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Sauvat L, Verhoeven PO, Gagnaire J, Berthelot P, Paul S, Botelho-Nevers E, Gagneux-Brunon A. Vaccines and monoclonal antibodies to prevent healthcare-associated bacterial infections. Clin Microbiol Rev 2024; 37:e0016022. [PMID: 39120140 PMCID: PMC11391692 DOI: 10.1128/cmr.00160-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
SUMMARYHealthcare-associated infections (HAIs) represent a burden for public health with a high prevalence and high death rates associated with them. Pathogens with a high potential for antimicrobial resistance, such as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) and Clostridioides difficile, are responsible for most HAIs. Despite the implementation of infection prevention and control intervention, globally, HAIs prevalence is stable and they are mainly due to endogenous pathogens. It is undeniable that complementary to infection prevention and control measures, prophylactic approaches by active or passive immunization are needed. Specific groups at-risk (elderly people, chronic condition as immunocompromised) and also healthcare workers are key targets. Medical procedures and specific interventions are known to be at risk of HAIs, in addition to hospital environmental exposure. Vaccines or monoclonal antibodies can be seen as attractive preventive approaches for HAIs. In this review, we present an overview of the vaccines and monoclonal antibodies in clinical development for prevention of the major bacterial HAIs pathogens. Based on the current state of knowledge, we look at the challenges and future perspectives to improve prevention by these means.
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Affiliation(s)
- Léo Sauvat
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Paul O Verhoeven
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Julie Gagnaire
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Philippe Berthelot
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Stéphane Paul
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- CIC 1408 Inserm, Axe vaccinologie, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
- CIC 1408 Inserm, Axe vaccinologie, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Amandine Gagneux-Brunon
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
- CIC 1408 Inserm, Axe vaccinologie, University Hospital of Saint-Etienne, Saint-Etienne, France
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de Buys M, Moodley K, Cakic JN, Pietrzak JRT. Staphylococcus aureus colonization and periprosthetic joint infection in patients undergoing elective total joint arthroplasty: a narrative review. EFORT Open Rev 2023; 8:680-689. [PMID: 37655845 PMCID: PMC10548302 DOI: 10.1530/eor-23-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Peri-prosthetic joint infections (PJIs) following total joint arthroplasty (TJA) are associated with higher treatment costs, longer hospital admissions and increased morbidity and mortality. Colonization with Staphylococcus aureus is an independent and modifiable risk factor for PJIs and carriers of S. aureus are ten times more likely than non-carriers for post-operative infections. Screening and targeted decolonization, vs universal decolonization without screening, remains a controversial topic. We recommend a tailored approach, based on local epidemiological patterns, resource availability and logistical capacity. Universal decolonization is associated with lower rates of SSI and may reduce treatment costs.
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Affiliation(s)
- Michael de Buys
- Orthopaedic Surgery, University of Witswatersrand, Johannesburg, South Africa
| | | | - Josip Nenad Cakic
- Department Orthopaedic Surgery, Life Fourways Hospital, Johannesburg, South Africa
| | - Jurek R T Pietrzak
- Orthopaedic Surgery, University of Witswatersrand, Johannesburg, South Africa
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Amandine GB, Gagnaire J, Pelissier C, Philippe B, Elisabeth BN. Vaccines for healthcare associated infections without vaccine prevention to date. Vaccine X 2022; 11:100168. [PMID: 35600984 PMCID: PMC9118472 DOI: 10.1016/j.jvacx.2022.100168] [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: 12/17/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Abstract
In spite of the widespread implementation of preventive strategies, the prevalence of healthcare-associated infections (HAIs) remains high. The prevalence of multidrug resistant organisms is high in HAIs. In 2019, the World Health Organization retained antimicrobial resistance as one of the ten issues for global health. The development of vaccines may contribute to the fight against antimicrobial resistance to reduce the burden of HAIs. Staphylococcus aureus, Gram negative bacteria and Clostridium difficile are the most frequent pathogens reported in HAIs. Consequently, the development of vaccines against these pathogens is crucial. At this stage, the goal of obtaining effective vaccines against S.aureus and Gram negative bacteria has not yet been achieved. However, we can expect in the near future availability of a vaccine against C. difficile. In addition, identifying populations who may benefit from these vaccines is complex, as at-risk patients are not great responders to vaccines, or as vaccination may occur too late, when they are already confronted to the risk. Vaccinating healthcare workers (HCWs) against these pathogens may have an impact only if HCWs play a role in the transmission and in the pathogens acquisition in patients, if the vaccine is effective to reduce pathogens carriage and if vaccine coverage is sufficient to protect patients. Acceptance of these potential vaccines should be evaluated and addressed in patients and in HCWs.
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Affiliation(s)
- Gagneux-Brunon Amandine
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France.,Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Julie Gagnaire
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France.,Infection Control Unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Carole Pelissier
- Occupational Health Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Berthelot Philippe
- CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France.,Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France.,Infection Control Unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Botelho-Nevers Elisabeth
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France.,CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France.,Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
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Lee BY, Bartsch SM, Ferguson MC, Wedlock PT, O’Shea KJ, Siegmund SS, Cox SN, McKinnell JA. The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PLoS Comput Biol 2021; 17:e1008470. [PMID: 33411742 PMCID: PMC7790237 DOI: 10.1371/journal.pcbi.1008470] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
Finding medications or vaccines that may decrease the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could potentially reduce transmission in the broader population. We developed a computational model of the U.S. simulating the spread of SARS-CoV-2 and the potential clinical and economic impact of reducing the infectious period duration. Simulation experiments found that reducing the average infectious period duration could avert a median of 442,852 [treating 25% of symptomatic cases, reducing by 0.5 days, reproductive number (R0) 3.5, and starting treatment when 15% of the population has been exposed] to 44.4 million SARS-CoV-2 cases (treating 75% of all infected cases, reducing by 3.5 days, R0 2.0). With R0 2.5, reducing the average infectious period duration by 0.5 days for 25% of symptomatic cases averted 1.4 million cases and 99,398 hospitalizations; increasing to 75% of symptomatic cases averted 2.8 million cases. At $500/person, treating 25% of symptomatic cases saved $209.5 billion (societal perspective). Further reducing the average infectious period duration by 3.5 days averted 7.4 million cases (treating 25% of symptomatic cases). Expanding treatment to 75% of all infected cases, including asymptomatic infections (R0 2.5), averted 35.9 million cases and 4 million hospitalizations, saving $48.8 billion (societal perspective and starting treatment after 5% of the population has been exposed). Our study quantifies the potential effects of reducing the SARS-CoV-2 infectious period duration.
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Affiliation(s)
- Bruce Y. Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Sarah M. Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Marie C. Ferguson
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Patrick T. Wedlock
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Kelly J. O’Shea
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Sheryl S. Siegmund
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Sarah N. Cox
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - James A. McKinnell
- Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, United States of America
- Torrance Memorial Medical Center, Torrance, California, United States of America
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Bartsch SM, O'Shea KJ, Ferguson MC, Bottazzi ME, Cox SN, Strych U, McKinnell JA, Wedlock PT, Siegmund SS, Hotez PJ, Lee BY. How Efficacious Must a COVID-19 Coronavirus Vaccine be to Prevent or Stop an Epidemic by Itself. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32511569 DOI: 10.1101/2020.05.29.20117184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Given the continuing coronavirus disease 2019 (COVID-19) pandemic and much of the U.S. implementing social distancing due to the lack of alternatives, there has been a push to develop a vaccine to eliminate the need for social distancing. METHODS In 2020, we developed a computational model of the U.S. simulating the spread of COVID-19 coronavirus and vaccination. RESULTS Simulation experiments revealed that when vaccine efficacy exceeded 70%, coverage exceeded 60%, and vaccination occurred on day 1, the attack rate dropped to 22% with daily cases not exceeding 3.2 million (reproductive rate, R0, 2.5). When R0 was 3.5, the attack rate dropped to 41% with daily cases not exceeding 14.4 million. Increasing coverage to 75% when vaccination occurred by day 90 resulted in 5% attack rate and daily cases not exceeding 258,029when R0 was 2.5 and a 26% attack rate and maximum daily cases of 22.6 million when R0 was 3.5. When vaccination did not occur until day 180, coverage (i.e., those vaccinated plus those otherwise immune) had to reach 100%. A vaccine with an efficacy between 40% and 70% could still obviate the need for other measures under certain circumstances such as much higher, and in some cases, potentially unachievable, vaccination coverages. CONCLUSION Our study found that to either prevent or largely extinguish an epidemic without any other measures (e.g., social distancing), the vaccine has to have an efficacy of at least 70%.
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Wu S, Liu Y, Lei L, Zhang H. Virulence of methicillin-resistant Staphylococcus aureus modulated by the YycFG two-component pathway in a rat model of osteomyelitis. J Orthop Surg Res 2019; 14:433. [PMID: 31831035 PMCID: PMC6909630 DOI: 10.1186/s13018-019-1508-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives Methicillin-resistant Staphylococcus aureus (MRSA) strains present an urgent medical problem in osteomyelitis cases. Our previous study indicated that the YycFG two-component regulatory pathway is associated with the bacterial biofilm organization of MRSA strains. The aim of this study was to investigate the regulatory roles of ASyycG in the bacterial biofilm formation and the pathogenicity of MRSA strains using an antisense RNA strategy. Methods An ASyycG-overexpressing MRSA clinical isolate was constructed. The bacterial growth was monitored, and the biofilm biomass on bone specimens was examined using scanning electron microscopy and confocal laser scanning microscopy. Furthermore, quantitative RT-PCR (QRT-PCR) analysis was used to measure the expression of yycF/G/H and icaA/D in the MRSA and ASyycG strains. The expression of the YycG protein was quantified by Western blot assays. We validated the role of ASyycG in the invasive ability and pathogenicity of the strains in vivo using histology and peptide nucleic acid fluorescent in situ hybridization. Results The results showed that overexpression of ASyycG lead to a reduction in biofilm formation and exopolysaccharide (EPS) synthesis compared to the control MRSA strains. The ASyycG strains exhibited decreased expression of the yycF/G/H and icaA/D genes. Furthermore, Western blot data showed that the production of the YycG protein was inhibited in the ASyycG strains. In addition, we demonstrated that ASyycG suppressed the invasive ability and pathogenicity of the strain in vivo using an SPF (specific pathogen free) rat model. Conclusion In summary, the overexpression of ASyycG leads to a reduction in biofilm formation and bacterial pathogenicity in vivo, which provides a potential target for the management of MRSA-induced osteomyelitis.
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Affiliation(s)
- Shizhou Wu
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu City, 610041, Sichuan, China
| | - Yunjie Liu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Lei Lei
- State Key Laboratory of Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, NO.14 Renmin South Road, Chengdu City, 610041, Sichuan, China.
| | - Hui Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu City, 610041, Sichuan, China.
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Matza LS, Kim KJ, Yu H, Belden KA, Chen AF, Kurd M, Lee BY, Webb J. Health state utilities associated with post-surgical Staphylococcus aureus infections. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:819-827. [PMID: 30887157 PMCID: PMC6652168 DOI: 10.1007/s10198-019-01036-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/08/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Surgical site infections (SSIs) are among the most common and potentially serious complications after surgery. Staphylococcus aureus is a virulent pathogen frequently identified as a cause of SSI. As vaccines and other infection control measures are developed to reduce SSI risk, cost-utility analyses (CUA) of these interventions are needed to inform resource allocation decisions. A recent systematic review found that available SSI utilities are of "questionable quality." Therefore, the purpose of this study was to estimate the disutility (i.e., utility decrease) associated with SSIs. METHODS In time trade-off interviews, general population participants in the UK (London, Edinburgh) valued health states drafted based on literature and clinician interviews. Health states described either joint or spine surgery, with or without an SSI. The utility difference between otherwise identical health states with and without the SSI represented the disutility associated with the SSI. RESULTS A total of 201 participants completed interviews (50.2% female; mean age = 46.2 years). Mean (SD) utilities of health states describing joint and spine surgery without infections were 0.79 (0.23) and 0.78 (0.23). Disutilities of SSIs ranged from - 0.03 to - 0.32, depending on severity of the infection and subsequent medical interventions. All differences between corresponding health with and without SSIs were statistically significant (all p < 0.001). CONCLUSION The preference-based SSI disutilities derived in this study may be used to represent mild and serious SSIs in CUAs assessing and comparing the value of vaccinations that may reduce the risk of SSIs.
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Affiliation(s)
- Louis S. Matza
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| | - Katherine J. Kim
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| | - Holly Yu
- Pfizer Inc, Collegeville, PA USA
| | - Katherine A. Belden
- Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - Antonia F. Chen
- Department of Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Mark Kurd
- Department of Orthopedic Surgery Sidney Kimmel Medical College, Thomas Jefferson University The Rothman Institute, Philadelphia, PA USA
| | - Bruce Y. Lee
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Jason Webb
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
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Cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections. Int Urogynecol J 2019; 31:285-289. [PMID: 31263916 DOI: 10.1007/s00192-019-04034-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We evaluate the cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections. MATERIALS AND METHODS A decision tree model was used to assess the cost-effectiveness of prophylactic antibiotics in preventing catheter-associated urinary tract infections for patients with a short-term indwelling urinary catheter. The model accounted for incidence of urinary tract infections with and without the use of prophylactic antibiotics, incidence of antibiotic-resistant urinary tract infections, as well as costs associated with diagnosis and treatment of urinary tract infections and antibiotic-resistant urinary tract infections. Costs were calculated from the health care system's perspective. We conducted one-way sensitivity analyses. RESULTS The base case analysis showed that the use of prophylactic antibiotics is cost-saving in preventing catheter-associated urinary tract infections. The use of prophylactic antibiotics resulted in lower costs and higher quality-adjusted life-years compared with no prophylactic antibiotics. Sensitivity analyses showed that the optimal strategy changes to no prophylactic antibiotics when the incidence of urinary tract infections after prophylactic antibiotics exceeds 22% or the incidence of developing urinary tract infections without prophylactic antibiotics is less than 12%. Varying the costs of prophylactic antibiotics, urinary tract infection treatment, or antibiotic-resistant urinary tract infection treatment within a reasonable range did not change the optimal strategy. CONCLUSIONS Prophylactic antibiotic use to prevent catheter-associated urinary tract infections is cost-effective under most conditions. These results were sensitive to the likelihood of developing catheter-associated urinary tract infections with and without prophylactic antibiotics. Our results are limited to the cost-effectiveness perspective on this clinical practice.
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Gagneux-Brunon A, Lucht F, Launay O, Berthelot P, Botelho-Nevers E. Vaccines for healthcare-associated infections: present, future, and expectations. Expert Rev Vaccines 2018; 17:421-433. [DOI: 10.1080/14760584.2018.1470507] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Amandine Gagneux-Brunon
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| | - Frédéric Lucht
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| | - Odile Launay
- Inserm CIC 1417, I-REIVAC, University of Paris-Descartes, University Hospital of Cochin-Broca-Hôtel-Dieu, Paris, France
| | - Philippe Berthelot
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
- Infection control unit, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
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Shao L, Zhen P, Ma Y, Gong D, Wang Y. [Comparative study of different concentrations of methicillin-resistant Staphylococcus aureus in the preparation of chronic femoral osteomyelitis models]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:412-419. [PMID: 29806298 PMCID: PMC8414348 DOI: 10.7507/1002-1892.201711082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/03/2018] [Indexed: 11/03/2022]
Abstract
Objective To investigate the appropriate concentration of methicillin-resistant Staphylococcus aureus (MRSA) in establishing chronic femoral osteomyelitis model in rabbits. Methods Forty-eight adult New Zealand white rabbits were randomly divided into 6 groups with 8 rabbits in each group. Animals in groups B, C, D, E, and F were injected 1×10 9, 1×10 8, 1×10 7, 1×10 6, 1×10 5 CFU/mL MRSA on the location of 2 cm of the femoral supracondyle, respectively, and group A was injected with aseptic saline as a control. The general observation were performed at 4 weeks after operation, and the wound secretions were taken for bacteriological examination. The serum C-reactive protein content was detected at preoperation and 2 weeks and 4 weeks after operation. The X-ray, CT scan, and Norden imaging scoring were performed at 4 weeks after operation. At 4 weeks after operation, the animals were sacrificed, and the specimens were observed and evaluated by general scores; and the HE staining and histological score were also performed. Results Five rabbits died of severe infection in group B, 2 died in group C, and no rabbit died in groups D, E, and F. General observation showed that the incision healed without soft tissue swelling in group A; most animals had visible incision swelling and sinus formation, femoral thickening, bone destruction, and damage decreased with the decreasing of the concentration of liquid bacterial in groups B-D; the infection signs were seen in groups E and F, and the degree of infection were less than that of group D. Bacteriological examination showed that fistula formation animal in groups B, C, D, and E were cultured with positive results, and with the decrease of concentration, the number of animal fistula formation decreased gradually; and bacteriological culture did not be performed in group F because of no sinus formation. There was no significant difference in the content of C-reactive protein between groups before operation ( P>0.05). The contents of C-reactive protein in groups B-F were significantly higher than those in group A at 2 and 4 weeks after operation ( P<0.05). At 4 weeks after operation, the content of C-reactive protein was in the order of groups B, C, D, E, F, and A in turn from high to low, showing significant differences between groups ( P<0.05). Imaging examination showed that there was no soft tissue swelling and bone destruction in group A; bone destruction, massive sequestrum formation, and soft tissue swelling were found in groups B and C; bone destruction was observed in groups D and E, and the degree of sequestrum formation was not as good as that in group C; and there was a small amount of bone infection in group F. The Norden scores in groups B-F were significantly higher than that in group A, and in groups B and C than those in groups D, E, and F, and in groups D and E than that in group F ( P<0.05); there was no significant difference between groups B and C, and between groups D and E ( P>0.05). The specimens general observation scores in groups B-F were significantly higher than that in group A, while in groups B and C than those in groups D, E, and F ( P<0.05); there was no significant difference between groups D, E, and F ( P>0.05). HE staining showed that the structure of bone trabecula in group A was clear and the structure was arranged neatly; in groups B-F, trabecular bone destruction and inflammatory cell infiltration were seen and the degree gradually decreased. The histological scores in groups B-F were significantly higher than that in group A, and in group B than those in groups C-F, in groups C and D than that in group F ( P<0.05); there was no significant difference between groups C, D, and E, and between groups E and F ( P>0.05). Conclusion The optimal MRSA concentration of rabbit model of chronic osteomyelitis of femur is between 1×10 6 and 1×10 7 CFU/mL.
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Affiliation(s)
- Longlong Shao
- Gansu University of Traditional Chinese Medicine, Lanzhou Gansu, 730000, P.R.China
| | - Ping Zhen
- Department of Orthopedics, General Hospital of Lanzhou Military Region of Chinese PLA, Lanzhou Gansu, 730050,
| | - Yonghai Ma
- Department of Orthopedics, General Hospital of Lanzhou Military Region of Chinese PLA, Lanzhou Gansu, 730050, P.R.China
| | - Dong Gong
- Department of Orthopedics, General Hospital of Lanzhou Military Region of Chinese PLA, Lanzhou Gansu, 730050, P.R.China
| | - Yunlong Wang
- Department of Orthopedics, General Hospital of Lanzhou Military Region of Chinese PLA, Lanzhou Gansu, 730050, P.R.China
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Blanchette KA, Wenke JC. Current therapies in treatment and prevention of fracture wound biofilms: why a multifaceted approach is essential for resolving persistent infections. J Bone Jt Infect 2018; 3:50-67. [PMID: 29761067 PMCID: PMC5949568 DOI: 10.7150/jbji.23423] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/16/2018] [Indexed: 12/13/2022] Open
Abstract
Traumatic orthopedic injuries, particularly extremity wounds, are a significant cause of morbidity. Despite prophylactic antibiotic treatment and surgical intervention, persistent infectious complications can and do occur. Persistent bacterial infections are often caused by biofilms, communities of antibiotic tolerant bacteria encased within a matrix. The structural and metabolic differences in this mode of growth make treatment difficult. Herein, we describe both established and novel, experimental treatments targeted at various stages of wound healing that are specifically aimed at reducing and eliminating biofilm bacteria. Importantly, the highly tolerant nature of these bacterial communities suggests that most singular approaches could be circumvented and a multifaceted, combinatorial approach will be the most effective strategy for treating these complicated infections.
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Affiliation(s)
| | - Joseph C Wenke
- US Army Institute of Surgical Research, Ft Sam Houston, TX
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12
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Gagneux-Brunon A, Lucht F, Launay O, Berthelot P, Botelho-Nevers E. Les vaccins dans la prévention des infections associées aux soins. JOURNAL DES ANTI-INFECTIEUX 2017. [PMCID: PMC7148680 DOI: 10.1016/j.antinf.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Les infections associées aux soins (IAS) constituent un véritable problème de santé publique. Escherichia coli, Staphylococcus aureus, Clostridium difficile sont les plus souvent à l’origine des IAS. L’antibiorésistance fréquente complique encore la prise en charge et des impasses thérapeutiques existent à présent. Les mesures d’hygiène hospitalière bien qu’essentielles sont insuffisantes pour diminuer drastiquement les IAS. Ainsi, des stratégies alternatives à l’antibiothérapie s’avèrent nécessaires pour prévenir et traiter les IAS. Parmi celles-ci, la vaccination et l’immunisation passive sont probablement les plus prometteuses. Nous avons fait une mise au point sur les vaccins disponibles et en développement clinique pour lutter contre les IAS, chez les patients à risque d’IAS et les soignants. L’intérêt de la vaccination grippale et rotavirus chez les patients pour prévenir ces IAS virales a été examiné. Le développement d’un vaccin anti-S. aureus, déjà émaillé de 2 échecs est complexe. Toutefois, ces échecs ont permis d’améliorer les connaissances sur l’immunité anti-S. aureus. La mise à disposition d’un vaccin préventif anti-C. difficile semble plus proche. Pour les autres bactéries gram négatif responsables d’IAS, le développement est moins avancé. La vaccination des patients à risques d’IAS pose également des problèmes de réponse vaccinale qu’il faudra résoudre pour utiliser cette stratégie. Ainsi, la vaccination des soignants, de par l’effet de groupe permet également de prévenir les IAS. Nous faisons ici le point sur l’intérêt de la vaccination des soignants contre la rougeole, la coqueluche, la grippe, la varicelle, l’hépatite B pour réduire les IAS avec des vaccins déjà disponibles.
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13
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Abstract
Staphylococcus aureus is a leading pathogen in surgical site, intensive care unit, and skin infections, as well as healthcare-associated pneumonias. These infections are associated with an enormous burden of morbidity, mortality, and increase of hospital length of stay and patient cost. S. aureus is impressively fast in acquiring antibiotic resistance, and multidrug-resistant strains are a serious threat to human health. Due to resistance or insufficient effectiveness, antibiotics and bundle measures leave a tremendous unmet medical need worldwide. There are no licensed vaccines on the market despite the significant efforts done by public and private initiatives. Indeed, vaccines tested in clinical trials in the last two decades have failed to show efficacy. However, they targeted single antigens and contained no adjuvants and efficacy trials were performed in severely ill subjects. Herein, we provide a comprehensive evaluation of potential target populations for efficacy trials taking into account key factors such as population size, incidence of S. aureus infection, disease outcome, primary endpoints, as well as practical advantages and disadvantages. We describe the whole-blood assay as a potential surrogate of protection, and we show the link between phase III clinical trial data of failed vaccines with their preclinical observations. Finally, we give our perspective on how new vaccine formulations and clinical development approaches may lead to successful S. aureus vaccines.
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14
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Gheorghe A, Moran G, Duffy H, Roberts T, Pinkney T, Calvert M. Health Utility Values Associated with Surgical Site Infection: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1126-37. [PMID: 26686800 DOI: 10.1016/j.jval.2015.08.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/29/2015] [Accepted: 08/03/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a costly postoperative complication whose impact on patients' health-related quality of life is highly uncertain and has not been summarized to date. OBJECTIVE The objective was to summarize the evidence base on SSI health utility values reported in patient-level studies and decision models. METHODS A systematic review of SSI utility values reported in patient-level and decision modeling studies was carried out. Studies in which utility values for SSI were either invoked (e.g., model-based economic evaluations) or elicited (e.g., valuation exercises), or at least one non-preference-based instrument was administered to patients with SSI after open surgery were included. Mapping algorithms were used, where appropriate, to calculate utilities from primary data. Results were summarized narratively, and the quality of the utility values used in the included modeling studies was assessed. RESULTS Of 6552 records identified in the database search, 28 studies were included in the review: 19 model-based economic evaluations and 9 patient-level studies. SSI utility decrements ranged from 0.04 to 0.48, of which 19 ranged from 0.1 to 0.3. SSI utility decrements could be calculated for three patient-level studies, and their values ranged from 0.05 (7 days postoperatively) to 0.124 (1 year postoperatively). In most modeling studies, SSI utilities were informed by authors' assumptions or by secondary sources. CONCLUSIONS SSI may substantially affect patients' health utility and needs to be considered when modeling decision problems in surgery. The evidence base for SSI utilities is of questionable quality and skewed toward orthopedic surgery. Further research must concentrate on producing reliable estimates for patients without orthopedic problems.
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Affiliation(s)
- Adrian Gheorghe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Grace Moran
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Helen Duffy
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Thomas Pinkney
- Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
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15
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McNeely TB, Shah NA, Fridman A, Joshi A, Hartzel JS, Keshari RS, Lupu F, DiNubile MJ. Mortality among recipients of the Merck V710 Staphylococcus aureus vaccine after postoperative S. aureus infections: an analysis of possible contributing host factors. Hum Vaccin Immunother 2015; 10:3513-6. [PMID: 25483690 DOI: 10.4161/hv.34407] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In a blinded randomized trial, preoperative receipt of the Merck V710 Staphylococcus aureus vaccine was associated with a higher mortality rate than placebo in patients who later developed postoperative S. aureus infections. Of the tested patients, all 12 V710 recipients (but only 1 of 13 placebo recipients) with undetectable serum IL2 levels prior to vaccination and surgery died after postoperative S. aureus infection. The coincidence of 3 factors (low prevaccination IL-2 levels, receipt of V710, and postoperative S. aureus infection) appeared to substantially increase mortality in our study population after major cardiothoracic surgery. Furthermore, 9 of the 10 V710 recipients with undetectable preoperative IL17a levels and postoperative S. aureus infections died. Although the current study is hypothesis-generating and the exact pathophysiology remains speculative, these findings raise concern that immune predispositions may adversely impact the safety and efficacy of staphylococcal vaccines actively under development. The potential benefits of an effective vaccine against S. aureus justify continued but cautious pursuit of this elusive goal.
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16
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Oritavancin Pharmacokinetics and Bone Penetration in Rabbits. Antimicrob Agents Chemother 2015; 59:6501-5. [PMID: 26239977 DOI: 10.1128/aac.00981-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/30/2015] [Indexed: 11/20/2022] Open
Abstract
The pharmacokinetics and bone concentrations of oritavancin were investigated after a single intravenous dose was administered to rabbits. The pharmacokinetic profile of oritavancin in rabbits showed that it is rapidly distributed to bone tissues, with concentrations remaining stable for up to 168 h, the last measured time point. Based on these findings, further evaluation of oritavancin for the treatment of infections in bone tissues is warranted.
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17
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Cooper RA. Surgical site infections: epidemiology and microbiological aspects in trauma and orthopaedic surgery. Int Wound J 2014; 10 Suppl 1:3-8. [PMID: 24251837 DOI: 10.1111/iwj.12179] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Causative agents of wound infections and the routes by which they access surgical incision sites have been recognised for more than a century. Despite knowledge of the factors that influence the risks of surgical site infections (SSIs) and the means to prevent and/or control them, surgical patients still get infections. Traditional systems of classifying and diagnosing SSIs and the diversity of microbial flora reported in contemporary SSIs will be described. Strategies available to prevent and control SSIs will be critically reviewed and the need to develop alternative approaches will be discussed.
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Affiliation(s)
- Rose A Cooper
- Centre for Biomedical Sciences, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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18
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Reizner W, Hunter J, O’Malley N, Southgate R, Schwarz E, Kates S. A systematic review of animal models for Staphylococcus aureus osteomyelitis. Eur Cell Mater 2014; 27:196-212. [PMID: 24668594 PMCID: PMC4322679 DOI: 10.22203/ecm.v027a15] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Staphylococcus aureus (S. aureus) osteomyelitis is a significant complication for orthopaedic patients undergoing surgery, particularly with fracture fixation and arthroplasty. Given the difficulty in studying S. aureus infections in human subjects, animal models serve an integral role in exploring the pathogenesis of osteomyelitis, and aid in determining the efficacy of prophylactic and therapeutic treatments. Animal models should mimic the clinical scenarios seen in patients as closely as possible to permit the experimental results to be translated to the corresponding clinical care. To help understand existing animal models of S. aureus, we conducted a systematic search of PubMed and Ovid MEDLINE to identify in vivo animal experiments that have investigated the management of S. aureus osteomyelitis in the context of fractures and metallic implants. In this review, experimental studies are categorised by animal species and are further classified by the setting of the infection. Study methods are summarised and the relevant advantages and disadvantages of each species and model are discussed. While no ideal animal model exists, the understanding of a model's strengths and limitations should assist clinicians and researchers to appropriately select an animal model to translate the conclusions to the clinical setting.
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Affiliation(s)
| | | | | | | | | | - S.L. Kates
- Address for correspondence: Stephen L. Kates, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA,
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19
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Brown AF, Leech JM, Rogers TR, McLoughlin RM. Staphylococcus aureus Colonization: Modulation of Host Immune Response and Impact on Human Vaccine Design. Front Immunol 2014; 4:507. [PMID: 24409186 PMCID: PMC3884195 DOI: 10.3389/fimmu.2013.00507] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/21/2013] [Indexed: 12/15/2022] Open
Abstract
In apparent contrast to its invasive potential Staphylococcus aureus colonizes the anterior nares of 20–80% of the human population. The relationship between host and microbe appears particularly individualized and colonization status seems somehow predetermined. After decolonization, persistent carriers often become re-colonized with their prior S. aureus strain, whereas non-carriers resist experimental colonization. Efforts to identify factors facilitating colonization have thus far largely focused on the microorganism rather than on the human host. The host responds to S. aureus nasal colonization via local expression of anti-microbial peptides, lipids, and cytokines. Interplay with the co-existing microbiota also influences colonization and immune regulation. Transient or persistent S. aureus colonization induces specific systemic immune responses. Humoral responses are the most studied of these and little is known of cellular responses induced by colonization. Intriguingly, colonized patients who develop bacteremia may have a lower S. aureus-attributable mortality than their non-colonized counterparts. This could imply a staphylococcal-specific immune “priming” or immunomodulation occurring as a consequence of colonization and impacting on the outcome of infection. This has yet to be fully explored. An effective vaccine remains elusive. Anti-S. aureus vaccine strategies may need to drive both humoral and cellular immune responses to confer efficient protection. Understanding the influence of colonization on adaptive response is essential to intelligent vaccine design, and may determine the efficacy of vaccine-mediated immunity. Clinical trials should consider colonization status and the resulting impact of this on individual patient responses. We urgently need an increased appreciation of colonization and its modulation of host immunity.
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Affiliation(s)
- Aisling F Brown
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute , Dublin , Ireland
| | - John M Leech
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute , Dublin , Ireland
| | - Thomas R Rogers
- Sir Patrick Dun Laboratory, Department of Clinical Microbiology, Trinity College Dublin, St James's Hospital , Dublin , Ireland
| | - Rachel M McLoughlin
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute , Dublin , Ireland
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20
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Rasigade JP, Vandenesch F. Staphylococcus aureus: a pathogen with still unresolved issues. INFECTION GENETICS AND EVOLUTION 2013; 21:510-4. [PMID: 23994773 DOI: 10.1016/j.meegid.2013.08.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 12/11/2022]
Abstract
Staphylococcus aureus is a major human pathogen, and considerable research efforts have been put forward to improve our understanding of its complex pathogenesis. In spite of these efforts, the burden of staphylococcal infections is still on the rise. This review focuses on a selected set of crucial unresolved questions regarding this pathogen, namely: (i) the nature of the driving forces behind the rise and decline of methicillin-resistant S.aureus (MRSA) clones; (ii) the mechanisms by which a commensal becomes a pathogen; (iii) the molecular underpinnings of toxin overexpression in hypervirulent MRSA clones such as USA300; and (iv) the repeated failures of anti-S.aureus vaccine approaches.
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Affiliation(s)
- Jean-Philippe Rasigade
- UMR U1111 INSERM Université de Lyon, Site Laënnec, 8 rue Guillaume Paradin, 69372 Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Est, 69 Boulevard Pinel, 69677 Bron, France
| | - François Vandenesch
- UMR U1111 INSERM Université de Lyon, Site Laënnec, 8 rue Guillaume Paradin, 69372 Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Est, 69 Boulevard Pinel, 69677 Bron, France.
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21
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Skurnik D, Kropec A, Roux D, Theilacker C, Huebner J, Pier GB. Natural antibodies in normal human serum inhibit Staphylococcus aureus capsular polysaccharide vaccine efficacy. Clin Infect Dis 2012; 55:1188-97. [PMID: 22806596 PMCID: PMC3529611 DOI: 10.1093/cid/cis624] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 07/09/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Vaccines against Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenzae type b induce functional opsonic or bactericidal antibodies to surface capsular polysaccharides (CP). Targeting the comparable Staphylococcus aureus CP seems logical, but to date such efforts have failed in human trials. Studies using immunization-induced animal antibodies have documented interference in opsonic and protective activities of antibodies to CP by antibodies to another S. aureus cell surface polysaccharide, poly-N-acetyl glucosamine (PNAG). Here we evaluated whether natural antibody to PNAG in normal human serum (NHS) had a similar deleterious effect. METHODS Functional and/or protective activities of antibody to S. aureus CP and PNAG antigens in patients with bacteremia, in mice immunized with combinations of CP and PNAG conjugate vaccines, and in serum samples of healthy subjects with natural antibody to PNAG, to which immunization-induced animal antibodies to CP antigens were added, were evaluated. RESULTS Antibodies to PNAG and CP that mutually interfered with opsonic killing of S. aureus were detected in 9 of 15 bacteremic patients. Active immunization of mice with combinations of PNAG and CP conjugate antigens always induced antibodies that interfered with each other's functional activity. Non-opsonic natural antibodies to PNAG found in NHS interfered with the functional and protective activities of immunization-induced antibody to CP antigens during experimental infection with S. aureus. CONCLUSIONS Both immunization-induced animal antibodies and natural antibodies to PNAG in NHS interfere with the protective activities of immunization-induced antibody to S. aureus CP5 and CP8 antigens, representing potential barriers to successful use of CP-specific vaccines.
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Affiliation(s)
- David Skurnik
- Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea Kropec
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Germany
| | - Damien Roux
- Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christian Theilacker
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Germany
| | - Johannes Huebner
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Germany
| | - Gerald B. Pier
- Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Song Y, Tai JH, Bartsch SM, Zimmerman RK, Muder RR, Lee BY. The potential economic value of a Staphylococcus aureus vaccine among hemodialysis patients. Vaccine 2012; 30:3675-82. [PMID: 22464963 PMCID: PMC3371356 DOI: 10.1016/j.vaccine.2012.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/20/2012] [Accepted: 03/15/2012] [Indexed: 01/08/2023]
Abstract
Staphylococcus aureus infections are a substantial problem for hemodialysis patients. Several vaccine candidates are currently under development, with hemodialysis patients being one possible target population. To determine the potential economic value of an S. aureus vaccine among hemodialysis patients, we developed a Markov decision analytic computer simulation model. When S. aureus colonization prevalence was 1%, the incremental cost-effectiveness ratio (ICER) of vaccination was ≤$25,217/quality-adjusted life year (QALY). Vaccination became more cost-effective as colonization prevalence, vaccine efficacy, or vaccine protection duration increased or vaccine cost decreased. Even at 10% colonization prevalence, a 25% efficacious vaccine costing $100 prevented 29 infections, 21 infection-related hospitalizations, and 9 inpatient deaths per 1000 vaccinated HD patients. Our results suggest that an S. aureus vaccine would be cost-effective (i.e., ICERs ≤ $50,000/QALY) among hemodialysis patients over a wide range of S. aureus prevalence, vaccine costs and efficacies, and vaccine protection durations and delineate potential target parameters for such a vaccine.
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Affiliation(s)
- Yeohan Song
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh 3520 Forbes Avenue, First Floor Pittsburgh, PA 15213, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15260, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | - Julie H.Y. Tai
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh 3520 Forbes Avenue, First Floor Pittsburgh, PA 15213, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15260, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | - Sarah M. Bartsch
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh 3520 Forbes Avenue, First Floor Pittsburgh, PA 15213, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15260, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | - Richard K. Zimmerman
- Department of Family Medicine, University of Pittsburgh School of Medicine, 3518 Fifth Avenue, Pittsburgh, PA 15261, USA
| | - Robert R. Muder
- Division of Infectious Diseases, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA
| | - Bruce Y. Lee
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh 3520 Forbes Avenue, First Floor Pittsburgh, PA 15213, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15260, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
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23
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Abstract
We review prevention strategies to minimise the risk of MRSA soft tissue and bone infections, which can be devastating for the patient and costly for the healthcare provider. Department of Health (England) policy is that screening for emergency admissions will be mandatory from 2011, in addition to existent elective admission screening. Rapid screening technology has not been shown to be cost-effective, meaning that there will be a lag time between admission and the patient's MRSA status being known. Thus, standard infection control policies regarding isolation of high-risk patients will remain, with a continuing focus on MRSA decolonisation, aimed at minimising the risks of auto-infection and transmission to other patients. Antimicrobial prescribing policies should be designed to take into account the local burden of resistant organisms, but also minimise unnecessary antibiotic use. There is an increasing realisation that reducing the use of fluoroquinolones and third-generation cephalosporins (which have been associated with increased carriage of MRSA) in patient populations where MRSA is prevalent can be a useful control measure. Prevention of orthopaedic infections clearly involves general operating theatre protocols, such as suitable antiseptic skin preparation, and additional measures including the use of laminar airflow. Antibiotic prophylaxis is adjusted in patients known to have MRSA to include a glycopeptide, and local guidelines may adopt such regimens for all patients due to the burden of MRSA in the local patient population. A future development that may have an effect on practice is the development of a Staphylococcus aureus vaccine, which has been shown to be cost-effective in a computer-modelled evaluation.
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24
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Abstract
New vaccine pricing is a complicated process that could have substantial long-standing scientific, medical, and public health ramifications. Pricing can have a considerable impact on new vaccine adoption and, thereby, either culminate or thwart years of research and development and public health efforts. Typically, pricing strategy consists of the following ten components: 1. Conduct a target population analysis; 2. Map potential competitors and alternatives; 3. Construct a vaccine target product profile (TPP) and compare it to projected or actual TPPs of competing vaccines; 4. Quantify the incremental value of the new vaccine's characteristics; 5. Determine vaccine positioning in the marketplace; 6. Estimate the vaccine price-demand curve; 7. Calculate vaccine costs (including those of manufacturing, distribution, and research and development); 8. Account for various legal, regulatory, third party payer, and competitor factors; 9. Consider the overall product portfolio; 10. Set pricing objectives; 11. Select pricing and pricing structure. While the biomedical literature contains some studies that have addressed these components, there is still considerable room for more extensive evaluation of this important area.
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Affiliation(s)
- Bruce Y Lee
- University of Pittsburgh School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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25
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Varrone JJ, Li D, Daiss JL, Schwarz EM. Anti-Glucosaminidase Monoclonal Antibodies as a Passive Immunization for Methicillin-Resistant Staphylococcus aureus (MRSA) Orthopaedic Infections. ACTA ACUST UNITED AC 2011; 8:187-194. [PMID: 22328866 DOI: 10.1138/20110506] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, methicillin-resistant Staphylococcus aureus (MRSA) has surpassed HIV as the most deadly pathogen in the United States, accounting for over 100,000 deaths per year. In orthopedics, MRSA osteomyelitis has become the greatest concern in patient care, despite the fact that improvements in surgical technique and aggressive antibiotic prophylaxis have decreased the infection rate for most procedures to less than 5%. This great concern is largely due to the very poor outcomes associated with MRSA osteomyelitis, which includes 30-50% failure rates for revision surgery. Thus, there is a need to develop additional therapeutic interventions such as passive immunization, particularly for immunocompromised patients and the elderly who are typically poor responders to active vaccines. Using a novel murine model of implant-associated osteomyelitis in which a stainless steel pin is coated with bioluminescent S. aureus and implanted transcortically through the tibial metaphysis, we discovered that mice protect themselves from this infection by mounting a specific IgG2b response against the peptidoglycan hydrolase, glucosaminidase (Gmd), an enzyme involved in cell wall digestion during binary fission. Since this subunit of S. aureus autolysin is essential for bacterial growth, and no genetic variation has been identified among clinical strains, we propose that monoclonal antibodies against this enzyme would have multiple mechanisms of action, including promotion of opsonophagocytosis and direct inhibition of enzyme function. Here we review the field of MRSA osteomyelitis and our research to date on the development of an anti-Gmd passive immunotherapy.
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Affiliation(s)
- John J Varrone
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York, USA
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26
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Lee BY, Wiringa AE. The 2009 H1N1 influenza pandemic: a case study of how modeling can assist all stages of vaccine decision-making. HUMAN VACCINES 2011; 7:115-9. [PMID: 21263227 DOI: 10.4161/hv.7.1.13740] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
During the 2009 H1N1 influenza pandemic nearly every decision associated with new vaccine development and dissemination occurred from the Spring of 2009, when the novel virus first emerged, to the Fall of 2009, when the new vaccines started reaching the thighs, arms and noses of vaccinees. In many ways, 2009 served as a crash course on how mathematical and computational modeling can assist all aspects of vaccine decision-making. Modeling influenced pandemic vaccine decision-making, but not to its fullest potential. The 2009 H1N1 pandemic demonstrated that modeling can help answer questions about new vaccine development, distribution, and administration such as (1) is a vaccine needed, (2) what characteristics should the vaccine have, (3) how should the vaccine be distributed, (4) who should receive the vaccine and in what order and (5) when should vaccination be discontinued? There is no need to wait for another pandemic to enhance the role of modeling, as new vaccine candidates for a variety of infectious diseases are emerging every year. Greater communication between decision makers and modelers can expand the use of modeling in vaccine decision-making to the benefit of all vaccine stakeholders and health around the globe.
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Affiliation(s)
- Bruce Y Lee
- University of Pittsburgh School of Medicine and Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA.
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27
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Safety and immunogenicity of a novel Staphylococcus aureus vaccine: results from the first study of the vaccine dose range in humans. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 17:1868-74. [PMID: 20943877 DOI: 10.1128/cvi.00356-10] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Merck V710 is a novel vaccine containing the conserved Staphylococcus aureus iron surface determinant B shown to be protective in animal models. A phase I, multicenter, double-blind study of the dose range was conducted to assess the immunogenicity and safety of an adjuvanted liquid formulation of V710. A total of 124 adults (18 to 55 years of age) were randomized 1:1:1:1 to receive one 0.5-ml intramuscular injection of V710 (5 μg, 30 μg, or 90 μg) or saline placebo. A positive immune response was defined as at least a 2-fold increase in IsdB-specific IgG levels from baseline levels. Local and systemic adverse events were assessed for 5 and 14 days, respectively, following vaccination. Positive immune responses were detected in 12 (67%) of the 18 subjects in the groups receiving 30 and 90 μg V710 tested at day 10. At day 14, a significantly greater proportion of subjects manifested a positive immune response with higher geometric mean concentrations in the V710 30-μg (86%; geometric mean concentration of 116 μg/ml) and 90-μg (87%; geometric mean concentration of 131 μg/ml) dose groups than in the V710 5-μg (29%; geometric mean concentration of 51 μg/ml) or placebo (4%; geometric mean concentration of 23 μg/ml) groups. Immune responses were durable through day 84. Subjects <40 and ≥40 years of age had comparable immune responses. The most common adverse events were injection-site pain, nausea, fatigue, and headache, usually of mild intensity. No immediate reactions or serious adverse events were reported. In this first study of V710 in humans, a single 30-μg or 90-μg dose was more immunogenic than the 5-μg dose or placebo. Immune responses were evident by 10 to 14 days after vaccination in most responders.
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