%) subjects were screened by NHS at the maternity and 40% of them failed the test. Through the ABR test, 6 (5.77%) infants evidenced sensorineural hearing loss, 4 of them being diagnosed at 4 months, and 2 at 6 months of age; all of them failed the NHS and had family history and admission at NICU for over 5 days as the most prevalent hearing risks; in addition, family members of all children perceived their hearing impairment.
Conclusion
Advances could be observed regarding the age of the diagnosis after the implementation of the NHS held at the analyzed public service clinic.
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Affiliation(s)
- Flavia Mara Fernandes da Silva Reis
- Maternity, Hospital do Trabalhador do Paraná, Curitiba, PR, Brazil.,Speech Therapy Clinic, Universidade Tuiuti do Paraná, Curitiba, PR, Brazil
| | | | - Juliana De Conto
- Communication Disorders Program, Universidade Tuiuti do Paraná, Curitiba, PR, Brazil
| | - Milena Iantas
- Speech Therapy Clinic, Universidade Tuiuti do Paraná, Curitiba, PR, Brazil
| | - Débora Lüders
- Communication Disorders Program, Universidade Tuiuti do Paraná, Curitiba, PR, Brazil
| | - Jair Marques
- Department of Audiology, Universidade Tuiuti do Paraná, Curitiba, PR, Brazil
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Abstract
INTRODUCTION The National Commission for the Early Detection of Hearing Loss (CODEPEH) recommends the re-evaluation of hearing in children who have suffered any potentially harmful event, such as the prescription of ototoxic antibiotics such as gentamicin. The evoked otoacoustic emissions (EOAE) are a good method for assessing the integrity of cochlear functionality. MATERIAL AND METHOD A prospective study is presented, including 92 children who were treated with intravenous gentamicin for septic risk/sepsis or urinary tract infection. The children underwent serial EOAE: on admission, at the end of treatment and one month later (if altered on discharge). RESULTS In the end, none of the subjects were affected by the treatment. CONCLUSION Gentamicin appears to be a safe antibiotic in treatments lasting <10days and at the doses described. EOAE are an inexpensive, fast, non-invasive and reliable method to check for gentamicin ototoxicity. This could save in the determination of drug levels.
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18
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Kenyon EJ, Kirkwood NK, Kitcher SR, O'Reilly M, Derudas M, Cantillon DM, Goodyear RJ, Secker A, Baxendale S, Bull JC, Waddell SJ, Whitfield TT, Ward SE, Kros CJ, Richardson GP. Identification of ion-channel modulators that protect against aminoglycoside-induced hair cell death. JCI Insight 2017; 2:96773. [PMID: 29263311 DOI: 10.1172/jci.insight.96773] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/15/2017] [Indexed: 12/22/2022] Open
Abstract
Aminoglycoside antibiotics are used to treat life-threatening bacterial infections but can cause deafness due to hair cell death in the inner ear. Compounds have been described that protect zebrafish lateral line hair cells from aminoglycosides, but few are effective in the cochlea. As the aminoglycosides interact with several ion channels, including the mechanoelectrical transducer (MET) channels by which they can enter hair cells, we screened 160 ion-channel modulators, seeking compounds that protect cochlear outer hair cells (OHCs) from aminoglycoside-induced death in vitro. Using zebrafish, 72 compounds were identified that either reduced loading of the MET-channel blocker FM 1-43FX, decreased Texas red-conjugated neomycin labeling, or reduced neomycin-induced hair cell death. After testing these 72 compounds, and 6 structurally similar compounds that failed in zebrafish, 13 were found that protected against gentamicin-induced death of OHCs in mouse cochlear cultures, 6 of which are permeant blockers of the hair cell MET channel. None of these compounds abrogated aminoglycoside antibacterial efficacy. By selecting those without adverse effects at high concentrations, 5 emerged as leads for developing pharmaceutical otoprotectants to alleviate an increasing clinical problem.
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Affiliation(s)
| | | | | | | | - Marco Derudas
- Sussex Drug Discovery Centre, School of Life Sciences, and
| | - Daire M Cantillon
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | | | | | - Sarah Baxendale
- Bateson Centre and Department of Biomedical Science, University of Sheffield, Sheffield, United Kingdom
| | - James C Bull
- Department of Biosciences, College of Science, Swansea University, Swansea, United Kingdom
| | - Simon J Waddell
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Tanya T Whitfield
- Bateson Centre and Department of Biomedical Science, University of Sheffield, Sheffield, United Kingdom
| | - Simon E Ward
- Sussex Drug Discovery Centre, School of Life Sciences, and.,Medicines Discovery Institute, Cardiff University, Cardiff, United Kingdom
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19
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Jiang M, Taghizadeh F, Steyger PS. Potential Mechanisms Underlying Inflammation-Enhanced Aminoglycoside-Induced Cochleotoxicity. Front Cell Neurosci 2017; 11:362. [PMID: 29209174 PMCID: PMC5702304 DOI: 10.3389/fncel.2017.00362] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/03/2017] [Indexed: 12/20/2022] Open
Abstract
Aminoglycoside antibiotics remain widely used for urgent clinical treatment of life-threatening infections, despite the well-recognized risk of permanent hearing loss, i.e., cochleotoxicity. Recent studies show that aminoglycoside-induced cochleotoxicity is exacerbated by bacteriogenic-induced inflammation. This implies that those with severe bacterial infections (that induce systemic inflammation), and are treated with bactericidal aminoglycosides are at greater risk of drug-induced hearing loss than previously recognized. Incorporating this novel comorbid factor into cochleotoxicity risk prediction models will better predict which individuals are more predisposed to drug-induced hearing loss. Here, we review the cellular and/or signaling mechanisms by which host-mediated inflammatory responses to infection could enhance the trafficking of systemically administered aminoglycosides into the cochlea to enhance the degree of cochleotoxicity over that in healthy preclinical models. Once verified, these mechanisms will be potential targets for novel pharmacotherapeutics that reduce the risk of drug-induced hearing loss (and acute kidney damage) without compromising the life-saving bactericidal efficacy of aminoglycosides.
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Affiliation(s)
- Meiyan Jiang
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Farshid Taghizadeh
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Peter S Steyger
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States.,National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States
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20
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Jiang M, Karasawa T, Steyger PS. Aminoglycoside-Induced Cochleotoxicity: A Review. Front Cell Neurosci 2017; 11:308. [PMID: 29062271 PMCID: PMC5640705 DOI: 10.3389/fncel.2017.00308] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/15/2017] [Indexed: 12/20/2022] Open
Abstract
Aminoglycoside antibiotics are used as prophylaxis, or urgent treatment, for many life-threatening bacterial infections, including tuberculosis, sepsis, respiratory infections in cystic fibrosis, complex urinary tract infections and endocarditis. Although aminoglycosides are clinically-essential antibiotics, the mechanisms underlying their selective toxicity to the kidney and inner ear continue to be unraveled despite more than 70 years of investigation. The following mechanisms each contribute to aminoglycoside-induced toxicity after systemic administration: (1) drug trafficking across endothelial and epithelial barrier layers; (2) sensory cell uptake of these drugs; and (3) disruption of intracellular physiological pathways. Specific factors can increase the risk of drug-induced toxicity, including sustained exposure to higher levels of ambient sound, and selected therapeutic agents such as loop diuretics and glycopeptides. Serious bacterial infections (requiring life-saving aminoglycoside treatment) induce systemic inflammatory responses that also potentiate the degree of ototoxicity and permanent hearing loss. We discuss prospective clinical strategies to protect auditory and vestibular function from aminoglycoside ototoxicity, including reduced cochlear or sensory cell uptake of aminoglycosides, and otoprotection by ameliorating intracellular cytotoxicity.
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Affiliation(s)
- Meiyan Jiang
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Takatoshi Karasawa
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Peter S Steyger
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States.,National Center for Rehabilitative Auditory Research, Portland VA Medical Center (VHA), Portland, OR, United States
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21
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Effects of Aminoglycoside Antibiotics on Human Embryonic Stem Cell Viability during Differentiation In Vitro. Stem Cells Int 2017; 2017:2451927. [PMID: 29147115 PMCID: PMC5632925 DOI: 10.1155/2017/2451927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/30/2017] [Accepted: 08/29/2017] [Indexed: 11/17/2022] Open
Abstract
Human embryonic stem cells (hESCs) are being used extensively in array of studies to understand different mechanisms such as early human embryogenesis, drug toxicity testing, disease modeling, and cell replacement therapy. The protocols for the directed differentiation of hESCs towards specific cell types often require long-term cell cultures. To avoid bacterial contamination, these protocols include addition of antibiotics such as pen-strep and gentamicin. Although aminoglycosides, streptomycin, and gentamicin have been shown to cause cytotoxicity in various animal models, the effect of these antibiotics on hESCs is not clear. In this study, we found that antibiotics, pen-strep, and gentamicin did not affect hESC cell viability or expression of pluripotency markers. However, during directed differentiation towards neural and hepatic fate, significant cell death was noted through the activation of caspase cascade. Also, the expression of neural progenitor markers Pax6, Emx2, Otx2, and Pou3f2 was significantly reduced suggesting that gentamicin may adversely affect early embryonic neurogenesis whereas no effect was seen on the expression of endoderm or hepatic markers during differentiation. Our results suggest that the use of antibiotics in cell culture media for the maintenance and differentiation of hESCs needs thorough investigation before use to avoid erroneous results.
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22
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Garinis AC, Liao S, Cross CP, Galati J, Middaugh JL, Mace JC, Wood AM, McEvoy L, Moneta L, Lubianski T, Coopersmith N, Vigo N, Hart C, Riddle A, Ettinger O, Nold C, Durham H, MacArthur C, McEvoy C, Steyger PS. Effect of gentamicin and levels of ambient sound on hearing screening outcomes in the neonatal intensive care unit: A pilot study. Int J Pediatr Otorhinolaryngol 2017; 97:42-50. [PMID: 28483249 PMCID: PMC5439527 DOI: 10.1016/j.ijporl.2017.03.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hearing loss rates in infants admitted to neonatal intensive care units (NICU) run at 2-15%, compared to 0.3% in full-term births. The etiology of this difference remains poorly understood. We examined whether the level of ambient sound and/or cumulative gentamicin (an aminoglycoside) exposure affect NICU hearing screening results, as either exposure can cause acquired, permanent hearing loss. We hypothesized that higher levels of ambient sound in the NICU, and/or gentamicin dosing, increase the risk of referral on the distortion product otoacoustic emission (DPOAE) assessments and/or automated auditory brainstem response (AABR) screens. METHODS This was a prospective pilot outcomes study of 82 infants (<37 weeks gestational age) admitted to the NICU at Oregon Health & Science University. An ER-200D sound pressure level dosimeter was used to collect daily sound exposure in the NICU for each neonate. Gentamicin dosing was also calculated for each infant, including the total daily dose based on body mass (mg/kg/day), as well as the total number of treatment days. DPOAE and AABR assessments were conducted prior to discharge to evaluate hearing status. Exclusion criteria included congenital infections associated with hearing loss, and congenital craniofacial or otologic abnormalities. RESULTS The mean level of ambient sound was 62.9 dBA (range 51.8-70.6 dBA), greatly exceeding American Academy of Pediatrics (AAP) recommendation of <45.0 dBA. More than 80% of subjects received gentamicin treatment. The referral rate for (i) AABRs, (frequency range: ∼1000-4000 Hz), was 5%; (ii) DPOAEs with a broad F2 frequency range (2063-10031 Hz) was 39%; (iii) DPOAEs with a low-frequency F2 range (<4172 Hz) was 29%, and (iv) DPOAEs with a high-frequency F2 range (>4172 Hz) was 44%. DPOAE referrals were significantly greater for infants receiving >2 days of gentamicin dosing compared to fewer doses (p = 0.004). The effect of sound exposure and gentamicin treatment on hearing could not be determined due to the low number of NICU infants without gentamicin exposure (for control comparisons). CONCLUSION All infants were exposed to higher levels of ambient sound that substantially exceed AAP guidelines. More referrals were generated by DPOAE assessments than with AABR screens, with significantly more DPOAE referrals with a high-frequency F2 range, consistent with sound- and/or gentamicin-induced cochlear dysfunction. Adding higher frequency DPOAE assessments to existing NICU hearing screening protocols could better identify infants at-risk for ototoxicity.
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Affiliation(s)
- Angela C. Garinis
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon
| | - Selena Liao
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon
| | - Campbell P. Cross
- School of Medicine, Oregon Health & Science University, Portland, Oregon,Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon
| | - Johnathan Galati
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon
| | - Jessica L. Middaugh
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon
| | - Jess C. Mace
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon
| | - Anna-Marie Wood
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon
| | - Lindsey McEvoy
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon
| | - Lauren Moneta
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon
| | - Troy Lubianski
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon
| | - Noe Coopersmith
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon
| | - Nicholas Vigo
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Christopher Hart
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Artur Riddle
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Olivia Ettinger
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon
| | - Casey Nold
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon
| | - Heather Durham
- Child Development and Research Center, Oregon Health & Science University, Portland, Oregon
| | - Carol MacArthur
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon
| | - Cynthia McEvoy
- Department of Neonatology, Oregon Health & Science University, Portland, Oregon
| | - Peter S. Steyger
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon,Oregon Hearing Research Center, Oregon Health & Science University, Portland, Oregon
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23
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Garinis AC, Cross CP, Srikanth P, Carroll K, Feeney MP, Keefe DH, Hunter LL, Putterman DB, Cohen DM, Gold JA, Steyger PS. The cumulative effects of intravenous antibiotic treatments on hearing in patients with cystic fibrosis. J Cyst Fibros 2017; 16:401-409. [PMID: 28238634 DOI: 10.1016/j.jcf.2017.01.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/07/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aminoglycosides (AGs) and glycopeptides are antibiotics essential for treating life-threatening respiratory infections in patients with cystic fibrosis (CF). The goal of this study was to examine the effects of cumulative intravenous (IV)-AG (amikacin and/or tobramycin) and/or glycopeptide (vancomycin) dosing on hearing status in patients with CF. METHODS Hearing thresholds were measured from 0.25 to 16.0kHz, in 81 participants with CF. Participants were categorized into two groups: normal hearing in both ears (≤25dB HL for all frequency bands) or hearing loss (>25dB HL for any frequency band in either ear). Participants were also characterized into quartiles by their cumulative IV-AG (with or without vancomycin) exposure. Dosing was calculated using two strategies: (i) total number of lifetime doses, and (ii) total number of lifetime doses while accounting for the total doses per day. This was referred to as the "weighted" method. RESULTS Participants in the hearing loss group were significantly older than those in the normal-hearing group. After adjusting for gender and age at the time of hearing test, participants in the two highest-quartile exposure groups were almost 5 X more likely to have permanent sensorineural hearing loss than those in the two lowest-quartile exposure groups. There was a small group of CF patients who had normal hearing despite high exposure to IV-antibiotics. CONCLUSIONS Cumulative IV-antibiotic dosing has a significant negative effect on hearing sensitivity in patients with CF, when controlling for age and gender effects. A trend for increasing odds of hearing loss was associated with increasing cumulative IV-antibiotic dosing.
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Affiliation(s)
- Angela C Garinis
- Otolaryngology, Oregon Health & Science University, Portland, OR, United States; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States.
| | - Campbell P Cross
- Otolaryngology, Oregon Health & Science University, Portland, OR, United States; School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Priya Srikanth
- Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Kelly Carroll
- Otolaryngology, Oregon Health & Science University, Portland, OR, United States
| | - M Patrick Feeney
- Otolaryngology, Oregon Health & Science University, Portland, OR, United States; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States
| | - Douglas H Keefe
- Boys Town National Research Hospital, Omaha, NE, United States
| | - Lisa L Hunter
- Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Daniel B Putterman
- Otolaryngology, Oregon Health & Science University, Portland, OR, United States; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States
| | - David M Cohen
- Nephrology, Oregon Health & Science University, Portland, OR, United States
| | - Jeffrey A Gold
- Pulmonology, Oregon Health & Science University, Portland, OR, United States
| | - Peter S Steyger
- Otolaryngology, Oregon Health & Science University, Portland, OR, United States
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