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Ali H, Anwar S, Ali Khan R. Rapid detection of bactericidal efficacy of nanoparticles coated polyurethane foam by synchronous fluorescence spectroscopy. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 323:124877. [PMID: 39096680 DOI: 10.1016/j.saa.2024.124877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024]
Abstract
The ability of right-angled synchronous fluorescence spectroscopy (SFS) was explored to analyse the bacterial load in water treated with green synthesized silver nanoparticles (AgNPs) coated polyurethane foam (PUF). Gram negative (Escherichia coli, Pseudomonas aeruginosa) and Gram positive (Staphylococcus aureus) bacteria cultured in nutrient broth were diluted in autoclaved water containing NPs-coated PUF. The survival rate of S. aureus and E. coli lowered after ten minutes as compared to P. aeruginosa; however, after thirty minutes, the percentage viability dropped and recorded as 3.4%, 0.9%, and 0.1% for E. coli, P. aeruginosa and S. aureus respectively in the treated suspensions. No spectral change was observed in the fluorescence emission from the positive control and treated bacterial suspension owing to the masking effect of the emission from nutrient broth. In parallel, SF spectra recorded for directly picked bacterial colony dissolved in water showed remarkable drop in tryptophan emission after treatment with NPs-coated PUF. The SF data changes were assisted by hierarchical cluster analysis, which also made it possible to distinguish between positive control and treated bacterial suspensions. SFS has shown to be a reliable substitute for the culture plate approach for the quick identification of bacterial contamination in water.
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Affiliation(s)
- Hina Ali
- National Institute of Lasers and Optronics College, Pakistan Institute of Engineering and Applied Sciences, Nilore 45650, Islamabad, Pakistan.
| | - Shahzad Anwar
- National Institute of Lasers and Optronics College, Pakistan Institute of Engineering and Applied Sciences, Nilore 45650, Islamabad, Pakistan
| | - Rafaqat Ali Khan
- National Institute of Lasers and Optronics College, Pakistan Institute of Engineering and Applied Sciences, Nilore 45650, Islamabad, Pakistan
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Chen J, Xia B, Liu Y, Sun W, Liu F, Pang J, Cheng H. Clinical outcomes and safety of polymyxin B versus tigecycline combination therapy for pneumonia of carbapenem-resistant Klebsiella pneumoniae: a retrospective cohort study. Ann Med 2024; 56:2397087. [PMID: 39239861 PMCID: PMC11382689 DOI: 10.1080/07853890.2024.2397087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/08/2024] [Accepted: 07/23/2024] [Indexed: 09/07/2024] Open
Abstract
PURPOSE Infection by carbapenem-resistant Klebsiella pneumoniae (CRKP) has high mortality. There is no clear optimal therapeutic choice for pneumonia caused by CRKP. The aim of this study was to compare the clinical outcomes and safety of the standard doses of polymyxin B-based regimens vs tigecycline-based regimens and to identify risk factors for mortality. METHODS This retrospective cohort study included patients with pneumonia caused by CRKP between January 1, 2020 and December 31, 2022. The primary outcomes were 7-day bacterial eradication rate and 14- and 28-day all-cause mortality. The secondary outcome was incidence of acute kidney injury. RESULTS Seventy-three patients were included in this study, 29 in the polymyxin B-based combination therapy group and 44 in tigecycline-based combination therapy group. There were no significant differences between the two groups in terms of the 7-day bacterial eradication rate (31.03% vs 20.45%, p = 0.409), the 14-day all-cause mortality (37.93% vs 22.73%, p = 0.160), and the incidence of acute kidney injury (14.29% vs 6.82%, p = 0.526). The 28-day all-cause mortality in the polymyxin B-based therapy group was higher than in the tigecycline-based group (75.86% vs 45.45%, p = 0.010). Binary logistic regression analysis revealed that male and previous use of carbapenems were independent factors associated with 28-day all-cause mortality for patients treated with polymyxin B (p < 0.05). CONCLUSIONS Polymyxin B-based combination therapy at the standard dose should be used with caution for patients with CRKP-induced pneumonia, especially for men who used carbapenems prior to CRKP detection.
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Affiliation(s)
- Jing Chen
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Binbin Xia
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Wenfang Sun
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Fang Liu
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jingyao Pang
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hua Cheng
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Khwaza V, Aderibigbe BA. Potential Pharmacological Properties of Triterpene Derivatives of Ursolic Acid. Molecules 2024; 29:3884. [PMID: 39202963 PMCID: PMC11356970 DOI: 10.3390/molecules29163884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
Ursolic acid (UA) and its derivatives have garnered significant attention due to their extensive pharmacological activity. UA is a pentacyclic triterpenoid found in a variety of plants, such as apples, rosemary, thyme, etc., and it possesses a range of pharmacological properties. Researchers have synthesized various derivatives of UA through structural modifications to enhance its potential pharmacological properties. Various in vitro and in vivo studies have indicated that UA and its derivatives possess diverse biological activities, such as anticancer, antifungal, antidiabetic, antioxidant, antibacterial, anti-inflammatory and antiviral properties. This review article provides a review of the biological activities of UA and its derivatives to show their valuable therapeutic properties useful in the treatment of different diseases, mainly focusing on the relevant structure-activity relationships (SARs), the underlying molecular targets/pathways, and modes of action.
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Affiliation(s)
- Vuyolwethu Khwaza
- Department of Chemistry, University of Fort Hare, Alice Campus, Alice 5700, Eastern Cape, South Africa
| | - Blessing A. Aderibigbe
- Department of Chemistry, University of Fort Hare, Alice Campus, Alice 5700, Eastern Cape, South Africa
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Sendra E, Fernández-Muñoz A, Zamorano L, Oliver A, Horcajada JP, Juan C, Gómez-Zorrilla S. Impact of multidrug resistance on the virulence and fitness of Pseudomonas aeruginosa: a microbiological and clinical perspective. Infection 2024; 52:1235-1268. [PMID: 38954392 PMCID: PMC11289218 DOI: 10.1007/s15010-024-02313-x] [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: 03/22/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
Pseudomonas aeruginosa is one of the most common nosocomial pathogens and part of the top emergent species associated with antimicrobial resistance that has become one of the greatest threat to public health in the twenty-first century. This bacterium is provided with a wide set of virulence factors that contribute to pathogenesis in acute and chronic infections. This review aims to summarize the impact of multidrug resistance on the virulence and fitness of P. aeruginosa. Although it is generally assumed that acquisition of resistant determinants is associated with a fitness cost, several studies support that resistance mutations may not be associated with a decrease in virulence and/or that certain compensatory mutations may allow multidrug resistance strains to recover their initial fitness. We discuss the interplay between resistance profiles and virulence from a microbiological perspective but also the clinical consequences in outcomes and the economic impact.
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Affiliation(s)
- Elena Sendra
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
| | - Almudena Fernández-Muñoz
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
| | - Laura Zamorano
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
| | - Antonio Oliver
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Juan
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain.
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain.
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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Wu H, Li M, Shou C, Shi F, Song X, Hu Q, Wang Y, Chen Y, Tong X. Pathogenic spectrum and drug resistance of bloodstream infection in patients with acute myeloid leukaemia: a single centre retrospective study. Front Cell Infect Microbiol 2024; 14:1390053. [PMID: 38912203 PMCID: PMC11190328 DOI: 10.3389/fcimb.2024.1390053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 06/25/2024] Open
Abstract
Background Bloodstream infection (BSI) represent a prevalent complication in haematological malignancies (HMs). Typically, Patients with BSI usually undergo empirical treatment pending pathogen identification. The timely and effective management of BSIs significantly influences patient prognosis. However, pathogen distribution in BSIs exhibits regional variation. In this study, we investigated the clinical characteristics, pathogen spectrum, drug resistance, risk factors of short-term prognosis and long-term prognostic factors of acute myeloid leukemia (AML) patients with BSI at Zhejiang Provincal People's Hospital. Methods From 2019 to 2021, a total of 56 AML patients with BSI were treated in the Department of Haematology at Zhejiang Province People's Hospital. Data regarding pathogen spectrum and drug resistance were collected for analysis. The patients were stratified into non-survivor cohort and survivor cohort within 30 days after BSI, and the predictors of 30-days mortality were identified through both univariate and multivariate Logistic regression analyses. Furthermore, Kaplan-Meier survival analysis and Cox regression analysis were employed to ascertain the risk factors associated with poor prognosis in AML patients complicated by BSI. Results A total of 70 strains of pathogenic bacteria were isolated from 56 AML patients with BSI. Gram-negative bacteria constituted the predominant pathogens (71.4%), with Klebsiella pneumoniae being the most prevalent (22.9%). Gram-positive bacteria and fungi accounted for 22.9% and 5.7%, respectively. Univariate and multivariate analyses revealed significant differences in total protein, albumin levels, and the presence of septic shock between the non-survivor cohort and the survior cohort 30 days post-BSI. COX regression analysis showed that agranulocytosis duration exceeding 20 days (HR:3.854; 95% CI: 1.451-10.242) and septic shock (HR:3.788; 95% CI: 1.729-8.299) were independent risk factors for poor prognosis in AML patients complicated by BSI. Notably, the mortality rate within 30 days after Stenotrophomonas maltophilia infection was up to 71.4%. Conclusions In this study, Gram-negative bacteria, predominantly Klebsiella pneumoniae, constituted the primary pathogens among AML patients with BSIs. Serum albumin levels and the presence of septic shock emerged as independent risk factors for mortality within 30 days among AML patients with BSI. In terms of long-term prognosis, extended agranulocytosis duration exceeding 20 days and septic shock were associated with elevated mortality rates in AML patients with BSI. Additionally, in our centre, Stenotrophomonas maltophilia infection was found to be associated with a poor prognosis. Early intervention for Stenotrophomonas maltophilia infection in our centre could potentially improve patient outcomes.
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Affiliation(s)
- Han Wu
- Graduate School of Clinical Medicine, Jinzhou Medical University, Jinzhou, Liaoning, China
- Cancer Center, Department of Hematology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Manning Li
- Graduate School of Clinical Medicine, Jinzhou Medical University, Jinzhou, Liaoning, China
- Cancer Center, Department of Hematology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chunyi Shou
- Cancer Center, Department of Hematology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Fangfang Shi
- Cancer Center, Department of Hematology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiaolu Song
- Cancer Center, Department of Hematology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qingfeng Hu
- Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ying Wang
- Department of Central Laboratory, Affiliated Hangzhou First People’s Hospital, Xihu University, Hangzhou, Zhejiang, China
| | - Yirui Chen
- Cancer Center, Department of Hematology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiangmin Tong
- Cancer Center, Department of Hematology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Department of Hematology, Affiliated Hangzhou First People’s Hospital, Xihu University, Hangzhou, Zhejiang, China
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Kroneislová G, Závora J, Adámková VG, Rýdlová A, Adámková V. In vitro activity of antibiotics potentially effective against difficult-to-treat strains of Gram-negative rods: retrospective study. Sci Rep 2024; 14:8310. [PMID: 38594467 PMCID: PMC11004177 DOI: 10.1038/s41598-024-59036-0] [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: 06/28/2023] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
Bacterial resistance surveillance is one of the main outputs of microbiological laboratories and its results are important part of antimicrobial stewardship (AMS). In this study, the susceptibility of specific bacteria to selected antimicrobial agents was tested. The susceptibility of 90 unique isolates of pathogens of critical priority obtained from clinically valid samples of ICU patients in 2017-2021 was tested. 50% of these fulfilled difficult-to-treat resistance (DTR) criteria and 50% were susceptible to all antibiotics included in the definition. 10 Enterobacterales strains met DTR criteria, and 2 (20%) were resistant to colistin (COL), 2 (20%) to cefiderocol (FCR), 7 (70%) to imipenem/cilastatin/relebactam (I/R), 3 (30%) to ceftazidime/avibactam (CAT) and 5 (50%) to fosfomycin (FOS). For Enterobacterales we also tested aztreonam/avibactam (AZA) for which there are no breakpoints yet. The highest MIC of AZA observed was 1 mg/l, MIC range in the susceptible cohort was 0.032-0.064 mg/l and in the DTR cohort (incl. class B beta-lactamase producers) it was 0.064-1 mg/l. Two (13.3%) isolates of Pseudomonas aeruginosa (15 DTR strains) were resistant to COL, 1 (6.7%) to FCR, 13 (86.7%) to I/R, 5 (33.3%) to CAT, and 5 (33.3%) to ceftolozane/tazobactam. All isolates of Acinetobacter baumannii with DTR were susceptible to COL and FCR, and at the same time resistant to I/R and ampicillin/sulbactam. New antimicrobial agents are not 100% effective against DTR. Therefore, it is necessary to perform susceptibility testing of these antibiotics, use the data for surveillance (including local surveillance) and conform to AMS standards.
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Affiliation(s)
- Gabriela Kroneislová
- Department of Clinical Microbiology and ATB Centre, Institute of Medical Biochemistry and Laboratory Diagnostic, First Faculty of Medicine, Charles University and General University Hospital, Ke Karlovu 2, Prague, 12808, Czech Republic.
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology, Prague, Czech Republic.
| | - Jan Závora
- Department of Clinical Microbiology and ATB Centre, Institute of Medical Biochemistry and Laboratory Diagnostic, First Faculty of Medicine, Charles University and General University Hospital, Ke Karlovu 2, Prague, 12808, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacký University-Olomouc, Olomouc, Czech Republic
| | | | - Anna Rýdlová
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Václava Adámková
- Department of Clinical Microbiology and ATB Centre, Institute of Medical Biochemistry and Laboratory Diagnostic, First Faculty of Medicine, Charles University and General University Hospital, Ke Karlovu 2, Prague, 12808, Czech Republic
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Michels-Zetsche JD, Gassmann V, Jasuja JK, Neetz B, Höger P, Meis J, Britsch S, Sommerwerck U, Fähndrich S, Bornitz F, Müller MM, Herth FJF, Trudzinski FC. Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation. Respir Res 2024; 25:69. [PMID: 38317197 PMCID: PMC10840161 DOI: 10.1186/s12931-024-02694-5] [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: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Although multidrug-resistant bacteria (MDR) are common in patients undergoing prolonged weaning, there is little data on their impact on weaning and patient outcomes. METHODS This is a retrospective analysis of consecutive patients who underwent prolonged weaning and were at a university weaning centre from January 2018 to December 2020. The influence of MDR colonisation and infection on weaning success (category 3a and 3b), successful prolonged weaning from invasive mechanical ventilation (IMV) with or without the need for non-invasive ventilation (NIV) compared with category 3c (weaning failure 3cI or death 3cII) was investigated. The pathogen groups considered were: multidrug-resistant gram-negative bacteria (MDRGN), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. (VRE). RESULTS A total of 206 patients were studied, of whom 91 (44.2%) showed evidence of MDR bacteria (32% VRE, 1.5% MRSA and 16% MDRGN), with 25 patients also meeting the criteria for MDR infection. 70.9% of the 206 patients were successfully weaned from IMV, 8.7% died. In 72.2% of cases, nosocomial pneumonia and other infections were the main cause of death. Patients with evidence of MDR (infection and colonisation) had a higher incidence of weaning failure than those without evidence of MDR (48% vs. 34.8% vs. 21.7%). In multivariate analyses, MDR infection (OR 4.9, p = 0.004) was an independent risk factor for weaning failure, along with male sex (OR 2.3, p = 0.025), Charlson Comorbidity Index (OR 1.2, p = 0.027), pH (OR 2.7, p < 0.001) and duration of IMV before admission (OR 1.01, p < 0.001). In addition, MDR infection was the only independent risk factor for death (category 3cII), (OR 6.66, p = 0.007). CONCLUSION Patients with MDR infection are significantly more likely to die during the weaning process. There is an urgent need to develop non-antibiotic approaches for the prevention and treatment of MDR infections as well as clinical research on antibiotic stewardship in prolonged weaning as well as in ICUs.
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Affiliation(s)
- Julia D Michels-Zetsche
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany.
| | - Vicky Gassmann
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Jasmin K Jasuja
- Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Benjamin Neetz
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Philipp Höger
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Jan Meis
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Simone Britsch
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, European Center for Angioscience (ECAS), University Medical Center Mannheim, German Center for Cardiovascular Research (DZHK), Partner Site, Heidelberg/Mannheim, Germany
| | - Urte Sommerwerck
- Department of Pneumology, Krankenhaus der Augustinerinnen Cologne, Cologne, Germany
| | - Sebastian Fähndrich
- Department of Pneumology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Florian Bornitz
- Department of Pneumology and Internal Intensive Care Medicine, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Michael M Müller
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
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Cosentino F, Viale P, Giannella M. MDR/XDR/PDR or DTR? Which definition best fits the resistance profile of Pseudomonas aeruginosa? Curr Opin Infect Dis 2023; 36:564-571. [PMID: 37930070 PMCID: PMC10836784 DOI: 10.1097/qco.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE OF REVIEW The aim of this narrative review is to compare the prognostic utility of the new definition of difficult-to-treat resistance (DTR) vs. established definitions in patients with Pseudomonas aeruginosa infection to understand the therapeutic implications of resistance classification and its impact on clinical outcome. RECENT FINDINGS Among Gram-negative bacteria (GNB), P. aeruginosa (PA) is associated with high rates of morbidity and mortality, mostly related to its intrinsic capacity of developing antibiotic resistance. Several classifications of antibiotic resistance have been proposed in the last 15 years. The most common used is that from Magiorakos et al. including multidrug resistance (MDR), extensively drug-resistant (XDR) and pan drug resistance (PDR) according to the number of antibiotic classes showing in vitro activity. A further classification based on the resistance to specific antibiotic classes (i.e. fluoroquinolones, cephalosporins, carbapenem resistance) was also proposed. However, both of them have been criticized because of limited usefulness in clinical practice and for poor correlation with patient outcome, mainly in infections due to PA. More recently the new definition of difficult-to-treat resistance (DTR) has been proposed referring to nonsusceptibility to all first-line agents showing high-efficacy and low-toxicity (i.e. carbapenems, β-lactam-β-lactamase inhibitor combinations, and fluoroquinolones). Studies including large cohorts of patients with GNB bloodstream infections have confirmed the prognostic value of DTR classification and its clinical usefulness mainly in infections due to PA. Indeed, in the recent documents from the Infectious Diseases Society of America (IDSA) on the management of antibiotic resistant GNB infections, the DTR classification was applied to PA. SUMMARY DTR definition seems to identify better than MDR/XDR/PDR and single class resistant categories the cases of PA with limited treatment options. It requires periodic revision in order to remain up-to-date with the introduction of new antibiotics and the evolving pattern of resistance.
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Affiliation(s)
- Federica Cosentino
- Department of Medical and Surgical Sciences, University of Bologna
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, University of Bologna
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Corbella L, Fernández-Ruiz M, Ruiz-Ruigómez M, Rodríguez-Goncer I, Silva JT, Hernández-Jiménez P, López-Medrano F, Lizasoain M, Villa J, Aguado JM, San-Juan R. Production of OXA-48 carbapenemase acts as an independent risk factor for poor outcome in Klebsiella pneumoniae infection. Eur J Clin Microbiol Infect Dis 2023; 42:1485-1497. [PMID: 37889370 DOI: 10.1007/s10096-023-04675-w] [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: 08/09/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To know whether the production of OXA-48 carbapenemase exerts an independent impact on the outcome of Klebsiella pneumoniae infection, once adjusted by clinical syndrome and baseline risk factors. METHODS We performed a case-cohort study including 117 infectious episodes due to OXA-48-producing K. pneumoniae (OXA-48-Kp) and 117 episodes due to non-OXA-48-producing strains (non-OXA-48-Kp). Both groups were matched (1:1 ratio) by clinical syndrome (source of infection, preceding invasive procedures and indwelling devices, and associated bacteremia) and hospitalization ward at infection onset. Multivariate Cox regression was used to investigate the association between OXA-48-Kp infection and clinical cure by day 14 (primary outcome) and 30-day all-cause mortality (secondary outcome). RESULTS Both study groups were well balanced regarding underlying conditions and comorbidity burden. Sepsis or septic shock were more frequent in OXA-48-Kp cases than non-OXA-48-Kp controls (41 [35.0%] vs. 17 [14.5%]; P-value < 0.0001). Clinical cure by day 14 was less commonly achieved in OXA-48-Kp cases (49 [41.9%] vs. 95 [81.2%]; P-value < 0.001), whereas 30-day all-cause mortality was higher (33 [28.2%] vs. 18 [15.4%]; P-value = 0.018). Multivariate analysis confirmed that OXA-48-Kp infection was independently associated with the lack of 14-day clinical cure (adjusted hazard ratio [aHR]: 0.45; 95% confidential interval [95%CI]: 0.29-0.70; P-value < 0.0001). A non-significant association was observed for 30-day all-cause mortality (aHR: 1.65; 95%CI: 0.92-2.94; P-value = 0.093). CONCLUSION Our matched analysis suggests that the production of OXA-48 carbapenemase acts as an independent risk factor for poor outcome in K. pneumoniae infection as compared to episodes due to non-carbapenemase-producing strains.
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Affiliation(s)
- Laura Corbella
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain.
- Department of Medicine, Universidad Complutense, Madrid, Spain.
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
- Department of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María Ruiz-Ruigómez
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
| | - Isabel Rodríguez-Goncer
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
| | - José Tiago Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
| | - Pilar Hernández-Jiménez
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
- Department of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Lizasoain
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
- Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Jennifer Villa
- Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre", Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
- Department of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael San-Juan
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª Planta, Bloque D. Avda. de Córdoba S/N, 28041, Madrid, Spain
- Department of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic Review and Meta-analysis of Deaths Attributable to Antimicrobial Resistance, Latin America. Emerg Infect Dis 2023; 29:2335-2344. [PMID: 37877573 PMCID: PMC10617342 DOI: 10.3201/eid2911.230753] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Antimicrobial resistance is a pressing global health concern, leading to 4.95 million deaths in 2019. We conducted a systematic review and meta-analysis to assess the lethality attributed to infections caused by multidrug-resistant organisms (MDROs) in Latin America and the Caribbean. A comprehensive search of major databases retrieved relevant studies from 2000-2022. We included 54 observational studies, primarily from Brazil, Argentina, and Colombia. The most commonly studied organism was methicillin-resistant Staphylococcus aureus. The overall unadjusted case fatality rate related to MDROs was 45.0%; higher adjusted lethality was observed in persons infected with MDROs than in those infected with other pathogens (adjusted odds ratio 1.93, 95% CI 1.58-2.37). A higher lethality rate was seen in patients who did not receive appropriate empirical treatment (odds ratio 2.27, 95% CI 1.44-3.56). These findings underscore the increased lethality associated with antimicrobial resistance in Latin America and the Caribbean.
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11
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Hafiz TA, Alanazi S, Alghamdi SS, Mubaraki MA, Aljabr W, Madkhali N, Alharbi SR, Binkhamis K, Alotaibi F. Klebsiella pneumoniae bacteraemia epidemiology: resistance profiles and clinical outcome of King Fahad Medical City isolates, Riyadh, Saudi Arabia. BMC Infect Dis 2023; 23:579. [PMID: 37670240 PMCID: PMC10481561 DOI: 10.1186/s12879-023-08563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Klebsiella pneumoniae (K. pneumoniae) is the second leading cause of community-acquired and hospital-acquired gram-negative bloodstream infection (BSI). This study aimed to assess the epidemiological and microbial-resistance characteristics and clinical factors associated with K. pneumoniae BSI in Saudi Arabia. MATERIALS AND METHODS Data of 152 K. pneumoniae isolates diagnosed between January 2019 and January 2020 at King Fahad Medical City, Riyadh, Saudi Arabia were evaluated retrospectively. Clinical records of the patients were collected and analysed statistically. RESULTS In total, 152 cases of K. pneumoniae BSI were identified. Adult patients (66.4%) were at a higher risk of developing the infection than paediatric patients (33.6%). The rate of infection was slightly higher in women than in men. Neurological disorders were the predominant underlying conditions for the acquisition of K. pneumoniae BSI, at all ages. Most of the deceased patients were adults with multi-organ dysfunction. Klebsiella pneumoniae showed disturbing resistance to amoxicillin-clavulanate and cefuroxime (72.4%), ceftazidime (67.8), cephalothin (76.3%), and to Carbapenems (36.1%). CONCLUSIONS The impact of K. pneumoniae BSI was seen not only at the patient level, but also at the community level, and was related to multi-drug resistant infection. These findings provide a better understanding of microbial resistance and its association with patient clinical outcomes.
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Affiliation(s)
- Taghreed A Hafiz
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 12372, Saudi Arabia.
| | - Sarah Alanazi
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 12372, Saudi Arabia
| | - Shahad S Alghamdi
- Microbiology Department, Regional Laboratory and Central Blood Bank, Al-Baha, 65715, Saudi Arabia
| | - Murad A Mubaraki
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 12372, Saudi Arabia
| | - Waleed Aljabr
- Research Center, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| | - Nouf Madkhali
- Molecular Department, King Fahad Military Medical City, Dhahran, 31932, Saudi Arabia
| | - Sarah R Alharbi
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 12372, Saudi Arabia
| | - Khalifa Binkhamis
- Pathology Department, College of Medicine, King Saud University, Riyadh, 12372, Saudi Arabia
| | - Fawzia Alotaibi
- Pathology Department, College of Medicine, King Saud University, Riyadh, 12372, Saudi Arabia
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12
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Mills JP, Mantey J, Cassone M, Kaye KS, Mody L. Epidemiology of resistant gram-negative bacteria in nursing homes. Infect Control Hosp Epidemiol 2023; 44:1423-1428. [PMID: 36916011 PMCID: PMC10507500 DOI: 10.1017/ice.2022.225] [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: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Resistant gram-negative bacteria (R-GNB) colonization in nursing home patients can cause clinical infection and intrafacility transmission. Limited data exist on the roles of age and function on R-GNB colonization. METHODS A secondary data analysis was performed from a cohort study of 896 patients admitted to 6 Michigan nursing homes between November 2013 and May 2018. Swabs obtained upon enrollment, weekly for 1 month, then monthly until nursing home discharge from 5 anatomical sites were cultured for GNB. R-GNB were defined as resistant to ciprofloxacin, ceftazidime, or imipenem. Patients with growth of the same R-GNB as the initial positive visit, from any anatomical site at any subsequent visit, were considered persistently colonized. Demographic data, antibiotic use, device use, and physical self-maintenance scales (PSMSs) were obtained upon enrollment. Characteristics were compared between patients with R-GNB colonization versus those without, and those with persistent R-GNB colonization versus those with spontaneous decolonization. RESULTS Of 169 patients with a positive R-GNB culture and ≥2 subsequent study visits, 89 (53%) were transiently colonized and 80 (47%) were persistently colonized. Compared to uncolonized patients, persistent and transient R-GNB colonization were associated with higher PSMS score: 1.14 (95% confidence interval or CI, 1.05-1.23; P = .002) and 1.10 (95% CI, 1.01-1.19; P = .023), respectively. Persistent colonization was independently associated with longer duration of nursing home stay (1.02; 95% CI, 1.01-1.02; P < .001). Higher readmission rate among persistently colonized patients was observed on unadjusted analysis. CONCLUSIONS Persistent R-GNB colonization is associated with younger age, functional disability, and prolonged length of nursing home stay. In-depth longitudinal studies to understand new acquisition and transmission dynamics of R-GNB in nursing homes are needed.
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Affiliation(s)
- John P. Mills
- Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Julia Mantey
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Marco Cassone
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Keith S. Kaye
- Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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13
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Tsachouridou O, Pilalas D, Nanoudis S, Antoniou A, Bakaimi I, Chrysanthidis T, Markakis K, Kassomenaki A, Mantzana P, Protonotariou E, Skoura L, Metallidis S. Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin. Microorganisms 2023; 11:1711. [PMID: 37512883 PMCID: PMC10383448 DOI: 10.3390/microorganisms11071711] [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: 05/07/2023] [Revised: 06/07/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
The incidence of multidrug-resistant (MDR) bloodstream infections (BSIs) is associated with high morbidity and mortality. Little evidence exists regarding the epidemiology of BSIs and the use of appropriate empirical antimicrobial therapy in endemic regions. Novel diagnostic tests (RDTs) may facilitate and improve patient management. Data were assessed from patients with MDR Gram-negative bacteremia at a university tertiary hospital over a 12-month period. In total, 157 episodes of MDR Gram-negative BSI were included in the study. The overall mortality rate was 50.3%. Rapid molecular diagnostic tests were used in 94% of BSI episodes. In univariate analysis, age (OR 1.05 (95% CI 1.03, 1.08) p < 0.001), Charlson Comorbidity Index (OR 1.51 (95% CI 1.25, 1.83) p < 0.001), procalcitonin ≥ 1(OR 3.67 (CI 95% 1.73, 7.79) p < 0.001), and monotherapy with tigecycline (OR 3.64 (95% CI 1.13, 11.73) p = 0.030) were the only factors associated with increased overall mortality. Surprisingly, time to appropriate antimicrobial treatment had no impact on mortality. MDR pathogen isolation, other than Klebsiella pneumoniae and Acinetobacter baumanii, was associated with decreased mortality (OR 0.35 (95% CI 0.16, 0.79) p = 0.011). In multivariate analysis, the only significant factor for mortality was procalcitonin ≥ 1 (OR 2.84 (95% CI 1.13, 7.11) p = 0.025). In conclusion, in an endemic area, mortality rates in MDR BSI remain notable. High procalcitonin was the only variable that predicted death. The use of rapid diagnostics did not improve mortality rate.
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Affiliation(s)
- Olga Tsachouridou
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Dimitrios Pilalas
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Sideris Nanoudis
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Athanasios Antoniou
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Isidora Bakaimi
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Theofilos Chrysanthidis
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Konstantinos Markakis
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Angeliki Kassomenaki
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Paraskevi Mantzana
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Efthymia Protonotariou
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Lemonia Skoura
- Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
| | - Symeon Metallidis
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 55436 Thessaloniki, Greece
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Foschi C, Giorgi B, Ambretti S, Lazzarotto T, Violante FS. Real-Life Assessment of the Ability of an Ultraviolet C Lamp (SanificaAria 200, Beghelli) to Inactivate Airborne Microorganisms in a Healthcare Environment. Life (Basel) 2023; 13:life13051221. [PMID: 37240866 DOI: 10.3390/life13051221] [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: 04/20/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Airborne-mediated microbial diseases represent one of the major challenges to public health. Ultraviolet C radiation (UVC) is among the different sanitation techniques useful to reduce the risk of infection in healthcare facilities. Previous studies about the germicidal activity of UVC were mainly performed in artificial settings or in vitro models. This study aimed to assess the sanitizing effectiveness of a UVC device (SanificaAria 200, Beghelli, Valsamoggia, Bologna, Italy) in 'real-life' conditions by evaluating its ability to reduce microbial loads in several hospital settings during routine daily activities. The efficacy of the UVC lamp in reducing the bacterial component was evaluated by microbial culture through the collection of air samples in different healthcare settings at different times (30 min-24 h) after turning on the device. To assess the anti-viral activity, air samplings were carried out in a room where a SARS-CoV-2-positive subject was present. The UVC device showed good antibacterial properties against a wide range of microbial species after 6 h of activity. It was effective against possible multi-drug resistant microorganisms (e.g., Pseudomonas spp., Acinetobacter spp.) and spore-forming bacteria (e.g., Bacillus spp.). In addition, the UVC lamp was able to inactivate SARS-CoV-2 in just one hour. Thanks to its effectiveness and safety, SanificaAria 200 could be useful to inactivate airborne pathogens and reduce health risks.
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Affiliation(s)
- Claudio Foschi
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Section of Microbiology, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Beatrice Giorgi
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Simone Ambretti
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Section of Microbiology, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Section of Microbiology, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Francesco Saverio Violante
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Occupational Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
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Antimicrobial Resistant Pathogens Detected in Raw Pork and Poultry Meat in Retailing Outlets in Kenya. Antibiotics (Basel) 2023; 12:antibiotics12030613. [PMID: 36978480 PMCID: PMC10044985 DOI: 10.3390/antibiotics12030613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 03/22/2023] Open
Abstract
There is increasing proof of bacterial resistance to antibiotics all over the world, and this puts the effectiveness of antimicrobials that have been essential in decreasing disease mortality and morbidity at stake. The WHO has labeled some classes of antimicrobials as vitally important to human health. Bacteria from animals are thought to be reservoirs of resistance genes that can be transferred to humans through the food chain. This study aimed to identify the resistance patterns of bacteria from pork and poultry meat samples purchased from leading retail outlets in Kenya. Of the 393 samples collected, 98.4% of pork and 96.6% of poultry were contaminated with high levels of bacteria. Among the 611 bacterial isolates recovered, 38.5% were multi-drug resistant. This resistance was noted for critically essential antimicrobials (according to the WHO) such as rifampicin (96%), ampicillin (35%), cefotaxime (9%), cefepime (6%), and ciprofloxacin (6%). Moreover, there was high resistance to key antimicrobials for veterinary medicine such as tetracycline (39%), sulfamethoxazole (33%), and trimethoprim (30%). It is essential to spread awareness about the judicious use of antibiotics and take preventive measures to reduce disease burden.
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16
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Mantzana P, Protonotariou E, Kassomenaki A, Meletis G, Tychala A, Keskilidou E, Arhonti M, Katsanou C, Daviti A, Vasilaki O, Kagkalou G, Skoura L. In Vitro Synergistic Activity of Antimicrobial Combinations against Carbapenem- and Colistin-Resistant Acinetobacter baumannii and Klebsiella pneumoniae. Antibiotics (Basel) 2023; 12:antibiotics12010093. [PMID: 36671295 PMCID: PMC9855173 DOI: 10.3390/antibiotics12010093] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Polymyxins are commonly used as the last resort for the treatment of MDR Acinetobacter baumannii and Klebsiella pneumoniae nosocomial infections; however, apart from the already known toxicity issues, resistance to these agents is emerging. In the present study, we assessed the in vitro synergistic activity of antimicrobial combinations against carbapenem-resistant and colistin-resistant A. baumannii and K. pneumoniae in an effort to provide more options for their treatment. Two hundred A. baumannii and one hundred and six K. pneumoniae single clinical isolates with resistance to carbapenems and colistin, recovered between 1 January 2021 and 31 July 2022,were included. A. baumannii were tested by the MIC test strip fixed-ratio method for combinations of colistin with either meropenem or rifampicin or daptomycin. K. pneumoniae were tested for the combinations of colistin with meropenem and ceftazidime/avibactam with aztreonam. Synergy was observed at: 98.99% for colistin and meropenem against A. baumannii; 91.52% for colistin and rifampicin; and 100% for colistin and daptomycin. Synergy was also observed at: 73.56% for colistin and meropenem against K. pneumoniae and; and 93% for ceftazidime/avibactam with aztreonam. The tested antimicrobial combinations presented high synergy rates, rendering them valuable options against A. baumannii and K. pneumoniae infections.
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17
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Bartoszewicz M, Czaban SL, Bartoszewicz K, Kuźmiuk D, Ładny JR. Bacterial bloodstream infection in critically ill patients with COVID-19: a retrospective cohort study. Ther Adv Infect Dis 2023; 10:20499361231207178. [PMID: 37869469 PMCID: PMC10590042 DOI: 10.1177/20499361231207178] [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: 06/19/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Background Intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19), have a high risk of developing bloodstream infections (BSIs). However, the characteristics of and risk factors for BSIs in these patients remain unclear. Objective We aimed to identify prevalent causative pathogens of BSI and related factors in critically ill patients with COVID-19. Design This was a single-center, retrospective cohort study. Methods We analyzed the clinical characteristics and outcomes of 201 ICU patients with COVID-19. Logistic regression analysis was conducted to identify factors associated with BSI occurrence. Furthermore, we identified the primary causative pathogens of BSIs. The study outcomes were death or ICU discharge. Results Among the 201 included patients, 43 (21.4%) patients developed BSI. The mortality rate was non-significantly higher in the BSI group than in the BSI group (65.1% versus 58.9%, p = 0.487). There were significant between-group differences in the obesity prevalence and sex distribution, but not corticosteroid usage. BSI occurrence was significantly associated with duration of mechanical ventilation (MV), presence of ventilator-associated pneumonia, use of neuromuscular blocking agents, length of stay in ICU (ICU LOS), high body mass index (BMI), and male sex. The main causative pathogens were Klebsiella pneumoniae, Acinetobacter baumannii, and Enterococcus faecalis. Multi-drug-resistant pathogens were found in 87% of cases. Regardless of the origin, the common risk factors for BSI were ICU LOS and MV duration. All BSIs were acquired within the hospital setting, with ≈60% of the cases being primary BSIs. A small proportion of the BSI cases were catheter-related (four cases, 6.2%). Ventilator-associated pneumonia and urinary tract infections were present in 25% and 9.4% of the BSI cases, respectively. On average, the first positive blood culture appeared ≈11.4 (±9.7) days after ICU admission. Conclusion Elucidating the risk factors for and common pathogens of BSI can inform prompt management and prevention of BSIs.
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Affiliation(s)
- Mateusz Bartoszewicz
- Department of Anaesthesiology and Intensive Care, Medical University of Bialystok, Malmeda, Bialystok, Podlaskie, 15-089, Poland
| | - Sławomir Lech Czaban
- Department of Anaesthesiology and Intensive Care, Medical University of Bialystok, Bialystok, Poland
| | - Klaudia Bartoszewicz
- Department of Clinical Immunology, Medical University of Bialystok, Bialystok, Poland
| | - Damian Kuźmiuk
- Department of Anaesthesiology and Intensive Care, Medical University of Bialystok, Bialystok, Poland
| | - Jerzy Robert Ładny
- Department of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland
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Maia MDO, da Silveira CDG, Gomes M, Fernandes SES, Bezerra de Santana R, de Oliveira DQ, Amorim FFP, Neves FDAR, Amorim FF. Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects on Hospital Mortality. Infect Drug Resist 2023; 16:1693-1704. [PMID: 36992963 PMCID: PMC10042244 DOI: 10.2147/idr.s401754] [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: 01/17/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose To evaluate the effect of MDRO infection on hospital mortality and the risk factors among critically ill patients with sepsis at hospital admission. Patients and Methods A cross-sectional study was performed between April 2019 and May 2020, followed by a cohort to evaluate hospital mortality that prospectively included all consecutive patients 18 years or older with sepsis admitted within 48 hours of hospital admission to an adult ICU in Brazil. Patients' characteristics, blood samples within one hour of ICU admission, and microbiological results within 48h of hospital admission were collected. In addition, descriptive statistics, binary logistic regression, and propensity score matching were performed. Results At least one MDRO was isolated in 85 patients (9.8%). The extended-spectrum beta-lactamase-producing Enterobacterales are the most frequent organism (56.1%). Hypoxemic acute respiratory failure (OR 1.87, 95% CI 1.02-3.40, p = 0.04), Glasgow Coma Score below 15 (OR 2.57, 95% CI 1.38-4.80, p < 0.01), neoplasm (OR 2.66, 95% CI 1.04-6.82, p = 0.04) and hemoglobin below 10.0 g/dL (OR 1.82, 95% CI 1.05-3.16, p = 0.03) were associated with increased MDRO. Admission from the Emergency Department (OR 0.25, 95% CI 0.14-0.43, p < 0.01) was associated with decreased MDRO. In the multivariate analysis, MDRO at hospital admission increased hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). After propensity score-matching adjusted to age, APACHE II, SOFA, and dementia, MDRO at hospital admission was associated with significantly high hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). The E-value of adjusted OR for the effect of MDRO infection on hospital mortality was 3.41, with a 95% CI of 1.31, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect. Conclusion MDRO infection increased hospital mortality, and MDRO risk factors should be accessed even in patients admitted to ICU within 48 hours of hospital admission.
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Affiliation(s)
- Marcelo de Oliveira Maia
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
- Marcelo de Oliveira Maia, Programa de Pós-Graduação em Ciências da Saúde - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, 70701-907, Brazil, Email
| | - Carlos Darwin Gomes da Silveira
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Centro Universitário do Planalto Central (UNICEPLAC), Brasília, Federal District, Brazil
| | - Maura Gomes
- Intensive Care Unit, Hospital Santa Luzia Rede D’Or São Luiz, Brasília, Federal District, Brazil
| | | | | | | | | | | | - Fábio Ferreira Amorim
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
- Correspondence: Fábio Ferreira Amorim, Coordenação de Pesquisa e Comunicação Científica - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, 70701-907, Brazil, Email
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Thomas GR, Corso A, Pasterán F, Shal J, Sosa A, Pillonetto M, de Souza Peral RT, Hormazábal JC, Araya P, Saavedra SY, Ovalle MV, Jiménez Pearson MA, Chacón GC, Carbon E, Mazariegos Herrera CJ, Velásquez SDCG, Satan-Salazar C, Villavicencio F, Touchet NM, Busignani S, Mayta-Barrios M, Ramírez-Illescas J, Vega ML, Mogdasy C, Rosas V, Salgado N, Quiroz R, El-Omeiri N, Galas MF, Ramón-Pardo P, Melano RG. Increased Detection of Carbapenemase-Producing Enterobacterales Bacteria in Latin America and the Caribbean during the COVID-19 Pandemic. Emerg Infect Dis 2022; 28:1-8. [PMID: 36286547 PMCID: PMC9622262 DOI: 10.3201/eid2811.220415] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During 2020–2021, countries in Latin America and the Caribbean reported clinical emergence of carbapenemase-producing Enterobacterales that had not been previously characterized locally, increased prevalence of carbapenemases that had previously been detected, and co-production of multiple carbapenemases in some isolates. These increases were likely fueled by changes related to the COVID-19 pandemic, including empirical antibiotic use for potential COVID-19–related bacterial infections and healthcare limitations resulting from the rapid rise in COVID-19 cases. Strengthening antimicrobial resistance surveillance, epidemiologic research, and infection prevention and control programs and antimicrobial stewardship in clinical settings can help prevent emergence and transmission of carbapenemase-producing Enterobacterales.
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20
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Hernández-Jiménez P, López-Medrano F, Fernández-Ruiz M, Silva JT, Corbella L, San-Juan R, Lizasoain M, Díaz-Regañón J, Viedma E, Aguado JM. Risk Factors and Outcomes for Multidrug Resistant Pseudomonas aeruginosa Infection in Immunocompromised Patients. Antibiotics (Basel) 2022; 11:antibiotics11111459. [PMID: 36358114 PMCID: PMC9686626 DOI: 10.3390/antibiotics11111459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Pseudomonas aeruginosa (PSA) infection often occurs in immunocompromised patients, which also face an increased risk of multidrug-resistant (MDR) bacteria. A deeper knowledge of the risk factors for MDR-PSA infection in this patient population may help to choose appropriate empirical antibiotic therapy. Methods: a single-center case-control (1:2) retrospective study that included 48 patients with underlying immunosuppression developing MDR-PSA infection (cases) and 96 patients also immunocompromised that were infected with non-MDR-PSA (controls) was conducted. Both groups were matched by site of infection, clinical features and type of immunosuppression. Risk factors for MDR-PSA were assessed by logistic regression. Clinical outcomes were also compared between both groups. Results: immunosuppression was due to solid cancer in 63 (43.8%) patients, solid organ transplantation in 39 (27.1%), hematological disease in 35 (24.3%) and other causes in 7 (4.9%). Independent risk factors for MDR-PSA infection were diabetes mellitus (odds ratio [OR]: 4.74; 95% confidence interval [CI]: 1.63−13.79; p = 0.004), antibiotic therapy in the previous 3 months (OR: 5.32; 95% CI: 1.93−14.73; p = 0.001), previous MDR-PSA colonization (OR: 42.1; 95% CI: 4.49−394.8; p = 0.001) and septic shock (OR: 3.73; 95% CI: 1.36−10.21; p = 0.010). MDR-PSA cases were less likely to receive adequate empirical therapy (14 [29.2%] vs. 69 [71.9%]; p < 0.001). 30-day clinical improvement was less common in MDR-PSA cases (25 [52.1%] vs. 76 [79.2%]; p = 0.001). Conclusions: diabetes mellitus, previous MDR-PSA colonization, prior receipt of antibiotics and septic shock acted as risk factors for developing MDR-PSA infections in immunocompromised patients, who have a poorer outcome than those infected with non-MDR-PSA strains.
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Affiliation(s)
- Pilar Hernández-Jiménez
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-659537429
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - J. Tiago Silva
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Laura Corbella
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Rafael San-Juan
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Manuel Lizasoain
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | | | - Esther Viedma
- Department of Microbiology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid 28029, Spain
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21
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Yang P, Liu C, Wu Z, Zheng J, Yi J, Wu N, Wu Z, Lu M, Cui L, Shen N. Clinical Outcomes, Microbiological Characteristics and Risk Factors for Difficult-to-Treat Resistance to Klebsiella pneumoniae Infection. Infect Drug Resist 2022; 15:5959-5969. [PMID: 36262596 PMCID: PMC9574456 DOI: 10.2147/idr.s377064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This study aimed to identify the clinical outcomes, microbiological features and risk factors for difficult-to-treat resistance (DTR) Klebsiella pneumoniae (Kp) infection. Materials and Methods A retrospective study was conducted at Peking University Third Hospital from January 2020 to March 2021. DTR was defined as resistance to ≥1 carbapenem, ≥1 extended-spectrum cephalosporin, and ≥1 fluoroquinolone. Hypervirulent Kp (HvKp) was defined as peg-344-, iroB-, iucA-, rmpA-, or rmpA2-positive. Clinical data were collected. Antimicrobial susceptibility testing and string tests were performed to determine resistance and hypermucoviscosity phenotype. Whole genome sequencing was performed to analyze the sequence type (ST), capsular serotypes, resistance and virulence genes. Risk factors for 30-day mortality were analyzed. Results Fifty DTR-Kp (50.0%) strains were identified among 100 patients. Compared to non-DTR-Kp group, a significant number of patients with DTR-Kp infection experienced ICU admission (44.0% versus 10.0%, P<0.001) and mechanical ventilation after Kp detection (26.0% versus 10.0%, P=0.037). Notably, the percentage of hvKp among the DTR-Kp isolates increased consistently over the 15 months evaluated. Most DTR-Kp strains belonged to ST11 (82.0%), followed by ST15 (12.0%), ST86 (2.0%), ST996 (2.0%), and ST3157 (2.0%). DTR-Kp isolates possessed various resistance genes, such as blaKPC-2, blaTEM-1D and fosA3 (90.0%, 80.0% and 72.0%, respectively). Importantly, the yersiniabactin genes were significantly clustered in DTR group (48/50, 96.0%). The 30-day mortality was significantly higher in patients with DTR-Kp infection than non-DTR-Kp group (38.0% versus 8.2%, P=0.001). DTR-Kp infection (odds ratio [OR] = 4.196) was an independent risk factor for the 30-day mortality of Kp-infected patients. Additionally, cerebrovascular disease (OR = 2.780) and Charlson comorbidity index (OR= 1.584) were independent risk factors for DTR-Kp infections. Conclusion DTR-hvKp is rapidly emerging. The DTR-Kp strains harbored various resistance genes and high rates of yersiniabactin siderophore genes. DTR-Kp infection was an independent risk factor for mortality, suggesting that enhanced awareness essential.
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Affiliation(s)
- Ping Yang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, People’s Republic of China,Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Chao Liu
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Zhenchao Wu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Jiajia Zheng
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Juan Yi
- Institute of Medical Technology, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Nan Wu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Zhangli Wu
- Institute of Medical Technology, Peking University Health Science Center, Beijing, People’s Republic of China,Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Ming Lu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China,Department of Infectious Diseases, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Liyan Cui
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, People’s Republic of China,Correspondence: Liyan Cui; Ning Shen, Email ;
| | - Ning Shen
- Institute of Medical Technology, Peking University Health Science Center, Beijing, People’s Republic of China,Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China,Department of Infectious Diseases, Peking University Third Hospital, Beijing, People’s Republic of China
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22
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Bharadwaj A, Rastogi A, Pandey S, Gupta S, Sohal JS. Multidrug-Resistant Bacteria: Their Mechanism of Action and Prophylaxis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5419874. [PMID: 36105930 PMCID: PMC9467707 DOI: 10.1155/2022/5419874] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022]
Abstract
In the present scenario, resistance to antibiotics is one of the crucial issues related to public health. Earlier, such resistance to antibiotics was limited to nosocomial infections, but it has now become a common phenomenon. Several factors, like extensive development, overexploitation of antibiotics, excessive application of broad-spectrum drugs, and a shortage of target-oriented antimicrobial drugs, could be attributed to this condition. Nowadays, there is a rise in the occurrence of these drug-resistant pathogens due to the availability of a small number of effective antimicrobial agents. It has been estimated that if new novel drugs are not discovered or formulated, there would be no effective antibiotic available to treat these deadly resistant pathogens by 2050. For this reason, we have to look for the formulation of some new novel drugs or other options or substitutes to treat such multidrug-resistant microorganisms (MDR). The current review focuses on the evolution of the most common multidrug-resistant bacteria and discusses how these bacteria escape the effects of targeted antibiotics and become multidrug resistant. In addition, we also discuss some alternative mechanisms to prevent their infection as well.
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Affiliation(s)
- Alok Bharadwaj
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
| | - Amisha Rastogi
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
| | - Swadha Pandey
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
| | - Saurabh Gupta
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
| | - Jagdip Singh Sohal
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
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Adukauskiene D, Ciginskiene A, Adukauskaite A, Koulenti D, Rello J. Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii. Antibiotics (Basel) 2022; 11:antibiotics11070892. [PMID: 35884146 PMCID: PMC9311643 DOI: 10.3390/antibiotics11070892] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Multidrug-resistant A. baumannii (MDRAB) VAP has high morbidity and mortality, and the rates are constantly increasing globally. Mono- and polybacterial MDRAB VAP might differ, including outcomes. We conducted a single-center, retrospective (January 2014−December 2016) study in the four ICUs (12−18−24 beds each) of a reference Lithuanian university hospital, aiming to compare the clinical features and the 30-day mortality of monobacterial and polybacterial MDRAB VAP episodes. A total of 156 MDRAB VAP episodes were analyzed: 105 (67.5%) were monomicrobial. The 30-day mortality was higher (p < 0.05) in monobacterial episodes: overall (57.1 vs. 37.3%), subgroup with appropriate antibiotic therapy (50.7 vs. 23.5%), and subgroup of XDR A. baumannii (57.3 vs. 36.4%). Monobacterial MDRAB VAP was associated (p < 0.05) with Charlson comorbidity index ≥3 (67.6 vs. 47.1%), respiratory comorbidities (19.0 vs. 5.9%), obesity (27.6 vs. 9.8%), prior hospitalization (58.1 vs. 31.4%), prior antibiotic therapy (99.0 vs. 92.2%), sepsis (88.6 vs. 76.5%), septic shock (51.9 vs. 34.6%), severe hypoxemia (23.8 vs. 7.8%), higher leukocyte count on VAP onset (median [IQR] 11.6 [8.4−16.6] vs. 10.9 [7.3−13.4]), and RRT need during ICU stay (37.1 vs. 17.6%). Patients with polybacterial VAP had a higher frequency of decreased level of consciousness (p < 0.05) on ICU admission (29.4 vs. 14.3%) and on VAP onset (29.4 vs. 11.4%). We concluded that monobacterial MDRAB VAP had different demographic/clinical characteristics compared to polybacterial and carried worse outcomes. These important findings need to be validated in a larger, prospective study, and the management implications to be further investigated.
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Affiliation(s)
- Dalia Adukauskiene
- Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Ausra Ciginskiene
- Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
- Correspondence:
| | - Agne Adukauskaite
- Department of Cardiology and Angiology, University Hospital of Innsbruck, 6020 Innsbruck, Austria;
| | - Despoina Koulenti
- Second Critical Care Department, Attikon University Hospital, 12462 Athens, Greece;
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The Univesrity of Queensland, Brisbane 4029, Australia
| | - Jordi Rello
- Vall d‘Hebron Institute of Research, Vall d‘Hebron Campus Hospital, 08035 Barcelona, Spain;
- Clinical Research, CHU Nîmes, 30900 Nîmes, France
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24
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Dilworth TJ, Schulz LT, Micek ST, Kollef MH, Rose WE. β-Lactam Therapeutic Drug Monitoring in Critically Ill Patients: Weighing the Challenges and Opportunities to Assess Clinical Value. Crit Care Explor 2022; 4:e0726. [PMID: 35815181 PMCID: PMC9259115 DOI: 10.1097/cce.0000000000000726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE β-lactams are the cornerstone of empiric and targeted antibiotic therapy for critically ill patients. Recently, there have been calls to use β-lactam therapeutic drug monitoring (TDM) within 24-48 hours after the initiation of therapy in critically ill patients. In this article, we review the dynamic physiology of critically ill patients, β-lactam dose response in critically ill patients, the impact of pathogen minimum inhibitory concentration (MIC) on β-lactam TDM, and pharmacokinetics in critically ill patients. Additionally, we highlight available clinical data to better inform β-lactam TDM for critically ill patients. DATA SOURCES We retrospectively analyzed patients admitted for sepsis or septic shock at a single academic medical center who were treated with β-lactam antibiotics. STUDY SELECTION Indexed studies in PubMed in English language were selected for review on topics relative to critical care physiology, β-lactams, pharmacokinetics/pharmacodynamics, TDM, and antibiotic susceptibility. DATA EXTRACTION We reviewed potentially related studies on β-lactams and TDM and summarized their design, patients, and results. This is a synthetic, nonsystematic, review. DATA SYNTHESIS In the retrospective analysis of patients treated with β-lactam antibiotics, approximately one-third of patients received less than 48 hours of β-lactam therapy. Of those who continued beyond 48 hours, only 13.7% had patient-specific factors (augmented renal clearance, fluid overload, morbid obesity, and/or surgical drain), suggesting a potential benefit of β-lactam TDM. CONCLUSIONS These data indicate that a strategy of comprehensive β-lactam TDM for critically ill patients is unwarranted as it has not been shown yet to improve patient-oriented outcomes. This review demonstrates that β-lactam TDM in the ICU, while laudable, layers ambiguous β-lactam exposure thresholds upon uncertain/unknown MIC data within a dynamic, unpredictable patient population for whom TDM results will not be available fast enough to significantly affect care. Judicious, targeted TDM for those with risk factors for β-lactam over- or underexposure is a better approach but requires further study. Clinically, choosing the correct antibiotic and dosing β-lactams aggressively, which have a wide therapeutic index, to overcome critical illness factors appears to give critically ill patients the best likelihood of survival.
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Affiliation(s)
- Thomas J Dilworth
- Department of Pharmacy Services, Advocate Aurora Health, Milwaukee, WI
| | | | - Scott T Micek
- Center for Health Outcomes Research and Education, University of Health Sciences and Pharmacy, St. Louis, MO
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | - Warren E Rose
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI
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25
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Thomnoi T, Komenkul V, Prawang A, Santimaleeworagun W. Impact of Pharmacist-Led Implementation of a Community Hospital-Based Outpatient Parenteral Antimicrobial Therapy on Clinical Outcomes in Thailand. Antibiotics (Basel) 2022; 11:antibiotics11060760. [PMID: 35740166 PMCID: PMC9220076 DOI: 10.3390/antibiotics11060760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies have analyzed community hospital-based parenteral anti-infective therapy (CohPAT). We aimed to assess the clinical impact of a pharmacist-led implementation of a clinical practice guideline (CPG) for CohPAT, and to determine the pharmacist’s role in CohPAT medication management. The prospective-period patients (post-implementation group) were compared with the historical control-period patients (pre-implementation group) for receiving a continuous antimicrobial parenteral injection. A CPG was used for laboratory testing for efficacy and safety, the monitoring of adverse drug events during admission, microbiology results coordination, and dosage adjustment. For any antimicrobial drug-related problems, the pharmacist consulted with the clinicians. Over 14 months, 50 participants were included in each group. In the pre-implementation period, 7 (14%) and 4 (8%) out of 50 patients received an inappropriate dosage and nonlaboratory monitoring for dose adjustment, respectively. The patients received the proper dosage of antimicrobial agents, which increased significantly from 78% pre- to 100% post-implementation (p = 0.000). The pharmacist’s interventions during the prospective-period were completely accepted by the clinicians, and significantly greater laboratory monitoring complying with CPG was given to the postimplementation group than the pre-implementation group (100% vs. 60%; p = 0.000). Significantly less patients with unfavorable outcomes (failure or in-hospital mortality) were observed in the post-implementation than in the pre-implementation (6% vs. 26%; p = 0.006) group. For the logistic regression analysis, lower respiratory infection (adjusted OR, aOR 3.68; 95%CI 1.13–12.06) and the post-implementation period (aOR 0.21; 95%CI 0.06–0.83) were significant risk factors that were associated with unfavorable outcomes. Given the better clinical outcomes and the improved quality of septic patient care observed after implementation, pharmacist-led implementation should be adopted in healthcare settings.
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Affiliation(s)
- Teeranuch Thomnoi
- Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand; (T.T.); (V.K.)
- Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group (PIRBIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
- Pharmacy Unit, Khlong Luang Hospital, Pathum Thani 12120, Thailand
| | - Virunya Komenkul
- Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand; (T.T.); (V.K.)
| | - Abhisit Prawang
- Pharmacy Practice, College of Pharmacy, Rangsit University, Pathum Thani 12000, Thailand;
| | - Wichai Santimaleeworagun
- Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand; (T.T.); (V.K.)
- Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group (PIRBIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
- Correspondence: ; Tel.: +66-34-255-800; Fax: +66-34-255-801
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26
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Hao W, Che S, Li J, Luo J, Zhang W, Chen Y, Zhao Z, Wei H, Xie W. Synthesis of Berberine and Canagliflozin Chimera and Investigation into New Antibacterial Activity and Mechanisms. Molecules 2022; 27:molecules27092948. [PMID: 35566298 PMCID: PMC9100802 DOI: 10.3390/molecules27092948] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Berberine is an isoquinoline alkaloid isolated from Chinese herbal medicines such as Coptis chinensis. It has many pharmacological actions, such as antibacterial, hypoglycemic, anti-inflammatory, and so on. However, due to the low lipophilicity of berberine, it is difficult to penetrate the bacterial cell membrane and also difficult to be absorbed orally and usually needs a relatively high dose to achieve the ideal effect. The purpose of this study is to transform the structure of berberine in order to improve the bioavailability of berberine and reduce the dosage. Moreover, we introduce a pharmacophore named Canagliflozin, a hypoglycemic drug (which was also found to have potential anti-bacterial activity) into BBR to see whether this new compound has more existed activities. We at first connected berberine with Canagliflozin, to form a new compound (BC) and see whether BC has synergic effects. We use microbroth dilution method to determine the minimum inhibitory concentration of BC, determine the bacterial growth with the enzyme labeling instrument, observe the formation of bacterial biofilm with crystal violet staining method, observe the bacterial morphology with field emission scanning electron microscope, and determine the intracellular protein with SDS-PAGE. The above indicators reflect the damage of BC to bacteria. New compound BC was successfully obtained by chemical synthesis. The minimal inhibitory concentration of compound BC on three bacteria was significantly better than that of berberine and canagliflozin alone and the combination of berberine and canagliflozin. Moreover, compound BC has obvious destructive effect on bacterial morphology and biofilm, and the compound also has destructive effect on intracellular proteins. Therefore, new compound BC has broad-spectrum antibacterial activity and the inhibitory effect of BC might play a role by destroying the integrity of biofilm and the intracellular protein of bacteria. In conclusion, we create a new molecular entity of berberine and Canagliflozin chimera and open up a new prospect for berberine derivatives in the treatment of bacterial infection.
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Affiliation(s)
- Wenhui Hao
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (W.H.); (J.L.); (W.Z.); (Y.C.)
| | - Shiying Che
- School of Chemistry and Materials Science, Huaihua University, Huaihua 418000, China; (S.C.); (J.L.)
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xi’an-Xianyang New Ecomic Zone, Xianyang 712046, China
- Key Laboratory of Research and Utilization of Ethnomedicinal Plant Resources of Hunan Province, Huaihua University, Huaihua 418000, China
| | - Jinsheng Li
- School of Chemistry and Materials Science, Huaihua University, Huaihua 418000, China; (S.C.); (J.L.)
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xi’an-Xianyang New Ecomic Zone, Xianyang 712046, China
- Key Laboratory of Research and Utilization of Ethnomedicinal Plant Resources of Hunan Province, Huaihua University, Huaihua 418000, China
| | - Jingyi Luo
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (W.H.); (J.L.); (W.Z.); (Y.C.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Wanqiu Zhang
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (W.H.); (J.L.); (W.Z.); (Y.C.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Yang Chen
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (W.H.); (J.L.); (W.Z.); (Y.C.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Zijian Zhao
- School of Chemistry and Materials Science, Huaihua University, Huaihua 418000, China; (S.C.); (J.L.)
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xi’an-Xianyang New Ecomic Zone, Xianyang 712046, China
- Key Laboratory of Research and Utilization of Ethnomedicinal Plant Resources of Hunan Province, Huaihua University, Huaihua 418000, China
- Correspondence: (Z.Z.); (H.W.); (W.X.)
| | - Hao Wei
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xi’an-Xianyang New Ecomic Zone, Xianyang 712046, China
- Correspondence: (Z.Z.); (H.W.); (W.X.)
| | - Weidong Xie
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (W.H.); (J.L.); (W.Z.); (Y.C.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Correspondence: (Z.Z.); (H.W.); (W.X.)
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Derivation of a score to predict infection due to multi-drug resistant Pseudomonas aeruginosa: A tool for guiding empirical antibiotic treatment. J Glob Antimicrob Resist 2022; 29:215-221. [PMID: 35339736 DOI: 10.1016/j.jgar.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multidrug-resistant Pseudomonas aeruginosa (MDR-PSA) constitutes an emerging health problem. A predictive score of MDR-PSA infection would let early adaptation of empirical antibiotic therapy. METHODS We performed a single-center case-control (1:2) retrospective study including 100 patients with MDR-PSA and 200 with non-MDR-PSA infection. Cases and controls were matched by site of infection, clinical characteristics and immunosuppression. A point risk score for prediction of MDR-PSA infection was derived from a logistic regression model. Secondary outcomes (clinical improvement, complications and discharge) were also compared. RESULTS Cases with MDR-PSA infection were younger than controls (67.5 vs. 73.0 years; P=0.031) and have more frequently cirrhosis (9% vs. 2%; P=0.005). Independent risk factors for MDR-PSA infection were prior antibiotic treatment (80% vs. 50.5%; P<0.001), prior colonization with MDR bacteria (41% vs. 13.5%; P<0.001), hospital-acquired infection (63% vs. 47%; P=0.009), and septic shock at diagnosis (33% vs. 14%; P<0.001). Adequate therapy was less frequent in MDR-PSA infections (31% vs. 66.5% for empirical therapy; P<0.001). The risk score included: previous MDR-PSA isolation (11 points), prior antibiotic use (3 points), hospital-acquired infection (2 points), and septic shock at diagnosis (2 points). It showed an area under the curve of 0.755 (95% CI: 0.70-0.81) and allowed to classify individual risk into various categories: 0-2 points (<20%), 3-5 points (25-45%), 7-11 points (55-60%), 13-16 points (75-87%) and a maximum of 18 points (93%). CONCLUSIONS Infections due to MDR-PSA have a poorer prognosis than those produced by non-MDR-PSA. Our score could guide empirical therapy for MDR-PSA when P. aeruginosa is isolated.
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Bazmi RR, Panichayupakaranant P. Synergistic interactions between artocarpin-rich extract, lawsone methyl ether and ampicillin on anti-MRSA and their antibiofilm formation. Lett Appl Microbiol 2022; 74:777-786. [PMID: 35100449 DOI: 10.1111/lam.13662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023]
Abstract
Artocarpin-rich extract (ARE) was prepared using a green technology and standardized to contain 49.6% w/w artocarpin, while lawsone methyl ether was prepared using a green semi-synthesis. ARE, LME and ampicillin exhibited weak anti-MRSA activity with the MICs of 31.2-62.5 µg/mL. Based on the checkerboard assay, the synergistic interaction between ARE (0.03 µg/mL) and LME (0.49 µg/mL) against four MRSA isolates were observed with the fractional inhibitory concentration index (FICI) value of 0.008, while those of ARE (1.95-7.81 µg/mL) and ampicillin (0.49 µg/mL) as well as LME (0.49-1.95 µg/mL) and ampicillin (0.49 µg/mL) were 0.016-0.257. The time kill confirmed the synergistic interactions against MRSA with different degrees. The combination of ARE and LME as well as its combinations with ampicillin altered the membrane permeability of MRSA, which led to release of the intracellular materials. In addition, each compound inhibited the biofilm formation of standard MRSA (DMST 20654) and the clinical isolate (MRSA 1096). These findings suggested that cocktails containing ARE and LME might be used to overcome problems associated with MRSA. Additionally, the results implied that combination of either ARE or LME with available conventional antibiotic agents might be effective in countering these perilous pathogens.
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Affiliation(s)
- Rizwan Rashid Bazmi
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat-Yai 90112, Thailand.,Faculty of Pharmaceutical Sciences, Govt. College University Faisalabad, Pakistan
| | - Pharkphoom Panichayupakaranant
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat-Yai 90112, Thailand.,Phytomedicine and Pharmaceutical Biotechnology Excellence Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat-Yai 90112, Thailand
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29
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Gómez-Zorrilla S, Becerra-Aparicio F, López Montesinos I, Ruiz de Gopegui E, Grau I, Pintado V, Padilla B, Benito N, Boix-Palop L, Fariñas MC, Peñaranda M, Gamallo MR, Martinez JA, Morte-Romea E, Del Pozo JL, Durán-Jordá X, Díaz-Regañón J, López-Mendoza D, Cantón R, Oliver A, Ruiz-Garbajosa P, Horcajada JP. A Large Multicenter Prospective Study of Community-Onset Healthcare Associated Bacteremic Urinary Tract Infections in the Era of Multidrug Resistance: Even Worse than Hospital Acquired Infections? Infect Dis Ther 2021; 10:2677-2699. [PMID: 34626347 PMCID: PMC8572918 DOI: 10.1007/s40121-021-00537-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Healthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes. METHODS ITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients < 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare-related infections and infections caused by unusual pathogens of the urinary tract. The main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality. RESULTS Four hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p < 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCA-BUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77-6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27-6.44) and Charlson index (aOR 1.11; 95% CI 1.01-1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40-0.93) were less likely to present clinical cure. CONCLUSION The rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure.
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Affiliation(s)
- Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain.
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - Federico Becerra-Aparicio
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Inmaculada López Montesinos
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Ruiz de Gopegui
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Inmaculada Grau
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Vicente Pintado
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Belén Padilla
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Natividad Benito
- Infectious Diseases Service, Hospital de la Santa Creui Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Service, Hospital Mutua de Terrassa, Barcelona, Spain
| | - Maria Carmen Fariñas
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Peñaranda
- Infectious Diseases Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Maria Rocío Gamallo
- Infectious Diseases Service, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Jose Antonio Martinez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Clinic, Barcelona, Spain
| | - Elena Morte-Romea
- Infectious Diseases Service, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | - Jose Luis Del Pozo
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Xavier Durán-Jordá
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | | | - Rafael Cantón
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Antonio Oliver
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Patricia Ruiz-Garbajosa
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain.
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
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Predictors of multidrug resistant Pseudomonas aeruginosa involvement in bloodstream infections. Curr Opin Infect Dis 2021; 34:686-692. [PMID: 34310454 DOI: 10.1097/qco.0000000000000768] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the last decades, there has been a worldwide worrisome spread of multidrug resistant (MDR) Pseudomonas aeruginosa. Treatment of these infections is challenging, in part due to the lack of therapeutic options, and the importance of prescribing an adequate empirical treatment. Bacteraemia is one of the most severe infections, with mortality rates ranging between 20 and 40%. RECENT FINDINGS It is key to understand which patients are at a higher risk of MDR P. aeruginosa bloodstream infection (BSI) to better direct empirical therapies and improve overall survival. Immunocompromised patients are among the most vulnerable for the worst outcomes. Environmental exposure, integrity of the microbiota, and host immunity are the key determinants for the initial colonization and expansion on mucosal surfaces and potential invasion afterwards by MDR P. aeruginosa. SUMMARY Available data suggest that high colonization pressure (settings with high prevalence like intensive care units), disruption of healthy microbiota (prior use of antibiotics, in particular fluoroquinolones), immunosuppression (neutropenia) and breaking natural barriers (venous or urine catheters), are the main risk factors for MDR P. aeruginosa BSI.
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Synthesis and bioactivities of new N-terminal dipeptide mimetics with aromatic amide moiety: Broad-spectrum antibacterial activity and high antineoplastic activity. Eur J Med Chem 2021; 228:113977. [PMID: 34772526 DOI: 10.1016/j.ejmech.2021.113977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/20/2022]
Abstract
The increasingly growing epidemics of multidrug-resistant bacteria are becoming severe public health threat. There is in an urgent need to develop new antibacterial agents with broad-spectrum antibacterial activity and high selectivity. Here, a series of N-terminal dipeptide mimetics with an aromatic amide moiety were synthesized from amino acids. The effects of amino acid type and aromatic moiety on the biological activities of the mimetics were evaluated. The dipeptide mimetics not only showed significant broad-spectrum antibacterial activity against Gram-negative (Escherichia coli and Klebsiella pneumoniae), Gram-positive (Staphylococcus aureus) and drug-resistant bacterium MRSA (methicillin-resistant S. aureus) but also demonstrated high selectivity for S. aureus versus mammalian erythrocytes. The coupling product of L-valine with p-alkynylaniline (dipeptide mimetic 7) exhibited the best antibacterial activities with minimum inhibitory concentration (MIC) ranging from 2.5 to 5 μg/mL. Moreover, the bactericidal kinetics and multi-passage resistance tests indicated that the mimetic 7 both rapidly killed bacteria and had a low probability of emergence of antimalarial resistance. Meanwhile, the mimetic 7 possessed the ability to both inhibit bacterial biofilm formation and eradicate mature biofilm. The depolarization and destruction of the bacterial cell membrane is the main sterilization mechanism, which hinders the propensity to develop bacterial resistance. Furthermore, the mimetic 7 also showed good antineoplastic activity against gastric cancer cell (SGC 7901, IC50 = 70.8 μg/mL), while it had very low toxicity to mammalian cell (L929). The mimetics bear considerable potential to be used as antibacterial and anticancer agents to combat antibiotic resistance.
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Maguigan KL, Al-Shaer MH, Peloquin CA. Beta-Lactams Dosing in Critically Ill Patients with Gram-Negative Bacterial Infections: A PK/PD Approach. Antibiotics (Basel) 2021; 10:1154. [PMID: 34680734 PMCID: PMC8532626 DOI: 10.3390/antibiotics10101154] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
Beta-lactam antibiotics are often the backbone of treatment for Gram-negative infections in the critically ill. Beta-lactams exhibit time-dependent killing, and their efficacy depends on the percentage of dosing interval that the concentration remains above the minimum inhibitory concentration. The Gram-negative resistance rates of pathogens are increasing in the intensive care unit (ICU), and critically ill patients often possess physiology that makes dosing more challenging. The volume of distribution is usually increased, and drug clearance is variable. Augmented renal clearance and hypermetabolic states increase the clearance of beta-lactams, while acute kidney injury reduces the clearance. To overcome the factors affecting ICU patients and decreasing susceptibilities, dosing strategies involving higher doses, and extended or continuous infusions may be required. In this review, we specifically examined pharmacokinetic models in ICU patients, to determine the desired beta-lactam regimens for clinical breakpoints of Enterobacterales and Pseudomonas aeruginosa, as determined by the European Committee on Antimicrobial Susceptibility Testing. The beta-lactams evaluated included penicillins, cephalosporins, carbapenems, and monobactams. We found that when treating less-susceptible pathogens, especially P. aeruginosa, continuous infusions are frequently needed to achieve the desired pharmacokinetic/pharmacodynamic targets. More studies are needed to determine optimal dosing strategies in the novel beta-lactams.
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Affiliation(s)
- Kelly L. Maguigan
- Pharmacy Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA;
| | - Mohammad H. Al-Shaer
- Infectious Disease Pharmacokinetics Lab, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA;
| | - Charles A. Peloquin
- Infectious Disease Pharmacokinetics Lab, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA;
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Chrystle M, Vishak A, Sindhu K, Jane M. Primary lung abscess due to multidrug-resistant Klebsiella pneumoniae. BMJ Case Rep 2021; 14:e244759. [PMID: 34511416 PMCID: PMC8438720 DOI: 10.1136/bcr-2021-244759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/03/2022] Open
Abstract
Primary lung abscess as a complication of necrotising community-acquired pneumonia due to multidrug-resistant (MDR) Klebsiella pneumoniae is rare. A 63-year-old man with a medical history of type 2 diabetes mellitus and chronic kidney disease was diagnosed with lung abscess due to MDR Klebsiella pneumoniae, a rare organism as a causative agent for community-acquired pneumonia. This unusual case revealed therapeutic challenges faced owing to factors such as drug-resistant pathogen, longer duration of antibiotics required for lung abscess and the chronic kidney status of the patient limiting the dosage of antibiotics. The clinical nuggets discussed in this case might pave the way in the future for management guidelines to be formulated in optimising the selection and duration of therapy for lung abscesses with MDR aetiology and in early recognition of this rare but dreaded entity.
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Affiliation(s)
- Mascarenhas Chrystle
- Respiratory Medicine/Medical Oncology, Kasturba Medical College Hospital, Mangalore, Karnataka, India
| | - Acharya Vishak
- Respiratory Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, Karnataka, India
| | - Kamath Sindhu
- Respiratory Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, Karnataka, India
| | - Mendonca Jane
- Respiratory Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Mangalore, Karnataka, India
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Xiao CY, Sun ZL, Huang J, Li RS, He JM, Gibbons S, Ju DW, Mu Q. Neolignans from Piper betle Have Synergistic Activity against Antibiotic-Resistant Staphylococcus aureus. J Org Chem 2021; 86:11072-11085. [PMID: 33439020 DOI: 10.1021/acs.joc.0c02682] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A phytochemical investigation of an extract of the leaves of Piper betle, guided by a synergistic antibacterial screen, led to the isolation and structural elucidation of 10 new neolignans, Pibeneolignan A-J (1-10), together with 11 known compounds. The structures and absolute configurations of the new compounds were elucidated on the basis of spectroscopic data, single-crystal X-ray diffraction analysis, and experimental and calculated ECD investigations. Compounds 1 and 2 are new naturally occurring neolignan skeletons, based on the cyclohept-2-ene-1,4-dione framework. We propose that these natural products are biosynthetically formed from bicyclic [3.2.1] neolignans by oxidative cleavage and ring opening at C-1' and C-2'. Among these compounds, 9, 13, 15, and 16, in combination with norfloxacin against an effluxing S. aureus strain (SA1199B), exhibited significant synergistic activity with fractional inhibitory concentration indices (FICIs) of 0.078, 0.156, 0.125, and 0.25, respectively. Bacterial growth curves, ethidium bromide (EtBr) efflux, and qRt-PCR were further employed to verify their synergistic antibacterial mechanism. Furthermore, computational molecular modeling suggested the binding of compounds 14-17 and 19 to the active site of the modeled structure of the NorA efflux pump, which is the main efflux pump in SA1199B.
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Affiliation(s)
- Chuan-Yun Xiao
- School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Zhong-Lin Sun
- School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Jiao Huang
- School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Rong-Sheng Li
- School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Jian-Ming He
- School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Simon Gibbons
- School of Pharmacy, University of East Anglia, Norwich NR4 7TJ, U.K
| | - Dian-Wen Ju
- School of Pharmacy, Fudan University, Shanghai 201203, China.,Shanghai Engineering Research Center of ImmunoTherapeutics, Shanghai 201203, China
| | - Qing Mu
- School of Pharmacy, Fudan University, Shanghai 201203, China
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Han HW, Patel KD, Kwak JH, Jun SK, Jang TS, Lee SH, Knowles JC, Kim HW, Lee HH, Lee JH. Selenium Nanoparticles as Candidates for Antibacterial Substitutes and Supplements against Multidrug-Resistant Bacteria. Biomolecules 2021; 11:1028. [PMID: 34356651 PMCID: PMC8301847 DOI: 10.3390/biom11071028] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
In recent years, multidrug-resistant (MDR) bacteria have increased rapidly, representing a major threat to human health. This problem has created an urgent need to identify alternatives for the treatment of MDR bacteria. The aim of this study was to identify the antibacterial activity of selenium nanoparticles (SeNPs) and selenium nanowires (SeNWs) against MDR bacteria and assess the potential synergistic effects when combined with a conventional antibiotic (linezolid). SeNPs and SeNWs were characterized by transmission electron microscopy (TEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), zeta potential, and UV-visible analysis. The antibacterial effects of SeNPs and SeNWs were confirmed by the macro-dilution minimum inhibitory concentration (MIC) test. SeNPs showed MIC values against methicillin-sensitive S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), vancomycin-resistant S. aureus (VRSA), and vancomycin-resistant enterococci (VRE) at concentrations of 20, 80, 320, and >320 μg/mL, respectively. On the other hand, SeNWs showed a MIC value of >320 μg/mL against all tested bacteria. Therefore, MSSA, MRSA, and VRSA were selected for the bacteria to be tested, and SeNPs were selected as the antimicrobial agent for the following experiments. In the time-kill assay, SeNPs at a concentration of 4X MIC (80 and 320 μg/mL) showed bactericidal effects against MSSA and MRSA, respectively. At a concentration of 2X MIC (40 and 160 μg/mL), SeNPs showed bacteriostatic effects against MSSA and bactericidal effects against MRSA, respectively. In the synergy test, SeNPs showed a synergistic effect with linezolid (LZD) through protein degradation against MSSA and MRSA. In conclusion, these results suggest that SeNPs can be candidates for antibacterial substitutes and supplements against MDR bacteria for topical use, such as dressings. However, for use in clinical situations, additional experiments such as toxicity and synergistic mechanism tests of SeNPs are needed.
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Affiliation(s)
- Hee-Won Han
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (H.-W.H.); (K.D.P.); (J.C.K.); (H.-W.K.)
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan 31116, Korea
| | - Kapil D. Patel
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (H.-W.H.); (K.D.P.); (J.C.K.); (H.-W.K.)
- Department of Materials Science and Engineering, Korea University, Seoul 02841, Korea
| | - Jin-Hwan Kwak
- Department of Life Science, Handong Global University, Pohang 37554, Korea;
| | - Soo-Kyung Jun
- Department of Dental Hygiene, Hanseo University, Seosan 31962, Korea;
| | - Tae-Su Jang
- Department of Pre-Medi, College of Medicine, Dankook University, Cheonan 31116, Korea;
| | - Sung-Hoon Lee
- Department of Oral Microbiology and Immunology, College of Dentistry, Dankook University, Cheonan 31116, Korea;
| | - Jonathan Campbell Knowles
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (H.-W.H.); (K.D.P.); (J.C.K.); (H.-W.K.)
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan 31116, Korea
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London, London NW3 2PF, UK
| | - Hae-Won Kim
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (H.-W.H.); (K.D.P.); (J.C.K.); (H.-W.K.)
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan 31116, Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
- Cell & Matter Institute, Dankook University, Cheonan 31116, Korea
- Department of Regenerative Dental Medicine, College of Dentistry, Dankook University, Cheonan 31116, Korea
| | - Hae-Hyoung Lee
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (H.-W.H.); (K.D.P.); (J.C.K.); (H.-W.K.)
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan 31116, Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
| | - Jung-Hwan Lee
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (H.-W.H.); (K.D.P.); (J.C.K.); (H.-W.K.)
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan 31116, Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
- Cell & Matter Institute, Dankook University, Cheonan 31116, Korea
- Department of Regenerative Dental Medicine, College of Dentistry, Dankook University, Cheonan 31116, Korea
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Chang RYK, Okamoto Y, Morales S, Kutter E, Chan HK. Hydrogel formulations containing non-ionic polymers for topical delivery of bacteriophages. Int J Pharm 2021; 605:120850. [PMID: 34216771 DOI: 10.1016/j.ijpharm.2021.120850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 02/01/2023]
Abstract
Hydrogel is an attractive delivery vehicle for phages as it keeps the wound moist, acts as a protective barrier and facilitates wound healing process. The aim of this study was to formulate biologically stable phage hydrogels that enable controlled release of infective phages. Pseudomonas-targeting phages, PEV1 (myovirus) and PEV31 (podovirus) were formulated in hydrogels (109 PFU/g) consisting of non-ionic polymers, including hydroxyethyl cellulose (HEC), hydroxypropyl methylcellulose (HPMC), polyethylene oxide (PEO), polyvinyl alcohol (PVA), hydroxypropyl cellulose (HPC) and polyvinylpyrrolidone (PVP). The formulations were evaluated for physical properties, in vitro release profiles, antibacterial activity, and storage stability. Controlled release of phages was observed in 7.5% PEO, 20% PVA and 75% PVP hydrogels with >108 PFU release within 8 h. Poor phage release (7 × 105-4 × 107 PFU) was observed in 5% HPMC, 5% HEC and 30% HPC gels. The biostability of the optimized hydrogels was phage-specific with less titer loss observed for PEV1 (0-0.8 log) than for PEV31 (0.3-1.4 log). Both phages remained stable in PEO, PVA and HPMC hydrogels with <1 log titer reductions when stored at 5 °C. This study showed that 7.5% PEO and 20% PVA hydrogel formulations could be promising therapeutic systems for delivering phages for the treatment of wound infections.
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Affiliation(s)
- Rachel Yoon Kyung Chang
- Advanced Drug Delivery Group, The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia.
| | - Yuko Okamoto
- Advanced Drug Delivery Group, The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia; Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan
| | | | | | - Hak-Kim Chan
- Advanced Drug Delivery Group, The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia.
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Chen Z, Zhou C, Xu Y, Wen K, Song J, Bai S, Wu C, Huang W, Cai Q, Zhou K, Wang H, Wang Y, Feng X, Bai Y. An alternatingly amphiphilic, resistance-resistant antimicrobial oligoguanidine with dual mechanisms of action. Biomaterials 2021; 275:120858. [PMID: 34044257 DOI: 10.1016/j.biomaterials.2021.120858] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
The increasing number of infections caused by multi-drug resistance (MDR) bacteria is an omen of a new global challenge. As one of the countermeasures under development, antimicrobial peptides (AMPs) and AMP mimics have emerged as a new family of antimicrobial agents with high potential, due to their low resistance generation rate and effectiveness against MDR bacterial strains resulted from their membrane-disrupting mechanism of action. However, most reported AMPs and AMP mimics have facially amphiphilic structures, which may lead to undesired self-aggregation and non-specific binding, as well as increased cytotoxicity toward mammalian cells, all of which put significant limits on their applications. Here, we report an oligomer with the size of short AMPs, with both hydrophobic carbon chain and cationic groups placed on its backbone, giving an alternatingly amphiphilic structure that brings better selectivity between mammalian and bacterial cell membranes. In addition, the oligomer shows affinity toward DNA, thus it can utilize bacterial DNA located in the vulnerable nucleoid as the second drug target. Benefiting from these designs, the oligomer shows higher therapeutic index and synergistic effect with other antibiotics, while its low resistance generation rate and effectiveness on multi-drug resistant bacterial strains can be maintained. We demonstrate that this alternatingly amphiphilic, DNA-binding oligomer is not only resistance-resistant, but is also able to selectively eliminate bacteria at the presence of mammalian cells. Importantly, the oligomer exhibits good in vivo activity: it cleans all bacteria on Caenorhabditis elegans without causing apparent toxicity, and significantly improves the survival rate of mice with severely infected wounds in a mice excision wound model study.
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Affiliation(s)
- Zhiyong Chen
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Cailing Zhou
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China; School of Biology, Hunan University, Changsha, Hunan, 410082, China
| | - Yangfan Xu
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China; School of Biology, Hunan University, Changsha, Hunan, 410082, China
| | - Kang Wen
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Junfeng Song
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Silei Bai
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Chenxuan Wu
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Wei Huang
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Qingyun Cai
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Kai Zhou
- Shenzhen Institute of Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology (Shenzhen People's Hospital), Shenzhen, Guangdong, 518035, China; The Second Clinical Medical College of Jinan University (Shenzhen People's Hospital), Shenzhen, Guangdong, 518020, China
| | - Hui Wang
- Department of Clinical Laboratories, Peking University People's Hospital, Beijing, 100044, China
| | - Yingjie Wang
- Institute of Systems and Physical Biology, Shenzhen Bay Laboratory, Shenzhen, Guangdong, 518055, China
| | - Xinxin Feng
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Yugang Bai
- Institute of Chemical Biology and Nanomedicine, State Key Laboratory of Chem-/Bio-Sensing and Chemometrics, Hunan Provincial Key Laboratory of Biomacromolecular Chemical Biology, And School of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan, 410082, China.
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Huh K, Chung DR, Ha YE, Ko JH, Kim SH, Kim MJ, Huh HJ, Lee NY, Cho SY, Kang CI, Peck KR, Song JH. Impact of Difficult-to-Treat Resistance in Gram-negative Bacteremia on Mortality: Retrospective Analysis of Nationwide Surveillance Data. Clin Infect Dis 2021; 71:e487-e496. [PMID: 31994704 DOI: 10.1093/cid/ciaa084] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/27/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Clinically relevant categorization of antimicrobial resistance is critical to mitigating the threat it poses. Difficult-to-treat resistance (DTR) is a recently proposed category defined as nonsusceptibility to all first-line antibiotic agents. METHODS A retrospective study was conducted with nonduplicate cases of gram-negative bloodstream infection (GNBSI) caused by 4 major taxa (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter species) identified from a nationwide surveillance database. DTR was defined as nonsusceptibility to all the β-lactams and fluoroquinolones tested. Patient characteristics and mortality were compared between DTR GNBSI and GNBSI caused by carbapenem-resistant but not DTR and extended-spectrum cephalosporin-resistant but not DTR isolates using Centers for Disease Control and Prevention definitions. Adjusted odds ratios (aORs) for 30-day in-hospital mortality were examined for DTR in overall and in propensity score-matched cohorts. RESULTS A total of 1167 episodes of monomicrobial GNBSI were identified, and 147 (12.6%) of the isolates were DTR. The majority of DTR isolates were Acinetobacter species (79.6%) and P. aeruginosa (17.7%). DTR infections were associated with previous antibiotic use, healthcare contact, ventilator use, and lower respiratory tract infection. Crude mortality for GNBSI caused by DTR was 50.3%. A multivariable model showed that only DTR, but not other categories, was significantly associated with mortality (adjusted odds ratio [aOR], 3.58 [95% confidence interval {CI}, 1.27-10.19]). DTR was also a significant predictor for mortality in the analysis of propensity score-matched cohorts (aOR, 3.48 [95% CI, 1.82-6.79]). CONCLUSIONS In patients with GNBSI, DTR was associated with higher mortality than those in other resistance categories. Our findings suggest that DTR could be useful for surveillance and prognostication.
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Affiliation(s)
- Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea
| | - Young Eun Ha
- Division of Infectious Diseases, Department of Medicine, Sejong Hospital, Bucheon, Republic of Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Si-Ho Kim
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Ji Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Song
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea
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Zhang H, Guo Z, Chai Y, Fang YP, Mu X, Xiao N, Guo J, Wang Z. Risk Factors for and Clinical Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Nosocomial Infections: A Retrospective Study in a Tertiary Hospital in Beijing, China. Infect Drug Resist 2021; 14:1393-1401. [PMID: 33880044 PMCID: PMC8053504 DOI: 10.2147/idr.s298530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have been increasingly reported worldwide. We aimed to identify the risk factors for nosocomial CRKP infections and assess the clinical outcomes. Patients and Methods We conducted a case-control study with data collected from January 2016 to December 2018 in China. Controls were selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible Klebsiella pneumonia (CSKP) infections. Risk factors for nosocomial CRKP infections and clinical outcomes were assessed with univariate and multivariate analyses. Results A total of one hundred forty-two patients with CRKP infections and one hundred forty-two patients with CSKP infections were enrolled in this study. Multivariate analysis showed that exposure to antibiotics within 3 months prior to admission (odds ratio OR, 2.585; 95% confidence interval [CI], 1.425–4.691; P=0.002), exposure to carbapenems (OR, 2.532; 95% CI, 1.376–4.660; P=0.003), exposure to fluoroquinolones (OR, 3.309; 95% CI, 1.326–8.257; P=0.010), and the presence of a nasogastric tube (OR, 2.796; 95% CI, 1.369–5.712; P=0.005) were independent risk factors for CRKP infections. The 30-day mortality rate in the CRKP group was 19.7%, while the in-hospital mortality rate was 28.9%. In the CRKP group, a higher creatinine level (OR, 1.009; 95% CI, 1.002–1.016; P = 0.013), being in shock at the time of a positive culture (OR, 4.454; 95% CI, 1.374–14.443; P = 0.013), and co-infection with other resistant bacteria (OR, 4.799; 95% CI, 1.229–18.740; P = 0.024) were independent predictors of in-hospital mortality in patients with CRKP infections. Kaplan–Meier curves showed that the CRKP group had a shorter survival time than the CSKP group. Conclusion Nosocomial CRKP infection was associated with exposure to carbapenems and fluoroquinolones within 3 months prior to hospitalization and the presence of a nasogastric tube. Patients infected with CRKP had higher 30-day and in-hospital mortality rates. A higher creatinine level, shock and co-infection with other resistant bacteria were independent predictors of in-hospital mortality in patients with CRKP infections.
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Affiliation(s)
- Huijuan Zhang
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China
| | - Zhe Guo
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China.,Department of Liver Intensive Care Unit, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China
| | - Yan Chai
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Yi-Peng Fang
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Xiangdong Mu
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China
| | - Nan Xiao
- Department of Laboratory Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China
| | - Jun Guo
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China
| | - Zhong Wang
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China.,Department of General Practice Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China
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40
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The effect of EDTA in combination with some antibiotics against clinical isolates of gram negative bacteria in Mansoura, Egypt. Microb Pathog 2021; 154:104840. [PMID: 33691177 DOI: 10.1016/j.micpath.2021.104840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/10/2021] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Abstract
Extensive use of antibiotics in clinical practice has been associated with increasing frequency of resistant microorganisms. So new strategy is needed to treat the resistant pathogens. Hence this study was conducted to determine the effect of Ethylenediaminetetraacetic acid (EDTA) in increasing the inhibition effect of some antibiotics on multi-drug resistant (MDR) gram-negative bacteria. For this purpose, 40 E. coli isolates, 40 K. pneumoniae isolates and 50 P. aeruginosa isolates were collected from different University's hospitals in Mansoura, Egypt. Antibacterial susceptibility pattern against 9 different antimicrobials were studied by disc diffusion method. Also the effect of two sub-inhibitory concentrations of EDTA (1 and 2 mM) on the inhibition zones of antibiotic discs against the highly multidrug resistant (MDR) isolates was determined. Checkerboard method was used for testing the activity of gentamicin/EDTA and cefotaxime/EDTA combinations on the highly MDR isolates. Additionally, the effect of EDTA on the expression of efflux pump genes was tested by real time-PCR. Most of the clinical isolates were found to be resistant to the tested antibiotics except imipenem and high prevalence of MDR isolates was recorded. 34 isolates were selected as those showed the highest multi-drug resistance and were tested to specify their MIC for EDTA as EDTA showed strong antibacterial activity with MIC ranging 4-8 mM. The addition of sub-MIC of EDTA (1or 2 mM) to the agar plate resulted in changing the 11 tested E. coli isolates from resistant to sensitive to ceftazidime, gentamicin, rifampin, ampicillin, erythromycin and vancomycin, the tested K. pneumoniae isolates were turned also from resistant to sensitive to gentamicin and ceftazidime, additionally the tested P. aeruginosa isolates became sensitive to gentamicin, ceftazidime and ciprofloxacin. Indifference to additive activity was observed for tested combinations and MIC value of cefotaxime or gentamicin in combination with EDTA was less than antibiotic alone in the most tested isolates. Moreover, significant reduction (P < 0.01) in the expression of all tested efflux pump genes in treated E. coli, K. pneumoniae and P. aeruginosa isolates with EDTA compared to untreated isolates was observed. In conclusion, these results suggest that the combination of antibiotic especially gentamicin with EDTA may be fruitful for management of resistant gram negative infections.
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Koukoubani T, Makris D, Daniil Z, Paraforou T, Tsolaki V, Zakynthinos E, Papanikolaou J. The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study. Health Qual Life Outcomes 2021; 19:72. [PMID: 33658021 PMCID: PMC7927260 DOI: 10.1186/s12955-021-01712-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background In the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a “nightmare scenario” with unknown clinical consequences. In the Greek ICU, in particular, gram negative ABRPs are now considered endemic. However, the possible longitudinal impact of ABRPs on long-term outcomes of ICU patients has not yet been determined. Methods In this two-year (January 2014-December 2015) single-centre observational longitudinal study, 351 non-neurocritical ICU patients ≥ 18 year-old were enrolled. Patients’ demographic, clinical and outcome data were prospectively collected. Quality-adjusted life years (QALY) were calculated at 6, 12, 18 and 24 months after ICU admission. Results Fifty-eight patients developed infections due to ABRP (ABRP group), 57 due to non-ABRP (non-ABRP group), and 236 demonstrated no infection (no-infection group) while in ICU. Multiple regression analysis revealed that multiple organ dysfunction syndrome score (OR: 0.676, 95%CI 0.584–0.782; P < 0.001) and continuous renal replacement therapy (OR: 4.453, 95%CI 1.805–10.982; P = 0.001) were the only independent determinants for ABRP infections in ICU. Intra-ICU, 90-day and 2-year mortality was 27.9%, 52.4% and 61.5%, respectively. Compared to the non-ABRP and no-infection group, the ABRP group demonstrated increased intra-ICU, 90-day and 2-year mortality (P ≤ 0.022), worse 2-year survival rates in ICU patients overall and ICU survivor subset (Log-rank test, P ≤ 0.046), and poorer progress over time in 2-year QALY kinetics in ICU population overall, ICU survivor and 2-year survivor subgroups (P ≤ 0.013). ABRP group was further divided into multi-drug and extensively-drug resistant subgroups [MDR (n = 34) / XDR (n = 24), respectively]. Compared to MDR subgroup, the XDR subgroup demonstrated increased ICU, 90-day and 2-year mortality (P ≤ 0.031), but similar 90-day and 2-year QALYs (P ≥ 0.549). ABRP infections overall (HR = 1.778, 95% CI 1.166–2.711; P = 0.008), as well as XDR [HR = 1.889, 95% CI 1.075–3.320; P = 0.027) but not MDR pathogens, were independently associated with 2-year mortality, after adjusting for several covariates of critical illness. Conclusions The present study may suggest a significant association between ABRP (especially XDR) infections in ICU and increased mortality and inability rates for a prolonged period post-discharge that requires further attention in larger-scale studies.
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Affiliation(s)
| | - Demosthenes Makris
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - Zoe Daniil
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - Theoniki Paraforou
- Department of Critical Care, General Hospital of Trikala, Thessaly, Greece
| | - Vasiliki Tsolaki
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - Epaminondas Zakynthinos
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - John Papanikolaou
- Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece.
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Giacomini E, Perrone V, Alessandrini D, Paoli D, Nappi C, Degli Esposti L. Evidence of Antibiotic Resistance from Population-Based Studies: A Narrative Review. Infect Drug Resist 2021; 14:849-858. [PMID: 33688220 PMCID: PMC7937387 DOI: 10.2147/idr.s289741] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
The 20th century witnessed the dawn of the antibiotic revolution and is now facing the rising phenomenon of antibiotic resistance. In this narrative review, we aim to describe antibiotic resistance in clinical practice settings through population-based studies from different countries reporting the role of misuse of antibiotics in the development of resistance and the clinical and economic burden associated. The misuse of antibiotics was documented in the wide population as well as in hospitals and care facilities. It was mainly reported as over-use and inappropriate prescribing. Improper dosage regimens and longer treatment duration were regarded as pivotal factors related to antibiotic resistance; the emerging strategy of "antibiotic-de-escalation" could be the key to overcome these issues. The investigation of the self-medication attitude revealed widespread antibiotic use without following medical instructions or medical consultation. Moreover, several studies established the association of antibiotic resistance with increased risk of longer hospitalizations and mortality, highlighting the heavy clinical and economic burden of this phenomenon. In this narrative review, the widespread inappropriate use of antibiotics emerged as one of the main causes of antibiotic resistance, which negative outcomes call for the development of antibiotic stewardship programs and global surveillance networks.
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Affiliation(s)
- Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | | | | | - Daniela Paoli
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Carmela Nappi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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43
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Maraolo AE, Corcione S, Grossi A, Signori A, Alicino C, Hussein K, Trecarichi EM, Viale P, Timsit JF, Veeraraghavan B, Villegas MV, Rahav G, Daikos GL, Vardakas KZ, Roilides E, Uhlemann AC, Ghafur AK, Mornese Pinna S, Bassetti M, Kohler PP, Giacobbe DR. The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients. Infect Dis Ther 2021; 10:541-558. [PMID: 33586088 PMCID: PMC7954918 DOI: 10.1007/s40121-021-00408-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/23/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. METHODS We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). RESULTS IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56-3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24-2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70-4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36-3.59; I2 = 58%). CONCLUSION Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials.
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Affiliation(s)
- Alberto E Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, AORN Dei Colli, Naples, Italy.
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Adriano Grossi
- Section of Hygiene, University Department of Life Sciences and Public Health, University Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Cristiano Alicino
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Medical Direction, Santa Corona Hospital, ASL 2 Regional Health System of Liguria, Pietra Ligure, Italy
| | - Khetam Hussein
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Enrico M Trecarichi
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Jean-François Timsit
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), Paris, France
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Maria V Villegas
- Grupo de Resistencia Antimicrobiana Y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Galia Rahav
- Infectious Diseases Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - George L Daikos
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.,Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
| | - Emmanuel Roilides
- Infectious Disease Unit and Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS Per L'Oncologia, L. go R. Benzi 10, Genoa, Italy
| | - Philipp P Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniele R Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS Per L'Oncologia, L. go R. Benzi 10, Genoa, Italy
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Quillici MCB, Resende DS, Gonçalves IR, Royer S, Sabino SS, Almeida VFD, Ribas RM, Gontijo Filho PP. Gram-negative bacilli bacteremia: a 7 year retrospective study in a referral Brazilian tertiary-care teaching hospital. J Med Microbiol 2021; 70. [PMID: 33258755 DOI: 10.1099/jmm.0.001277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Bloodstream infection is one of the most frequent and challenging hospital-acquired infections and it is associated with high morbidity, mortality and additional use of healthcare resources.Hypothesis/Gap Statement: Bloodstream infections have consequences for the patient, such as the evolution to mortality and inappropriate empirical antibiotic prescription, especially when caused by multidrug-resistant Gram-negative bacilli.Objective. To assess the impact of bloodstream infection and the status of multidrug resistance (MDR) in the evolution of patients who received inappropriate initial antibiotic therapy.Methods. A retrospective surveillance was conducted on nosocomial bloodstream infections caused by Gram-negative bacilli (GNB) from January 2012 to December 2018 in an adult intensive care unit of a Brazilian tertiary teaching hospital.Results. We identified 270 patients with GNB nosocomial bacteremia. Non-survivors were older (with an average age of 58.8 years vs 46.9 years, P=<0.0001), presented more severe illnesses, were immunosuppressed (73.7 vs 37.6%, P=<0.0001), were more likely to have septic shock (55.8 vs 22.4%, P=<0.0001) and had an increased usage of mechanical ventilators (98.6 vs 89.6%, P=0.0013) than survivors. In a logistic regression model, inappropriate empirical antibiotic therapy was not an independent predictor of mortality, different from mechanical ventilator (P=<0.0001; OR=28.0; 95% CI=6.3-123.6), septic shock (P=0.0051; OR=2.5; 95% CI=1.3-4.9) and immunosuppression (P=0.0066; OR=2.6; 95% CI=1.3-5.2). In contrast, in a separate model, MDR was strongly associated with the prescription of inappropriate initial antibiotic therapy (P=0.0030; OR=5.3; 95% CI=1.7-16.1). The main isolated pathogens were Acinetobacter baumannii (23.6 %) and Klebsiella pneumoniae (18.7 %). The frequency of MDR organisms was high (63.7 %), especially among non-fermenting bacilli (60.9 %), highlighting A. baumannii (81.6 %) and Pseudomonas aeruginosa (41.8 %).Conclusion. Illness severity (septic shock and immunosuppression) and mechanical ventilation were identified as predictors of mortality. Additionally, MDR was a major determinant of inappropriate antibiotic empirical therapy, but not associated with mortality, and both characteristics were not statistically associated with death.
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Affiliation(s)
- Maria Clara Bisaio Quillici
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Daiane Silva Resende
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Iara Rossi Gonçalves
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Sabrina Royer
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Vitelhe Ferreira de Almeida
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Rosineide Marques Ribas
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Paulo Pinto Gontijo Filho
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
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Han HW, Kwak JH, Jang TS, Knowles JC, Kim HW, Lee HH, Lee JH. Grapefruit Seed Extract as a Natural Derived Antibacterial Substance against Multidrug-Resistant Bacteria. Antibiotics (Basel) 2021; 10:antibiotics10010085. [PMID: 33477436 PMCID: PMC7830962 DOI: 10.3390/antibiotics10010085] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
Multidrug-resistant (MDR) bacteria are increasing due to the abuse and misuse of antibiotics, and nosocomial infections by MDR bacteria are also increasing. The aim of this study was to identify new substances that can target MDR bacteria among 12 plant extracts that are known to have antibacterial effects. The experiments were performed by the disk diffusion test and microdilution minimum inhibitory concentration (MIC) test, as described by the Clinical and Laboratory Standards Institute (CLSI). By screening against methicillin-sensitive Staphylococcus aureus (MSSA), grapefruit seed extract (GSE) was selected from 12 plant extracts for subsequent experiments. GSE showed antibacterial effects against methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) in the disk diffusion test. Even at the lowest concentration, GSE showed antibacterial activity in the microdilution MIC test. As a result, we can conclude that GSE is a naturally derived antibacterial substance that exhibits a favorable antibacterial effect even at a very low concentration, so it is a good candidate for a natural substance that can be used to prevent or reduce nosocomial infections as coating for materials used in medical contexts or by mixing a small amount with other materials.
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Affiliation(s)
- Hee-Won Han
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Chungcheongnam-do 31116, Korea; (H.-W.H.); (J.C.K.); (H.-W.K.)
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
| | - Jin-Hwan Kwak
- Department of Life Science, Handong Global University, 558 Handong-ro, Pohang, Gyeongsangbuk-do 37554, Korea;
| | - Tae-Su Jang
- Department of Pre-Medi, College of Medicine, Dankook University, 119 Dandae-ro, Cheonan, Chungcheongnam-do 31116, Korea;
| | - Jonathan Campbell Knowles
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Chungcheongnam-do 31116, Korea; (H.-W.H.); (J.C.K.); (H.-W.K.)
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, 119 Dandae-ro, Cheonan, Chungcheongnam-do 31116, Korea
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Hae-Won Kim
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Chungcheongnam-do 31116, Korea; (H.-W.H.); (J.C.K.); (H.-W.K.)
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Cell & Matter Institute, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Department of Regenerative Dental Medicine, College of Dentistry, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
| | - Hae-Hyoung Lee
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Chungcheongnam-do 31116, Korea; (H.-W.H.); (J.C.K.); (H.-W.K.)
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Correspondence: (H.-H.L.); (J.-H.L.); Tel.: +82-(0)-41-550-3083 (H.-H.L.); +82-41-550-3081 (J.-H.L.); Fax: +82-(0)-41-559-7839 (H.-H.L.); +82-41-559-7839 (J.-H.L.)
| | - Jung-Hwan Lee
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Chungcheongnam-do 31116, Korea; (H.-W.H.); (J.C.K.); (H.-W.K.)
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Cell & Matter Institute, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Department of Regenerative Dental Medicine, College of Dentistry, Dankook University, Cheonan, Chungcheongnam-do 31116, Korea
- Correspondence: (H.-H.L.); (J.-H.L.); Tel.: +82-(0)-41-550-3083 (H.-H.L.); +82-41-550-3081 (J.-H.L.); Fax: +82-(0)-41-559-7839 (H.-H.L.); +82-41-559-7839 (J.-H.L.)
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Pezzani MD, Tornimbene B, Pessoa-Silva C, de Kraker M, Rizzardo S, Salerno ND, Harbarth S, Tacconelli E. Methodological quality of studies evaluating the burden of drug-resistant infections in humans due to the WHO Global Antimicrobial Resistance Surveillance System target bacteria. Clin Microbiol Infect 2021; 27:S1198-743X(21)00006-9. [PMID: 33450389 PMCID: PMC8113024 DOI: 10.1016/j.cmi.2021.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/10/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The health impact of antimicrobial resistance (AMR) has not been included in the Global Burden of Disease (GBD) report, as reliable data have been lacking. AMR burden estimates have been derived from models combining incidence and/or prevalence data from national and/or international surveillance systems and mortality estimates from clinical studies. Depending on utilized empirical data, statistical methodology and applied endpoints, the validity and reliability of results can differ substantially. OBJECTIVES We assessed comprehensiveness, and internal and external validity of studies estimating the clinical impact of infections caused by the priority antibiotic resistant pathogens monitored by the WHO Global Antimicrobial Resistance Surveillance System. DATA SOURCES Ovid MEDLINE, January 1950 to March 2019, In-Process and other non-indexed citations were searched. STUDY ELIGIBILITY CRITERIA Studies reporting mortality, length of hospital stay, duration of the disease until remission and/or death, complications, hospital re-admissions, and follow-up beyond hospital discharge were eligible. METHODS The literature was searched according to the Cochrane recommendations and reported according to Preferred Reporting Items for Systematic Reviews. RESULTS Two-hundred and eighty-six studies out of 3529 were eligible. Studies derived mainly from high-income countries (215, 75%) and relied on data from retrospective (226, 79%), single-centre (201, 70%), cohort studies (243, 85%). The health impact was mostly limited to all-cause mortality (128, 45%) with heterogeneity in timing of assessment; attributable length of hospital stay was seldom adjusted for pre-infection admission time and a few studies had enough follow-up for assessing long-term sequelae. Overall, adjustment for confounding has shown a substantial improvement. Data on health state definitions and duration of diseases are generally lacking, precluding calculation of disability-adjusted life years, critical for application of the GBD study methodology. CONCLUSION Efforts to improve harmonization, representativeness, quality of AMR surveillance data and cohort studies to determine AMR attributable mortality and morbidity are urgently required. Policy makers need accurate and detailed burden estimates to inform prioritization of resource allocation, and to select the most effective intervention strategies to halt the AMR crisis.
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Affiliation(s)
- Maria Diletta Pezzani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Barbara Tornimbene
- Surveillance, Evidence & Laboratory Strengthening Unit, SPC Department, AMR Division, World Health Organization, Geneva, Switzerland
| | - Carmem Pessoa-Silva
- Surveillance, Evidence & Laboratory Strengthening Unit, SPC Department, AMR Division, World Health Organization, Geneva, Switzerland
| | - Marlieke de Kraker
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre on Patient Safety, Geneva, Switzerland
| | - Sebastiano Rizzardo
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nicola Duccio Salerno
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre on Patient Safety, Geneva, Switzerland
| | - Evelina Tacconelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; German Centre for Infection Research (DZIF TTU-HAARBI), Tübingen University Hospital, Tübingen, Germany
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Jiang AM, Liu N, Zhao R, Zheng HR, Chen X, Fan CX, Zhang R, Zheng XQ, Fu X, Yao Y, Tian T. Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis. Ann Clin Microbiol Antimicrob 2020; 19:53. [PMID: 33228668 PMCID: PMC7685587 DOI: 10.1186/s12941-020-00395-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 11/07/2020] [Indexed: 12/20/2022] Open
Abstract
Background The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients. Methods PubMed, EMBASE, and Cochrane Library were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results. Results 6,729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 =78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR = 3.20, 95% CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality. Conclusions Our study identified that BSIs caused by ESBL-PE in patients with malignancy were associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.
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Affiliation(s)
- Ai-Min Jiang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Na Liu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Rui Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao-Ran Zheng
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xue Chen
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Chao-Xin Fan
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Rui Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xiao-Qiang Zheng
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xiao Fu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China.
| | - Tao Tian
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China.
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Infection control measures in times of antimicrobial resistance: a matter of solidarity. Monash Bioeth Rev 2020; 38:47-55. [PMID: 33159651 PMCID: PMC7648233 DOI: 10.1007/s40592-020-00119-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 01/21/2023]
Abstract
Control measures directed at carriers of multidrug-resistant organisms are traditionally approached as a trade-off between public interests on the one hand and individual autonomy on the other. We propose to reframe the ethical issue and consider control measures directed at carriers an issue of solidarity. Rather than asking “whether it is justified to impose strict measures”, we propose asking “how to best care for a person’s carriership and well-being in ways that do not imply an unacceptable risk for others?”. A solidarity approach could include elevating baseline levels of precaution measures and accepting certain risks in cases where there is exceptionally much at stake. A generous national compensation policy that also covers for costs related to dedicated care is essential in a solidarity approach. An additional benefit of reframing the questions is that it helps to better acknowledge that being subjected to control measures is a highly personal matter.
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Wendt R, Nickel O, Botsch A, Lindner M, Bethge A, Marx K, Ruf BR, Beige J, Lübbert C. Low colonization rates with Multidrug-resistant Gram-negative bacteria in a German hospital-affiliated hemodialysis center. PLoS One 2020; 15:e0240314. [PMID: 33057439 PMCID: PMC7561126 DOI: 10.1371/journal.pone.0240314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Multidrug-resistant Gram-negative bacteria (MDRGN) are found with rising prevalence in non-hemodialysis risk populations as well as hemodialysis (HD) cohorts in Asia, Europe and North America. At the same time, colonization and consecutive infections with such pathogens may increase mortality and morbidity of affected individuals. We aimed to monitor intestinal MDRGN colonization in a yet not investigated German HD population. Methods We performed cross-sectional point-prevalence testing with 12 months follow-up and selected testing of relatives in an out-patient HD cohort of n = 77 patients by using microbiological cultures from fresh stool samples, combined with Matrix Assisted Laser Desorption Ionization—Time of Flight Mass Spectrometry (MALDI-TOF-MS) and antimicrobial susceptibility testing. Results We detected MDRGN in 8 out of 77 patients (10.4%) and 1 out of 22 relatives (4.5%), indicating only colonization and no infections. At follow-up, 2 patients showed phenotypic persistence of MDRGN colonization, and in 6 other patients de-novo MDRGN colonization could be demonstrated. Pathogens included Escherichia coli and Klebsiella pneumoniae (with extended-spectrum beta-lactamase [ESBL]-production as well as fluoroquinolone resistance), Stenotrophomonas maltophilia and Enterobacter cloacae. Conclusions In a single-center study, MDRGN colonization rates were below those found in non-HD high-risk populations and HD units in the US, respectively. Reasons for this could be high hygiene standards and a strict antibiotic stewardship policy with evidence of low consumption of fluoroquinolones and carbapenems in our HD unit and the affiliated hospital.
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Affiliation(s)
- Ralph Wendt
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
- Kuratorium for Dialysis and Transplantation (KfH) Renal Unit, Hospital St. Georg, Leipzig, Germany
| | - Olaf Nickel
- Department of Laboratory Medicine and Microbiology, Hospital St. Georg, Leipzig, Germany
| | - Almut Botsch
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Margareta Lindner
- Department of Laboratory Medicine and Microbiology, Hospital St. Georg, Leipzig, Germany
| | - Angela Bethge
- Department of Laboratory Medicine and Microbiology, Hospital St. Georg, Leipzig, Germany
| | - Kathrin Marx
- Hospital Pharmacy, Hospital St. Georg, Leipzig, Germany
| | - Bernhard R. Ruf
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Joachim Beige
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
- Kuratorium for Dialysis and Transplantation (KfH) Renal Unit, Hospital St. Georg, Leipzig, Germany
- Martin-Luther-University Halle/Wittenberg, Halle, Germany
| | - Christoph Lübbert
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- * E-mail:
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Almulhim AS, Al-Dahneen BA, Alsowaida YS. Pharmacists' Knowledge About the Impact of Augmented Renal Clearance on Antimicrobial Dosing in Critically Ill Patients: A Cross-Sectional Study. Infect Dis Ther 2020; 9:599-608. [PMID: 32594458 PMCID: PMC7452990 DOI: 10.1007/s40121-020-00310-9] [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: 05/04/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Broad-spectrum antibiotics are commonly prescribed in critically ill patients. While it is commonly believed that only patients with impaired renal function need dose adjustment, augmented renal clearance (ARC) is a phenomenon that warrants dose adjustment as well. In critically ill patients ARC is often undetectable because it is associated with a normal or decreased serum creatinine concentration (SCr). This study's objective was to assess pharmacists' knowledge about ARC identification, risk factors, affected antimicrobials, and dosing of antibiotics in patients with ARC. METHODS In January 2020, we carried out a cross-sectional study by sending out an online survey to the Saudi Pharmaceutical Society, Kuwait Pharmaceutical Association, and Oman Pharmaceutical Society. Due to the expected low response rate, we administered an electronic questionnaire to pharmacists attending Dubai International Pharmaceuticals and Technologies Conference and Exhibition 2020 (DUPHAT). RESULTS Data were collected from 288 respondents. However, only 134 were included in the final analysis following the exclusion of incomplete responses, no experience working in in-patient settings, and respondents who chose "no" universal ARC definition. Those who chose "yes" or "I do not know" regarding the universal definition of ARC were asked about SCr status in ARC. Elevation in SCr was chosen by 67/134 (50%) compared to those who chose decreased or normal (48/134, 35.8%). Regarding risk factors, only 1/134 (0.7%) respondent selected all risk factors. Two/134 (1.4%) respondents chose all hydrophilic antibiotics that are likely to be affected by ARC. Concerning the appropriate dose and frequency of piperacillin-tazobactam and meropenem, they were selected by 60.4% and 30.5%, respectively. CONCLUSION Pharmacists' knowledge about ARC was limited. Implementation of educational programs targeting hospital pharmacists, especially those practicing in critical care settings, and developing antimicrobial institutional guidelines are important.
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Affiliation(s)
- Abdulaziz S Almulhim
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
| | - Batool A Al-Dahneen
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Yazed S Alsowaida
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
- Department of Pharmacy Services, Pharmacy Administration, Brigham and Women's Hospital, Boston, MA, USA
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