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Hillyer T, Shin WS. Meropenem/Vaborbactam-A Mechanistic Review for Insight into Future Development of Combinational Therapies. Antibiotics (Basel) 2024; 13:472. [PMID: 38927139 PMCID: PMC11200783 DOI: 10.3390/antibiotics13060472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Beta-lactam antibiotics have been a major climacteric in medicine for being the first bactericidal compound available for clinical use. They have continually been prescribed since their development in the 1940s, and their application has saved an immeasurable number of lives. With such immense use, the rise in antibiotic resistance has truncated the clinical efficacy of these compounds. Nevertheless, the synergism of combinational antibiotic therapy has allowed these drugs to burgeon once again. Here, the development of meropenem with vaborbactam-a recently FDA-approved beta-lactam combinational therapy-is reviewed in terms of structure rationale, activity gamut, pharmacodynamic/pharmacokinetic properties, and toxicity to provide insight into the future development of analogous therapies.
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Affiliation(s)
- Trae Hillyer
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
- University Hospital and Northeast Ohio Medical University Scholarship Program, Rootstown, OH 44272, USA
| | - Woo Shik Shin
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
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Lontsi Ngoula G, Houcke S, Matheus S, Nkontcho F, Pujo JM, Higel N, Ba A, Cook F, Gourjault C, Mounier R, Nacher M, Demar M, Djossou F, Hommel D, Kallel H. Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana. Antibiotics (Basel) 2022; 12:58. [PMID: 36671259 PMCID: PMC9855120 DOI: 10.3390/antibiotics12010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
(1) Background: During the COVID-19 outbreak, several studies showed an increased prevalence of extended-spectrum β-lactamase producing Enterobacterales (ESBL-PE) carriage in intensive care units (ICUs). Our objective was to assess the impact of antibiotic prescriptions on the acquisition of ESBL-PE in ICUs during the COVID-19 crisis. (2) Methods: We conducted an observational study between 1 April 2020, and 31 December 2021, in the medical-surgical ICU of the Cayenne General Hospital. We defined two periods: Period 1 with routine, empirical antibiotic use, and Period 2 with no systematic empiric antibiotic prescription. (3) Results: ICU-acquired ESBL-PE carriage was 22.8% during Period 1 and 9.4% during Period 2 (p = 0.005). The main isolated ESBL-PE was Klebsiella pneumoniae (84.6% in Period 1 and 58.3% in Period 2). When using a generalized linear model with a Poisson family, exposure to cefotaxime was the only factor independently associated with ESBL-PE acquisition in ICU (p = 0.002, IRR 2.59 (95% IC 1.42-4.75)). The propensity scores matching estimated the increased risk for cefotaxime use to acquire ESBL-PE carriage at 0.096 (95% CI = 0.02-0.17), p = 0.01. (4) Conclusions: Exposure to cefotaxime in patients with severe COVID-19 is strongly associated with the emergence of ESBL-PE in the context of maximal infection control measures.
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Affiliation(s)
- Guy Lontsi Ngoula
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Stéphanie Houcke
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Séverine Matheus
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Flaubert Nkontcho
- Pharmacy Department, Cayenne General Hospital, 97306 Cayenne, French Guiana
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, 97300 Cayenne, French Guiana
| | - Jean Marc Pujo
- Emergency Department, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Nicolas Higel
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Absettou Ba
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Fabrice Cook
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Cyrille Gourjault
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Roman Mounier
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
- Department of Neuro-ICU, GHU-Paris, Paris University, 75014 Paris, France
| | - Mathieu Nacher
- Clinical Investigation Center, Antilles French Guiana (CIC Inserm 1424), Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Magalie Demar
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, 97300 Cayenne, French Guiana
- Polyvalent Biology Department, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Felix Djossou
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, 97300 Cayenne, French Guiana
- Tropical and Infectious Diseases Department, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Didier Hommel
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
| | - Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, 97306 Cayenne, French Guiana
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, 97300 Cayenne, French Guiana
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Mills JP, Marchaim D. Multidrug-Resistant Gram-Negative Bacteria: Infection Prevention and Control Update. Infect Dis Clin North Am 2021; 35:969-994. [PMID: 34752228 DOI: 10.1016/j.idc.2021.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Multidrug-resistant gram-negative bacteria (MDR-GNB) pose one of the greatest challenges to health care today because of their propensity for human-to-human transmission and lack of therapeutic options. Containing the spread of MDR-GNB is challenging, and the application of multifaceted infection control bundles during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article will review the utility of various infection control measures in containing the spread of various MDR-GNB and will provide the supporting evidence for these interventions.
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Affiliation(s)
- John P Mills
- Division of Infectious Diseases, University of Michigan Medical School, F4177 University Hospital South, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5226, USA.
| | - Dror Marchaim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
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Extended Spectrum Beta-Lactamase (ESBL) Produced by Gram-Negative Bacteria in Trinidad and Tobago. Int J Microbiol 2021; 2021:5582755. [PMID: 34475957 PMCID: PMC8408010 DOI: 10.1155/2021/5582755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022] Open
Abstract
Gram-negative bacterial infections are a global health problem. The production of beta-lactamase is still the most vital factor leading to beta-lactam resistance. In Trinidad and Tobago, extended spectrum beta-lactamase (ESBL) production has been detected and reported mainly in the isolates of Klebsiella pneumoniae and Escherichia coli and constitutes a public health emergency that causes high morbidity and mortality in some patients. In this literature review, the authors cover vast information on ESBL frequency and laboratory detection using both conventional and molecular methods from clinical data. The aim is to make the reader reflect on how the actual knowledge can be used for rapid detection and understanding of the spread of antimicrobial resistance problems stemming from ESBL production among common Gram-negative organisms in the health care system.
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