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Yin X, Gao Q, Li C, Yang Q, HongliangDong, Li Z. Leonurine alleviates vancomycin nephrotoxicity via activating PPARγ and inhibiting the TLR4/NF-κB/TNF-α pathway. Int Immunopharmacol 2024; 131:111898. [PMID: 38513573 DOI: 10.1016/j.intimp.2024.111898] [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] [Received: 02/04/2024] [Revised: 03/10/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
Vancomycin (VCM) is the first-line antibiotic for severe infections, but nephrotoxicity limits its use. Leonurine (Leo) has shown protective effects against kidney damage. However, the effect and mechanism of Leo on VCM nephrotoxicity remain unclear. In this study, mice and HK-2 cells exposed to VCM were treated with Leo. Biochemical and pathological analysis and fluorescence probe methods were performed to examine the role of Leo in VCM nephrotoxicity. Immunohistochemistry, q-PCR, western blot, FACS, and Autodock software were used to verify the mechanism. The present results indicate that Leo significantly alleviates VCM-induced renal injury, morphological damage, and oxidative stress. Increased intracellular and mitochondrial ROS in HK-2 cells and decreased mitochondrial numbers in mouse renal tubular epithelial cells were reversed in Leo-administrated groups. In addition, molecular docking analysis using Autodock software revealed that Leo binds to the PPARγ protein with high affinity. Mechanistic exploration indicated that Leo inhibited VCM nephrotoxicity via activating PPARγ and inhibiting the TLR4/NF-κB/TNF-α inflammation pathway. Taken together, our results indicate that the PPARγ inhibition and inflammation reactions were implicated in the VCM nephrotoxicity and provide a promising therapeutic strategy for renal injury.
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Affiliation(s)
- Xuedong Yin
- Department of Pharmacy, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; School of Medicine, Shanghai Jiao Tong University, Shanghai 200125, China
| | - Qian Gao
- Department of Pharmacy, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; School of Medicine, Shanghai Jiao Tong University, Shanghai 200125, China
| | - Chensuizi Li
- Department of Pharmacy, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; School of Medicine, Shanghai Jiao Tong University, Shanghai 200125, China
| | - Qiaoling Yang
- Department of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - HongliangDong
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200120, China.
| | - Zhiling Li
- Department of Pharmacy, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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Schuchter K, Shuler Truoccolo DM, Wilson WS, Anton G. Descriptive evaluation of patients receiving one-time intravenous vancomycin doses at a large academic medical center emergency department. Am J Emerg Med 2024; 77:177-182. [PMID: 38157592 DOI: 10.1016/j.ajem.2023.11.052] [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] [Received: 07/01/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Intravenous (IV) vancomycin is commonly used to treat a variety of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). The practice of administering a single dose of IV vancomycin prior to emergency department (ED) discharge may be clinically ineffective and foster antimicrobial resistance. Furthermore, this practice introduces an unnecessary infection risk along with preventable adverse effects while potentially increasing ED length of stay (LOS). There is a paucity of literature identifying patient characteristics and objective findings in this patient population, which may foster future antimicrobial stewardship initiatives in the ED. METHODS This was a single-center, retrospective, descriptive analysis of adult patients seen in the ED between January 2020 and January 2023 who received a single dose of IV vancomycin and were subsequently discharged from the ED without hospital admission. Information was collected on patient demographics and select comorbidities, vancomycin indication and dosing, ED LOS, initial vitals and labs, concomitant antibiotics administered, culture results, 30-day return ED visits and admissions, and antibiotics prescribed at ED discharge. RESULTS A total of 295 patients met inclusion criteria. A total of 32.1% of patients met SIRS criteria. The most commonly selected order indication for IV vancomycin was "skin and skin structure infection" (41%). A total of 86.1% of patients received concomitant antibiotics in the ED and only 54.6% of patients were prescribed oral antibiotics at ED discharge. A total of 80% of patients had at least one culture obtained during the ED visit. In those who had at least one culture obtained, 78.4% of patients had negative cultures and 4.2% of patients had MRSA positive cultures, with MRSA skin cultures being the most common (3.1%). Return ED visits and admissions within 30 days were not statistically significantly different between patients who did and did not receive oral antibiotics at ED discharge. CONCLUSIONS Despite a lack of clinical efficacy reported in prior literature and the potential risks, administration of a one-time dose of IV vancomycin prior to ED discharge is commonly encountered in clinical practice. There are opportunities for enhanced antimicrobial stewardship related to IV vancomycin use in the ED. Areas of future focus include the utilization of oral antimicrobials when clinically appropriate, particularly for skin and soft tissue infections, and clarification of antibiotic allergies.
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Affiliation(s)
- Kyle Schuchter
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA; Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | | | - William S Wilson
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Greta Anton
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
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Suprunowicz M, Tomaszek N, Urbaniak A, Zackiewicz K, Modzelewski S, Waszkiewicz N. Between Dysbiosis, Maternal Immune Activation and Autism: Is There a Common Pathway? Nutrients 2024; 16:549. [PMID: 38398873 PMCID: PMC10891846 DOI: 10.3390/nu16040549] [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] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Autism spectrum disorder (ASD) is a neuropsychiatric condition characterized by impaired social interactions and repetitive stereotyped behaviors. Growing evidence highlights an important role of the gut-brain-microbiome axis in the pathogenesis of ASD. Research indicates an abnormal composition of the gut microbiome and the potential involvement of bacterial molecules in neuroinflammation and brain development disruptions. Concurrently, attention is directed towards the role of short-chain fatty acids (SCFAs) and impaired intestinal tightness. This comprehensive review emphasizes the potential impact of maternal gut microbiota changes on the development of autism in children, especially considering maternal immune activation (MIA). The following paper evaluates the impact of the birth route on the colonization of the child with bacteria in the first weeks of life. Furthermore, it explores the role of pro-inflammatory cytokines, such as IL-6 and IL-17a and mother's obesity as potentially environmental factors of ASD. The purpose of this review is to advance our understanding of ASD pathogenesis, while also searching for the positive implications of the latest therapies, such as probiotics, prebiotics or fecal microbiota transplantation, targeting the gut microbiota and reducing inflammation. This review aims to provide valuable insights that could instruct future studies and treatments for individuals affected by ASD.
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Affiliation(s)
| | | | | | | | - Stefan Modzelewski
- Department of Psychiatry, Medical University of Bialystok, pl. Wołodyjowskiego 2, 15-272 Białystok, Poland; (M.S.); (N.T.); (A.U.); (K.Z.); (N.W.)
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4
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Zhou Y, Zhou Z, Wu X, Wang Z, Qi W, Yang J, Qing L, Tang J, Deng L. Down-Regulation of HSP by Pd-Cu Nanozymes for NIR Light Triggered Mild-Temperature Photothermal Therapy Against Wound Bacterial Infection: In vitro and in vivo Assessments. Int J Nanomedicine 2023; 18:4805-4819. [PMID: 37635910 PMCID: PMC10460177 DOI: 10.2147/ijn.s420298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose We aimed to develop an oxidative-stress-activated palladium-copper nanozyme to reduce bacterial's heat sensitivity by down-regulating heat shock proteins to overcome the shortcomings of conventional photothermal antimicrobial therapy and achieve mild photothermal bactericidal efficacy. Methods We first synthesized palladium-copper nanozymes (PC-NPs) by hydration and used transmission electron microscopy, X-ray diffraction, and Fourier transform infrared spectroscopy to demonstrate their successful preparation. Their photothermal therapy (PTT) and chemo-dynamic therapy (CDT) activities were then determined by a series of photothermal performance tests and peroxidase-like performance tests, and the destruction of heat shock proteins by reactive oxygen species (ROS) was verified at the protein level by Western Blotting tests, providing a basis for the effective bacteria-killing by the mild-temperature photothermal treatment subsequently applied. We also validated this promising programmed and controlled antimicrobial treatment with palladium-copper nanozymes by in vivo/in vitro antimicrobial assays. A hemolysis assay, MTT cytotoxicity test and histopathological analysis were also performed to assess the in vivo safety of PC-NPs. Results In the micro-acidic environment of bacterial infection, PC-NPs showed peroxidase-like activity that broke down the H2O2 at the wound into hydroxyl radicals and down-regulated bacterial heat shock proteins. The application of PC-NPs increased bacteria's sensitivity to subsequent photothermal treatment, enabling the elimination of bacteria via mild photothermal treatment. Conclusion The programmed synergistic catalytic enhancement of CDT and mild photothermal therapy achieves the most efficient killing of bacteria and their biofilms, which brings future thinking in the relationship between heat shock proteins and oxidative stress damage in bacteria.
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Affiliation(s)
- Yan Zhou
- State Key Laboratory of Developmental Biology of Freshwater Fish, Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, People’s Republic of China
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Biology, College of Chemistry and Chemical Engineering, Hunan University, Key Laboratory for Bio-Nanotechnology and Molecule Engineering of Hunan Province, Changsha, Hunan, People’s Republic of China
| | - Zekun Zhou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Xiaojuan Wu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Biology, College of Chemistry and Chemical Engineering, Hunan University, Key Laboratory for Bio-Nanotechnology and Molecule Engineering of Hunan Province, Changsha, Hunan, People’s Republic of China
| | - Zefeng Wang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Biology, College of Chemistry and Chemical Engineering, Hunan University, Key Laboratory for Bio-Nanotechnology and Molecule Engineering of Hunan Province, Changsha, Hunan, People’s Republic of China
| | - Wangdan Qi
- State Key Laboratory of Developmental Biology of Freshwater Fish, Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, People’s Republic of China
| | - Jing Yang
- State Key Laboratory of Developmental Biology of Freshwater Fish, Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, People’s Republic of China
| | - Liming Qing
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Juyu Tang
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Le Deng
- State Key Laboratory of Developmental Biology of Freshwater Fish, Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, People’s Republic of China
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López-González I, Hernández-Heredia AB, Rodríguez-López MI, Auñón-Calles D, Boudifa M, Gabaldón JA, Meseguer-Olmo L. Evaluation of the In Vitro Antimicrobial Efficacy against Staphylococcus aureus and epidermidis of a Novel 3D-Printed Degradable Drug Delivery System Based on Polycaprolactone/Chitosan/Vancomycin-Preclinical Study. Pharmaceutics 2023; 15:1763. [PMID: 37376211 DOI: 10.3390/pharmaceutics15061763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Acute and chronic bone infections, especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), remains a major complication and therapeutic challenge. It is documented that local administration of vancomycin offers better results than the usual routes of administration (e.g., intravenous) when ischemic areas are present. In this work, we evaluate the antimicrobial efficacy against S. aureus and S. epidermidis of a novel hybrid 3D-printed scaffold based on polycaprolactone (PCL) and a chitosan (CS) hydrogel loaded with different vancomycin (Van) concentrations (1, 5, 10, 20%). Two cold plasma treatments were used to improve the adhesion of CS hydrogels to the PCL scaffolds by decreasing PCL hydrophobicity. Vancomycin release was measured by means of HPLC, and the biological response of ah-BM-MSCs growing in the presence of the scaffolds was evaluated in terms of cytotoxicity, proliferation, and osteogenic differentiation. The PCL/CS/Van scaffolds tested were found to be biocompatible, bioactive, and bactericide, as demonstrated by no cytotoxicity (LDH activity) or functional alteration (ALP activity, alizarin red staining) of the cultured cells and by bacterial inhibition. Our results suggest that the scaffolds developed would be excellent candidates for use in a wide range of biomedical fields such as drug delivery systems or tissue engineering applications.
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Affiliation(s)
- Iván López-González
- Tissue Regeneration and Repair Group: Orthobiology, Biomaterials and Tissue Engineering, UCAM-Universidad Católica de Murcia, Campus de los Jerónimos 135, Guadalupe, 30107 Murcia, Spain
| | - Ana Belén Hernández-Heredia
- Molecular Recognition and Encapsulation Research Group (REM), Health Sciences Department, UCAM-Universidad Católica de Murcia, Campus de los Jerónimos 135, Guadalupe, 30107 Murcia, Spain
| | - María Isabel Rodríguez-López
- Molecular Recognition and Encapsulation Research Group (REM), Health Sciences Department, UCAM-Universidad Católica de Murcia, Campus de los Jerónimos 135, Guadalupe, 30107 Murcia, Spain
| | - David Auñón-Calles
- Molecular Recognition and Encapsulation Research Group (REM), Health Sciences Department, UCAM-Universidad Católica de Murcia, Campus de los Jerónimos 135, Guadalupe, 30107 Murcia, Spain
| | - Mohamed Boudifa
- CRITT-Matériaux Innovation, 9 Rue Claude Chrétien, Campus Sup Ardenne, 08000 Charleville-Mézières, France
| | - José Antonio Gabaldón
- Molecular Recognition and Encapsulation Research Group (REM), Health Sciences Department, UCAM-Universidad Católica de Murcia, Campus de los Jerónimos 135, Guadalupe, 30107 Murcia, Spain
| | - Luis Meseguer-Olmo
- Tissue Regeneration and Repair Group: Orthobiology, Biomaterials and Tissue Engineering, UCAM-Universidad Católica de Murcia, Campus de los Jerónimos 135, Guadalupe, 30107 Murcia, Spain
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Aguilo Lafarga I, Pérez Moreno M, Herranz Bayo E, Merchante Andreu M, Huarte Lacunza R. Recommended doses of endovenous vancomycin are insufficient to achieve therapeutic concentrations in paediatric patients. Eur J Hosp Pharm 2023:ejhpharm-2023-003694. [PMID: 37105712 DOI: 10.1136/ejhpharm-2023-003694] [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: 01/14/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES Vancomycin therapeutic drug monitoring is challenging, especially in the paediatric population where evidence is scarce. The main objective of this study was to analyse the achievement of therapeutic concentrations of vancomycin in paediatric patients and to evaluate the current monitoring method (trough levels), doses used, and the time required to achieve target concentrations. METHODS Paediatric patients on treatment and monitored with vancomycin from November 2019 to December 2021 were included. Those with only one determination of serum vancomycin concentration were excluded. Demographic variables, analytical and microbiological parameters and toxicity data were collected. Pharmacokinetic parameters were assessed at baseline and during treatment. RESULTS 225 patients (40.9% female; 108 neonates, 49 infants and 68 children or adolescents) were included in the study. The main indications for vancomycin treatment were sepsis (33.9%) and fever of unknown origin (29.3%). Microbiological cultures were positive in 71.1%, mostly with Gram-positive bacteria (60.4%). Therapeutic levels of vancomycin were reached in only 20.1% of the participants in the first determination. After pharmacokinetic monitoring, 81.7% of patients reached therapeutic concentrations, requiring a 23% increase in the initial dose, a 2-day lag time and 1-2 dosage adjustments until the therapeutic concentration was reached. Of the total patients, 13 developed nephrotoxicity, nine neutropenia and one patient developed red man syndrome. CONCLUSIONS In our sample of paediatric patients, the recommended doses of vancomycin were insufficient to achieve therapeutic concentrations. Revision of the recommendations and/or a change in the method of pharmacokinetic monitoring is crucial to optimise treatment in this population.
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Affiliation(s)
| | - María Pérez Moreno
- Pharmacy Service, Hospital Universitario Miguel Servet, Zaragoza, Aragon, Spain
| | - Elena Herranz Bayo
- Pharmacy Service, Hospital Universitario Miguel Servet, Zaragoza, Aragon, Spain
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Phillips M, Rose J, Hamel A, Ingemi A. Safety and Feasibility Assessment of a Pharmacy-Driven AUC/MIC Vancomycin Dosing Protocol in a Multicenter Hospital System. Microbiol Spectr 2023; 11:e0331322. [PMID: 36840580 PMCID: PMC10100937 DOI: 10.1128/spectrum.03313-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/19/2023] [Indexed: 02/24/2023] Open
Abstract
Vancomycin is used for Gram-positive infections, including methicillin-resistant Staphylococcus aureus. The 2020 vancomycin guidelines described by M. J. Rybak, J. Le, T. P. Lodise, D. P. Levine, et al. (Am J Health Syst Pharm 77:835-864, 2020, https://doi.org/10.1093/ajhp/zxaa036) provided an update on vancomycin dosing, which recommended an optimal area under the concentration-time curve over 24 h to MIC (AUC/MIC) target of 400 to 600. In 2021, a pharmacy-driven AUC/MIC vancomycin dosing protocol was implemented across 12 Sentara Health System hospitals. The primary objective of this study was to assess if the pharmacy-driven AUC/MIC vancomycin dosing protocol led to fewer acute kidney injury (AKI) events than trough-based dosing. Secondary objectives included vancomycin duration, hospital length of stay, administered vancomycin dose during admission, vancomycin labs drawn during standard lab times, and cost. AKI was assessed in two separate ways: (i) modified AKIN (Acute Kidney Injury Network) criteria and (ii) a modified version from the vancomycin guidelines. Inferential statistics were used to analyze the results of this retrospective study. Per the AKIN definition, the rates of AKI were 13.9% (349/2,507) in the trough-based group and 14.9% (369/2,471) in the AUC/MIC-based group (P = 0.309). Per the definition of the vancomycin guidelines, the rates of AKI were 6.7% (169/2,507) in the trough-based group and 7.6% (187/2,471) in the AUC/MIC-based group (P = 0.258). A total of 52% (2,679/5,151) of vancomycin labs were obtained during standard lab times in the AUC group and 24% (1,144/4,766) in the trough group (P < 0.05). There was no difference in AKI events between AUC and trough dosing. Use of contrast dye may confound these results. AUC/MIC dosing was associated with more lab draws during standard times, a larger number of labs drawn per person, and less total use of vancomycin. IMPORTANCE In this article, we report that there were no differences in rates of acute kidney injury between trough-based vancomycin dosing and AUC/MIC-based vancomycin dosing across 12 hospitals. AUC/MIC dosing resulted in more vancomycin lab draws during standard lab draw times compared to trough dosing, thus making it more convenient for health care personnel. This study includes all uses for vancomycin, including empirical use, and all patient severity levels. Therefore, this research reflects real-world use of vancomycin in hospitals. AUC/MIC dosing is supported by various infectious disease societies. However, the feasibility of incorporating AUC/MIC dosing in hospitals is undetermined. This study is unique in that it includes hospitals of various sizes (small community hospitals and an academic teaching hospital), and it includes a feasibility component. Therefore, this study has broad applicability to other hospitals across the United States. This original research includes the clinical application of vancomycin in a multicenter health system.
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Affiliation(s)
| | - Jeremy Rose
- Sentara RMH Medical Center, Harrisonburg, Virginia, USA
| | - Ashlee Hamel
- Sentara Norfolk General Hospital, Norfolk, Virginia, USA
| | - Amanda Ingemi
- Sentara Norfolk General Hospital, Norfolk, Virginia, USA
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He P, Li X, Guo X, Bian X, Wang R, Wang Y, Huang S, Qi M, Liu Y, Feng M. Pharmacokinetics and Pharmacodynamics of a Novel Vancomycin Derivative LYSC98 in a Murine Thigh Infection Model Against Staphylococcus aureus. Infect Drug Resist 2023; 16:1019-1028. [PMID: 36845018 PMCID: PMC9946004 DOI: 10.2147/idr.s399150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction LYSC98 is a novel vancomycin derivative used for gram-positive bacterial infections. Here we compared the antibacterial activity of LYSC98 with vancomycin and linezolid in vitro and in vivo. Besides, we also reported the pharmacokinetic/pharmacodynamic (PK/PD) index and efficacy-target values of LYSC98. Methods The MIC values of LYSC98 were identified through broth microdilution method. A mice sepsis model was established to investigate the protective effect of LYSC98 in vivo. Single-dose pharmacokinetics of LYSC98 was studied in thigh-infected mice and liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was used to determine LYSC98 concentration in plasma. Dose fractionation studies were performed to evaluate different PK/PD indices. Two methicillin-resistant Staphylococcus aureus (MRSA) clinical strains were used in the dose ranging studies to determine the efficacy-target values. Results LYSC98 showed a universal antibacterial effect in Staphylococcus aureus with a MIC range of 2-4 µg/mL. In vivo, LYSC98 demonstrated distinctive mortality protection in mice sepsis model with an ED50 value of 0.41-1.86 mg/kg. The pharmacokinetics results displayed maximum plasma concentration (Cmax) 11,466.67-48,866.67 ng/mL, area under the concentration-time curve from 0 to 24 h (AUC0-24) 14,788.42-91,885.93 ng/mL·h, and elimination half-life (T1/2) 1.70-2.64 h, respectively. Cmax/MIC (R 2 0.8941) was proved to be the most suitable PK/PD index for LYSC98 to predict its antibacterial efficacy. The magnitude of LYSC98 Cmax/MIC associated with net stasis, 1, 2, 3 and 4 - log 10 kill were 5.78, 8.17, 11.14, 15.85 and 30.58, respectively. Conclusion Our study demonstrates that LYSC98 is more effective than vancomycin either in killing vancomycin-resistant Staphylococcus aureus (VRSA) in vitro or treating S. aureus infections in vivo, making it a novel and promising antibiotic. The PK/PD analysis will also contribute to the LYSC98 Phase I dose design.
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Affiliation(s)
- Peng He
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China
| | - Xin Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiaohan Guo
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China
| | - Xingchen Bian
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China
| | - Rui Wang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China
| | - Yue Wang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China
| | - Sijing Huang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China
| | - Mengya Qi
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China
| | - Yuanxia Liu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Department of Pathology, Shanghai, People’s Republic of China,Yuanxia Liu, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Department of Pathology, Shanghai, People’s Republic of China, Email
| | - Meiqing Feng
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China,Correspondence: Meiqing Feng, Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, 201203, People’s Republic of China, Tel +86 21 51980035, Email
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Marine Organisms as a Prolific Source of Bioactive Depsipeptides. Mar Drugs 2023; 21:md21020120. [PMID: 36827161 PMCID: PMC9966715 DOI: 10.3390/md21020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Depsipeptides, an important group of polypeptides containing residues of hydroxy acids and amino acids linked together by amide and ester bonds, have potential applications in agriculture and medicine. A growing body of evidence demonstrates that marine organisms are prolific sources of depsipeptides, such as marine cyanobacteria, sponges, mollusks, microorganisms and algae. However, these substances have not yet been comprehensively summarized. In order to enrich our knowledge about marine depsipeptides, their biological sources and structural features, as well as bioactivities, are highlighted in this review after an extensive literature search and data analysis.
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Shiraishi C, Kato H, Imai H, Iwamoto T. Impact of Extracorporeal Membrane Oxygenation in an Infant Treated with Vancomycin: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1839. [PMID: 36767208 PMCID: PMC9915104 DOI: 10.3390/ijerph20031839] [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: 12/08/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Vancomycin is a glycopeptide antibiotic used for prophylaxis and treatment of infections caused by methicillin-resistant Staphylococcus aureus. Although major organ sizes and functions mature during infancy, pharmacokinetic studies, especially those focused on infants, are limited. Changes in extracorporeal membrane oxygenation-related drug disposition largely contribute to changes in pharmacokinetics. Here, pharmacokinetic profiles of vancomycin in an infant receiving extracorporeal membrane oxygenation therapy are presented. A two-month-old Japanese infant with moderately decreased renal function was started on 12.0 mg/kg vancomycin every 8 h from day X for prophylaxis of pneumonia during extracorporeal membrane oxygenation therapy. As the trough concentration of vancomycin observed on day X+3 was 27.1 μg/mL, vancomycin was then discontinued. The trough concentration decreased to 18.6 μg/mL 24 h after discontinuation, and 9.0 mg/kg vancomycin every 12 h was restarted from day X+5. On day X+6, the trough concentration increased to 36.1 μg/mL, and vancomycin therapy was again discontinued. On day X+7, the trough concentration decreased to 22.4 μg/mL. The pharmacokinetic profiles of vancomycin based on first-order conditional estimation in this infant were as follows: plasma clearance = 0.053 L/kg/hour, distribution volume = 2.19 L/kg, and half-life = 29.5 h. This research reported the prolonged half-life of vancomycin during extracorporeal membrane oxygenation in infants with moderately decreased renal function.
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Affiliation(s)
- Chihiro Shiraishi
- Department of Pharmacy, Mie University Hospital, Tsu 514-8507, Japan
- Department of Clinical Pharmaceutics, Division of Clinical Medical Science, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Hideo Kato
- Department of Pharmacy, Mie University Hospital, Tsu 514-8507, Japan
- Department of Clinical Pharmaceutics, Division of Clinical Medical Science, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Tsu 514-8507, Japan
| | - Takuya Iwamoto
- Department of Pharmacy, Mie University Hospital, Tsu 514-8507, Japan
- Department of Clinical Pharmaceutics, Division of Clinical Medical Science, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
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11
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Alakeel YS, Alanazi GA, Alawbathani BS, Alshutwi KI, Alahmed YS. Vancomycin dosing required to achieve a therapeutic level in children post-surgical correction of congenital heart disease. Medicine (Baltimore) 2022; 101:e30145. [PMID: 36254077 PMCID: PMC9575798 DOI: 10.1097/md.0000000000030145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The vancomycin dosing range for safe and effective treatment remains uncertain for children who had corrective surgery for a congenital heart disease (CHD). We aimed to determine the vancomycin dosing requirements for this subgroup of patients. This prospective cohort study included children younger than 14 years old with CHD who received intravenous vancomycin for at least 3 days at the Pediatric Cardiology section of King Abdulaziz Medical City, Riyadh. In total, 140 pediatric patients with CHD were included with a median age of 0.57 years (interquartile range 0.21-2.2). The mean vancomycin total daily dose (TDD), 37.71 ± 6.8 mg/kg/day, was required to achieve a therapeutic trough concentration of 7-20 mg/L. The patient's age group and the care setting were significant predictors of the vancomycin dosing needs. Neonates required significantly lower doses of 34 ± 6.03 mg/kg/day (P = .002), and young children higher doses of 43.97 ± 9.4 mg/kg/day (P = .003). The dosage requirements were independent of the type of cardiac lesion, cardiopulmonary surgery exposure, sex, and BMI percentile. However, the patients in the pediatric cardiac ward required higher doses of vancomycin 41.08 ± 7.06 mg/kg/day (P = .039). After the treatment, 11 (8.5%) patients had an elevated Scr, and 3 (2.3%) patients developed AKI; however, none of the patients' sociodemographic factors or clinical variables, or vancomycin therapy characteristics was significantly associated with the renal dysfunction. Overall, the vancomycin TDD requirements are lower in pediatric post-cardiac surgery compared to non-cardiac patients and are modulated by several factors.
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Affiliation(s)
- Yousif S. Alakeel
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- * Correspondence: Yousif S. Alakeel, PharmD, MPH, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (e-mail: )
| | - Ghadah A. Alanazi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Bushra S. Alawbathani
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Kadi I. Alshutwi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yazeed S. Alahmed
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia
- Division of Pediatric Cardiology, Cardiac Sciences, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
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12
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Vliex LMM, Le GN, Fassarella M, Reijnders D, Goossens GH, Zoetendal EG, Penders J, Blaak EE. Fecal carriage of vanB antibiotic resistance gene affects adipose tissue function under vancomycin use. Gut Microbes 2022; 14:2083905. [PMID: 35695620 PMCID: PMC9196849 DOI: 10.1080/19490976.2022.2083905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Detrimental consequences of antibiotic treatment may include long-lasting disruption of the gut microbiota. Previous studies found no negative effects of antibiotics on metabolic health, although individualized responses were observed. Here, we aimed to investigate the subject-specific response to vancomycin use in tissue-specific insulin sensitivity by stratifying individuals based on the presence of antibiotic resistance genes (ARGs) or opportunistic pathogens (OPs) in the baseline fecal microbiota. Quantitative Polymerase Chain Reaction (qPCR) was used to detect ARGs and OPs in DNA isolated from fecal samples of 56 males with overweight/obesity (Body Mass Index: 25-35 kg/m2) and impaired glucose metabolism (fasting plasma glucose ≥5.6 mmol/L and/or 2-hour glucose 7.8-11.1 mmol/L). A two-step hyperinsulinemic-euglycemic clamp was performed to determine tissue-specific insulin sensitivity. Abdominal subcutaneous adipose tissue (AT) gene expression was assessed using Affymetrix microarray. Gut microbial composition was determined using the Human Intestinal Tract Chip (HITChip) microarray. At baseline, the vancomycin resistance gene vanB was present in 60% of our population. In individuals that were vanB-negative at baseline, AT insulin sensitivity (insulin-mediated suppression of plasma free fatty acids) improved during vancomycin use, while it decreased among vanB-positive individuals (% change post versus baseline: 14.1 ± 5.6 vs. -6.7 ± 7.5% (p = .042)). The vancomycin-induced increase in AT insulin sensitivity was accompanied by downregulation of inflammatory pathways and enrichment of extracellular matrix remodeling pathways in AT. In the vanB-positive group, well-known vanB-carrying bacteria, Enterococcus and Streptococcus, expanded in the gut microbiome. In conclusion, microbiome composition and adipose tissue biology were differentially affected by vancomycin treatment based on fecal vanB carriage.
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Affiliation(s)
- Lars M. M. Vliex
- Department of Human Biology, NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Giang N. Le
- Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marina Fassarella
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Dorien Reijnders
- Department of Human Biology, NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Gijs H. Goossens
- Department of Human Biology, NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Erwin G. Zoetendal
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands
| | - John Penders
- Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ellen E. Blaak
- Department of Human Biology, NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands,CONTACT Ellen E. Blaak Department of Human Biology, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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13
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Li L, Zhang L, Li S, Xu F, Li L, Li S, Lyu J, Yin H. Effect of First Trough Vancomycin Concentration on the Occurrence of AKI in Critically Ill Patients: A Retrospective Study of the MIMIC-IV Database. Front Med (Lausanne) 2022; 9:879861. [PMID: 35492325 PMCID: PMC9049893 DOI: 10.3389/fmed.2022.879861] [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: 02/20/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Vancomycin can effectively inhibit Gram-positive cocci and is widely used in critically ill patients. This study utilized a large public database to explore the effect of patients' first vancomycin trough concentration (FVTC) on the occurrence of acute kidney injury (AKI) and mortality after receiving vancomycin treatment in intensive care unit (ICU). Methods Critically ill patients who used vancomycin in the Medical Information Mart for Intensive Care (MIMIC) IV have been retrospectively studied. The outcomes included the occurrence of AKI during the use of vancomycin or within 72 h of withdrawal, ICU mortality and hospital mortality. Restricted cubic splines (RCS) were used to analyze the linear relationship between FVTC and the outcomes. Multivariate logistic/Cox regression analysis was used to analyze the association between patient's FVTC and the occurrence of AKI, ICU mortality, and in-hospital mortality. Results The study ultimately included 3,917 patients from the MIMIC-IV database who had been treated with vancomycin for more than 48 h. First of all, the RCS proved the linear relationship between FVTC and the outcomes. After controlling for all covariates as confounders in logistic/Cox regression, FVTC was a risk factor with the occurrence of AKI (OR: 1.02; 95% CI: 1.01–1.04), ICU mortality (HR: 1.02; 95% CI: 1.01–1.03), and in-hospital mortality (HR: 1.02; 95% CI: 1.01–1.03). Moreover, patients were divided into four groups in the light of the FVTC value: group1 ≤ 10 mg/L, 10 <group 2 ≤ 15 mg/L, 15 <group 3 ≤ 20 mg/L, group4 > 20 mg/L. Categorical variables indicated that group 3 and group 4 had a significant relationship on the occurrence of AKI [group 3: (OR: 1.36; 95% CI: 1.02–1.81); group 4: (OR: 1.76; 95% CI: 1.32–2.35)] and ICU mortality [group 3: (HR: 1.47; 95% CI: 1.03–2.09); group 4: (HR: 1.87; 95% CI: 1.33–2.62)], compared to group 1, while group 4 had a significant effect on in-hospital mortality (HR: 1.48; 95% CI: 1.15–1.91). Conclusions FVTC is associated with the occurrence of AKI and increased ICU and in-hospital mortality in critically ill patients. Therefore, in clinical practice, patients in intensive care settings receiving vancomycin should be closely monitored for FVTC to prevent drug-related nephrotoxicity and reduce patient mortality.
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Affiliation(s)
- Longzhu Li
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Luming Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shaojin Li
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fengshuo Xu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuna Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
- Jun Lyu
| | - Haiyan Yin
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Haiyan Yin
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14
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Ndayishimiye J, Cao Y, Kumeria T, Blaskovich MAT, Falconer JR, Popat A. Engineering mesoporous silica nanoparticles towards oral delivery of vancomycin. J Mater Chem B 2021; 9:7145-7166. [PMID: 34525166 DOI: 10.1039/d1tb01430g] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Vancomycin (Van) is a key antibiotic of choice for the treatment of systemic methicillin resistant Staphylococcus aureus (MRSA) infections. However, due to its poor membrane permeability, it is administered parenterally, adding to the cost and effort of treatment. The poor oral bioavailability of Van is mainly due to its physico-chemical properties that limit its paracellular and transcellular transport across gastrointestinal (GI) epithelium. Herein we report the development of silica nanoparticles (SNPs)-based formulations that are able to enhance the epithelial permeability of Van. We synthesized SNPs of different pore sizes (2 nm and 9 nm) and modified their surface charge and polarity by attaching different functional groups (-NH2, -PO3, and -CH3). Van was loaded within these SNPs at a loading capacity in the range of ca. 18-29 wt%. The Van-loaded SNPs exhibited a controlled release behaviour when compared to un-encapsulated Van which showed rapid release due to its hydrophilic nature. Among Van-loaded SNPs, SNPs with large pores showed a prolonged release compared to SNPs with small pores while SNPs functionalised with -CH3 groups exhibited a slowest release among the functionalised SNPs. Importantly, Van-loaded SNPs, especially the large pore SNPs with negative charge, enhanced the permeability of Van across an epithelial cell monolayer (Caco-2 cell model) by up to 6-fold, with Papp values up to 1.716 × 10-5 cm s-1 (vs. 0.304 × 10-5 cm s-1 for un-encapsulated Van) after 3 h. The enhancement was dependent on both the type of SNPs and their surface functionalisation. The permeation enhancing effect of SNPs was due to its ability to transiently open the tight junctions measured by decrease in transepithelial resistance (TEER) which was reversible after 3 h. All in all, our data highlights the potential of SNPs (especially SNPs with large pores) for oral delivery of Van or other antimicrobial peptides.
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Affiliation(s)
- John Ndayishimiye
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Queensland 4102, Australia.
| | - Yuxue Cao
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Queensland 4102, Australia.
| | - Tushar Kumeria
- School of Materials Science and Engineering, University of New South Wales, New South Wales, Australia
| | - Mark A T Blaskovich
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - James Robert Falconer
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Queensland 4102, Australia.
| | - Amirali Popat
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Queensland 4102, Australia. .,Mater Research Institute - The University of Queensland, Translational Research Institute, 37 Kent St, Woolloongabba, QLD 4102, Australia
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15
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Mohamadi Yarijani Z, Najafi H. Kidney injury in COVID-19 patients, drug development and their renal complications: Review study. Biomed Pharmacother 2021; 142:111966. [PMID: 34333286 PMCID: PMC8313500 DOI: 10.1016/j.biopha.2021.111966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023] Open
Abstract
Since December 2019, the world was encountered a new disease called coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although SARS-CoV-2 initially causes lung damage, it also affects many other organs, including the kidneys, and on average, 5–23% of people with COVID-19 develop the symptoms of acute kidney injury (AKI), including elevated blood creatinine and urea, hematuria, proteinuria, and histopathological damages. The exact mechanism is unknown, but the researchers believe that SARS-CoV-2 directly and indirectly affects the kidneys. The direct pathway is by binding the virus to ACE2 receptor in the kidney, damage to cells, the renin-angiotensin system disturbances, activating coagulation pathways, and damaging the renal vascular endothelium. The initial evidence from studying the kidney tissue in postmortem patients is more in favor of the direct pathway. The indirect pathway is created by increased cytokines and cytokine storm, sepsis, circulatory disturbances, hypoxemia, as well as using the nephrotoxic drugs. Using renal tissue biopsy and autopsy in the patients with COVID-19, recent studies found evidence for a predominant indirect pathway in AKI induction by SARS-CoV-2. Besides, some studies showed that the degree of acute tubular injury (ATI) in autopsies from COVID-19 victims is milder compared to AKI degree. We review the mechanism of AKI induction and the renal side effects of the most common drugs used to treat COVID-19 after the overview of the latest findings on SARS-CoV-2 pathogenicity.
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Affiliation(s)
- Zeynab Mohamadi Yarijani
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Houshang Najafi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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16
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Guerin E, Shkoporov AN, Stockdale SR, Comas JC, Khokhlova EV, Clooney AG, Daly KM, Draper LA, Stephens N, Scholz D, Ross RP, Hill C. Isolation and characterisation of ΦcrAss002, a crAss-like phage from the human gut that infects Bacteroides xylanisolvens. MICROBIOME 2021; 9:89. [PMID: 33845877 PMCID: PMC8042965 DOI: 10.1186/s40168-021-01036-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/12/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND The gut phageome comprises a complex phage community of thousands of individual strains, with a few highly abundant bacteriophages. CrAss-like phages, which infect bacteria of the order Bacteroidales, are the most abundant bacteriophage family in the human gut and make an important contribution to an individual's core virome. Based on metagenomic data, crAss-like phages form a family, with four sub-families and ten candidate genera. To date, only three representatives isolated in pure culture have been reported: ΦcrAss001 and two closely related phages DAC15 and DAC17; all are members of the less abundant candidate genus VI. The persistence at high levels of both crAss-like phage and their Bacteroidales hosts in the human gut has not been explained mechanistically, and this phage-host relationship can only be properly studied with isolated phage-host pairs from as many genera as possible. RESULTS Faeces from a healthy donor with high levels of crAss-like phage was used to initiate a faecal fermentation in a chemostat, with selected antibiotics chosen to inhibit rapidly growing bacteria and selectively enrich for Gram-negative Bacteroidales. This had the objective of promoting the simultaneous expansion of crAss-like phages on their native hosts. The levels of seven different crAss-like phages expanded during the fermentation, indicating that their hosts were also present in the fermenter. The enriched supernatant was then tested against individual Bacteroidales strains isolated from the same faecal sample. This resulted in the isolation of a previously uncharacterised crAss-like phage of candidate genus IV of the proposed Alphacrassvirinae sub-family, ΦcrAss002, that infects the gut commensal Bacteroides xylanisolvens. ΦcrAss002 does not form plaques or spots on lawns of sensitive cells, nor does it lyse liquid cultures, even at high titres. In keeping with the co-abundance of phage and host in the human gut, ΦcrAss002 and Bacteroides xylanisolvens can also co-exist at high levels when co-cultured in laboratory media. CONCLUSIONS We report the isolation and characterisation of ΦcrAss002, the first representative of the proposed Alphacrassvirinae sub-family of crAss-like phages. ΦcrAss002 cannot form plaques or spots on bacterial lawns but can co-exist with its host, Bacteroides xylanisolvens, at very high levels in liquid culture without impacting on bacterial numbers. Video abstract.
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Affiliation(s)
- Emma Guerin
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
| | | | | | | | | | - Adam G Clooney
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Karen M Daly
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | | | - Niamh Stephens
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - Dimitri Scholz
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - R Paul Ross
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - Colin Hill
- APC Microbiome Ireland, University College Cork, Cork, Ireland.
- School of Microbiology, University College Cork, Cork, Ireland.
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17
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Nguyen PT, JuÁrez O, Restaino L. A New Method for Detection of Arcobacter butzleri, Arcobacter cryaerophilus, and Arcobacter skirrowii Using a Novel Chromogenic Agar. J Food Prot 2021; 84:160-168. [PMID: 33411930 DOI: 10.4315/jfp-20-245] [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: 06/17/2020] [Accepted: 09/14/2020] [Indexed: 11/11/2022]
Abstract
ABSTRACT Arcobacter species are gram-negative rods that have been implicated in food- and waterborne illness. Although various cultural isolation methods have been proposed, the current procedures are unable to fully suppress the growth of background microbiota present in food samples, which inhibits Arcobacter isolation. The purpose of this study was to develop a selective enrichment broth and chromogenic plating medium to detect three Arcobacter species that have been recognized as emerging foodborne pathogens: Arcobacter butzleri, Arcobacter cryaerophilus, and Arcobacter skirrowii. The developed Nguyen-Restaino-Juárez (NRJ) Arcobacter detection system consists of a selective enrichment broth (NRJ-B) and a selective-differential plating medium (NRJ-M). The protocol of the detection method was determined by evaluating the growth of A. butzleri, A. cryaerophilus, and A. skirrowii under various temperatures (30, 35, and 42°C) and incubation (aerobic, microaerophilic, and anaerobic) conditions. Additionally, 47 Arcobacter strains and 39 non-Arcobacter strains were tested in inclusivity and exclusivity evaluations of NRJ-B and NRJ-M. Overall, the study determined that the optimal growth conditions of Arcobacter species using the NRJ Arcobacter detection system were aerobic incubation at 30°C. NRJ-B supported good growth of A. butzleri, A. cryaerophilus, and A. skirrowii while effectively suppressing the growth of non-Arcobacter strains after 48 h. Furthermore, NRJ-M yielded 97.8% inclusivity and 100.0% exclusivity using the tested strains and resulted in salmon-pigmented Arcobacter colonies (1.0 to 1.5 mm in diameter) after 72 h. The novel protocol is the first to develop a chromogenic plating medium for the isolation of Arcobacter species. This simple and accurate test method would greatly contribute to understanding the distribution of pathogenic Arcobacter species in food samples. HIGHLIGHTS
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Affiliation(s)
- Paul T Nguyen
- R & F Products, Inc., 2725 Curtiss Street, Downers Grove, Illinois 60188.,(ORCID: https://orcid.org/0000-0003-2187-2476 [P.T.N.])
| | - Oscar JuÁrez
- Department of Biological Sciences, Illinois Institute of Technology, 10 West 35th Street, Chicago, Illinois 60616, USA
| | - Lawrence Restaino
- R & F Products, Inc., 2725 Curtiss Street, Downers Grove, Illinois 60188
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18
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Ferraro S, Convertino I, Leonardi L, Blandizzi C, Tuccori M. Unresolved gustatory, olfactory and auditory adverse drug reactions to antibiotic drugs: a survey of spontaneous reporting to Eudravigilance. Expert Opin Drug Saf 2019; 18:1245-1253. [PMID: 31580740 DOI: 10.1080/14740338.2019.1676724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Sensory adverse drug reactions (ADRs) are generally expected to be transient in nature. However, spontaneous reports describe frequently these events as long-lasting or unresolved. In this study, the authors reviewed the Eudravigilance publicly accessible database to describe the volume and expectedness of potentially unresolved outcomes for gustatory, olfactory and auditory (GOA) suspected ADRs associated with antibiotics for systemic use.Methods: 'Overall' and 'GOA' suspected ADRs were extracted from Eudravigilance to estimate the distribution of their outcomes among different antibiotic groups. Then, the authors identified the drugs contributing to at least 15% of all suspected GOA ADRs observed for the antibiotic groups, and evaluated the expectedness.Results: The frequency of persistent/permanent outcomes was higher for GOA suspected ADRs, as compared to the overall ones. Unresolved and undetermined outcomes for antibiotic-associated GOA ADRs in Eudravigilance might hide a large number of events with underestimated clinical consequences. Several persistent/permanent antibiotic-associated GOA reactions could be classified as serious and unexpected.Conclusion: Potential long-lasting or irreversible GOA reactions are often reported for all antibiotics drugs. Further studies are warranted to clarify whether this is an actual safety issue or simply it reflects a general difficulty in outcomes assessment for such reactions.
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Affiliation(s)
- Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Leonardi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
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19
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Hussain S, Joo J, Kang J, Kim B, Braun GB, She ZG, Kim D, Mann AP, Mölder T, Teesalu T, Carnazza S, Guglielmino S, Sailor MJ, Ruoslahti E. Antibiotic-loaded nanoparticles targeted to the site of infection enhance antibacterial efficacy. Nat Biomed Eng 2018; 2:95-103. [PMID: 29955439 DOI: 10.1038/s41551-017-0187-5] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bacterial resistance to antibiotics has made it necessary to resort to antibiotics that have considerable toxicities. Here, we show that the cyclic 9-amino acid peptide CARGGLKSC (CARG), identified via phage display on Staphylococcus aureus (S. aureus) bacteria and through in vivo screening in mice with S. aureus-induced lung infections, increases the antibacterial activity of CARG-conjugated vancomycin-loaded nanoparticles in S. aureus-infected tissues and reduces the needed overall systemic dose, minimizing side effects. CARG binds specifically to S. aureus bacteria but not Pseudomonas bacteria in vitro, selectively accumulates in S. aureus-infected lungs and skin of mice but not in non-infected tissue and Pseudomonas-infected tissue, and significantly enhances the accumulation of intravenously injected vancomycin-loaded porous silicon nanoparticles bearing the peptide in S. aureus-infected mouse lung tissue. The targeted nanoparticles more effectively suppress staphylococcal infections in vivo relative to equivalent doses of untargeted vancomycin nanoparticles or of free vancomycin. The therapeutic delivery of antibiotic-carrying nanoparticles bearing peptides targeting infected tissue may help combat difficult-to-treat infections.
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Affiliation(s)
- Sazid Hussain
- Cancer Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Jinmyoung Joo
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, USA.,Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.,Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Kang
- Department of Nanoengineering, University of California, San Diego, La Jolla, CA, USA
| | - Byungji Kim
- Materials Science and Engineering Program, University of California, San Diego, La Jolla, CA, USA
| | - Gary B Braun
- Cancer Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.,STEMCELL Technologies Inc., Vancouver, Canada
| | - Zhi-Gang She
- Cancer Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.,Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dokyoung Kim
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, USA
| | - Aman P Mann
- Cancer Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Tarmo Mölder
- Laboratory of Cancer Biology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Tambet Teesalu
- Cancer Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.,Laboratory of Cancer Biology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.,Center for Nanomedicine, and Department of Cell, Molecular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Santina Carnazza
- Dipartimento di Scienze Chimiche, Biologiche, Farmaceutiche ed Ambientali- ChiBioFarAm, Università di Messina, Messina, Italy
| | - Salvatore Guglielmino
- Dipartimento di Scienze Chimiche, Biologiche, Farmaceutiche ed Ambientali- ChiBioFarAm, Università di Messina, Messina, Italy
| | - Michael J Sailor
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, USA.,Department of Nanoengineering, University of California, San Diego, La Jolla, CA, USA.,Materials Science and Engineering Program, University of California, San Diego, La Jolla, CA, USA
| | - Erkki Ruoslahti
- Cancer Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA. .,Center for Nanomedicine, and Department of Cell, Molecular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, CA, USA.
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20
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Tsukatani T, Suenaga H, Higuchi T, Shiga M, Noguchi K, Matsumoto K. Distinction of Gram-positive and -negative bacteria using a colorimetric microbial viability assay based on the reduction of water-soluble tetrazolium salts with a selection medium. J GEN APPL MICROBIOL 2012; 57:331-9. [PMID: 22353738 DOI: 10.2323/jgam.57.331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Bacteria are fundamentally divided into two groups: Gram-positive and Gram-negative. Although the Gram stain and other techniques can be used to differentiate these groups, some issues exist with traditional approaches. In this study, we developed a method for differentiating Gram-positive and -negative bacteria using a colorimetric microbial viability assay based on the reduction of the tetrazolium salt {2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H-tetrazolium, monosodium salt} (WST-8) via 2-methyl-1,4-napthoquinone with a selection medium. We optimized the composition of the selection medium to allow the growth of Gram-negative bacteria while inhibiting the growth of Gram-positive bacteria. When the colorimetric viability assay was carried out in a selection medium containing 0.5µg/ml crystal violet, 5.0 µg/ml daptomycin, and 5.0µg/ml vancomycin, the reduction in WST-8 by Gram-positive bacteria was inhibited. On the other hand, Gram-negative bacteria produced WST-8-formazan in the selection medium. The proposed method was also applied to determine the Gram staining characteristics of bacteria isolated from various foodstuffs. There was good agreement between the results obtained using the present method and those obtained using a conventional staining method. These results suggest that the WST-8 colorimetric assay with selection medium is a useful technique for accurately differentiating Gram-positive and -negative bacteria.
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Affiliation(s)
- Tadayuki Tsukatani
- Biotechnology and Food Research Institute, Fukuoka Industrial Technology Center, 1465-5 Aikawamachi, Kurume, Japan.
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21
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Basarslan F, Yilmaz N, Ates S, Ozgur T, Tutanc M, Motor VK, Arica V, Yilmaz C, Inci M, Buyukbas S. Protective effects of thymoquinone on vancomycin-induced nephrotoxicity in rats. Hum Exp Toxicol 2012; 31:726-33. [PMID: 22318306 DOI: 10.1177/0960327111433185] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Oxidative stress has been implicated as a potential responsible mechanism in the pathogenesis of vancomycin (VCM)-induced renal toxicity. Therefore, we aimed to investigate the protective effect of thymoquinone (TQ) against VCM-induced nephrotoxicity by tissue oxidant/antioxidant parameters and histological changes in rats. MATERIALS AND METHODS Wistar albino rats were randomly separated into four groups consisting of seven rats per group. The groups had normal saline (control group), VCM, VCM and TQ and TQ, respectively. VCM was injected intraperitoneally at a dose of 200 mg/kg and continued at 12-h intervals for 7 days. TQ was injected intraperitoneally at a dose of 10 mg/kg and continued at 24 h intervals for 8 days. Animals were killed and blood samples were analyzed for the levels of serum blood urea nitrogen (BUN) and creatinine (Cr). Kidney specimens were analyzed for levels of malondialdehyde (MDA) and activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) as well as for histopathological changes. RESULTS We found that the levels of serum BUN, Cr and kidney tissue MDA were increased in the VCM group. Activities of SOD and GSH-Px in kidney tissue were decreased. TQ administration ameliorated significantly these changes. CONCLUSION These results indicate that the TQ produces a protective mechanism against VCM-induced nephrotoxicity and suggest a role of oxidative stress in pathogenesis.
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Choi GS, Sung JM, Lee JW, Ye YM, Park HS. A case of occupational asthma caused by inhalation of vancomycin powder. Allergy 2009; 64:1391-2. [PMID: 19485984 DOI: 10.1111/j.1398-9995.2009.02067.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G-S Choi
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea.
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23
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King DW, Smith MA. Proliferative responses observed following vancomycin treatment in renal proximal tubule epithelial cells. Toxicol In Vitro 2005; 18:797-803. [PMID: 15465645 DOI: 10.1016/j.tiv.2004.03.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Accepted: 03/25/2004] [Indexed: 11/25/2022]
Abstract
Vancomycin (VAN) is a glycopeptide antibiotic used to treat gram-positive infections. Nephrotoxicity is a common side effect observed with vancomycin therapy. However, the mechanism of vancomycin-induced nephrotoxicity has not been fully characterized. In this study we examined the effect of vancomycin on cellular proliferation in renal proximal tubule cells. A dose- and time-dependent increase in cell number and total cellular protein was observed following vancomycin exposure. Vancomycin exposure also caused an increase in BrdU incorporation followed by the accumulation of renal proximal tubule cells in G(2)/M phase of the cell cycle. These effects were inhibited by pretreatment with the mitogen-activated protein kinase inhibitor, PD098059, suggesting an association between the cell proliferative effect of VAN and the induction of the mitogen-activated protein kinase signaling pathway. Mitochondrial function in renal proximal tubule cells was assessed using oxygen consumption and ATP concentrations. We observed an increase in oxygen consumption and ATP concentrations following short-term exposure to vancomycin. Together, our data suggest that vancomycin treatment produces alterations in mitochondrial function that coincide with a cell proliferative response in renal proximal tubule epithelial cells.
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Affiliation(s)
- D W King
- School of Public Health, University of Texas-Houston Health Science Center, Houston, TX 77030, USA.
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24
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Lundstrom TS, Sobel JD. Antibiotics for gram-positive bacterial infections: vancomycin, quinupristin-dalfopristin, linezolid, and daptomycin. Infect Dis Clin North Am 2004; 18:651-68, x. [PMID: 15308280 DOI: 10.1016/j.idc.2004.04.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An overview of the mechanism of action, dosing, clinical indications, and toxicities of the glycopeptide vancomycin is provided. Emerging gram-positive bacterial resistance to antimicrobials and its mechanisms are reviewed. Strategies to control emergence of resistance are proposed. Newer antimicrobial agents with activity against vancomycin-resistant organisms are now available and play a critical role in the treatment of life-threatening infections.
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Affiliation(s)
- Tammy S Lundstrom
- Division of Infectious Diseases, Wayne State University-Detroit Medical Center, 4201 St. Antoine UHC 2B, Detroit, MI 48201, USA.
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25
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Shah NP, Reddy P, Paladino JA, McKinnon PS, Klepser ME, Pashos CL. Direct medical costs associated with using vancomycin in methicillin-resistant Staphylococcus aureus infections: an economic model. Curr Med Res Opin 2004; 20:779-90. [PMID: 15200734 DOI: 10.1185/030079904125003638] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To quantify the direct medical costs associated with using vancomycin, as inpatient treatment, in methicillin-resistant Staphylococcus aureus infections, in four clinical indications: complicated skin and soft tissue infections (SSTI), bacteremia, infective endocarditis (IE), and hospital-acquired pneumonia (HAP). RESEARCH DESIGN AND METHODS A decision-analytic model was constructed to evaluate the cost of administering intravenous vancomycin. Cost inputs included hospitalization, drug procurement, materials, preparation and administration, renal function and drug monitoring, treating adverse events, and treatment failure. Probabilities and lengths of stay and treatment were obtained from the literature, an antimicrobial therapy database and clinical expert opinion. Univariate and multivariate sensitivity analyses were conducted to confirm the robustness of the baseline scenario. MAIN OUTCOME MEASURES The cost of using vancomycin in the four indications, including and excluding hospital cost. RESULTS Whereas the drug acquisition price of vancomycin 1g is US dollars 9.01 per dose, when all costs associated with using vancomycin were included, the cost per dose rose to US dollars 29-US dollars 43 per patient. Total costs per patient receiving multiple doses in a single course of treatment, excluding hospital room costs, were for SSTI, bacteremia, IE, and HAP,US dollars 779, US dollars 749, US dollars 2261, and US dollars 768, respectively. Total costs, including hospital length of stay, were for SSTI US dollars 23616, bacteremia US dollars 26446, IE US dollars 48925, and HAP US dollars 22493. In univariate analyses varying per diem hospital costs and length of stay had the greatest impact. Results of the multivariate analysis were comparable to the costs in the baseline scenario for all indications. CONCLUSIONS This analysis highlights the importance of capturing all costs associated with using a drug and not simply focusing on drug acquisition cost. Future economic analyses should identify and account for the key cost burdens of a particular treatment to calculate its true cost.
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Affiliation(s)
- Nisha P Shah
- Health Economic Research and Quality of Life Evaluation Services (HERQuLES), Abt Associates Inc., Cambridge MA, USA
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26
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Abstract
This review describes the use of vancomycin in neonates over the last three decades. Given the relation of late-onset neonatal septicaemia to outcome and the increase in coagulase-negative staphylococcal infection as causative organism, vancomycin remains an important antibacterial in the neonatal intensive care unit. The pharmacokinetic behaviour of vancomycin in neonates can be adequately described by a one- or two-compartment model and is mainly determined by postconceptional age and renal function. In neonates, a patent ductus arteriosus as well as treatment with indomethacin or extracorporeal membrane oxygenation (ECMO) leads to an increase in volume of distribution and a decrease in clearance. Microbiological studies in vitro have shown that an increase in vancomycin concentrations above the minimum inhibitory concentration does not result in more effective killing. The microbiological and clinical efficacy of vancomycin in neonates has only been studied explicitly in a restricted number of patients. There are no definitive data relating serum concentrations to effect in this patient group. Vancomycin-related nephrotoxicity and ototoxicity in neonates is rare, and no clear relation to serum concentrations has been demonstrated. Based on the pharmacokinetic profile of vancomycin in neonates, several administration regimens have been constructed. Recent guidelines have suggested that dosage can be independent of gestational age or postconceptional age in neonates without renal failure. In patients with renal failure, therapy can be adequately tailored by using a regimen based on serum creatinine. The usefulness of routine monitoring of peak serum concentrations is doubtful based on the current literature. Recent research demonstrates a shift towards taking only routine trough serum concentrations in order to optimise efficacy. Patients with renal failure and other special subpopulations, such as patients exposed to ECMO or indomethacin, need to be monitored more closely.
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Affiliation(s)
- Matthijs de Hoog
- Department of Pediatrics, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands.
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Khare M, Keady D. Antimicrobial therapy of methicillin resistant Staphylococcus aureus infection. Expert Opin Pharmacother 2003; 4:165-77. [PMID: 12562306 DOI: 10.1517/14656566.4.2.165] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is now one of the commonest causes of nosocomial infection worldwide. The mainstay of treatment until now has been the glycopeptides (vancomycin and teicoplanin). They are not without toxicity and need parenteral administration and monitoring of levels. The increasing frequency of MRSA infections, coupled with the emergence of glycopeptide resistance in S. aureus has made the introduction of new drugs active against Gram-positive organisms essential. New agents active against Gram-positive organisms represent either genuinely novel classes of antimicrobials (e.g., oxazolidinones and lipoproteins) or those derived from existing classes (e.g., tetracyclines, glycopeptides, streptogramins and cephalosporins). Some of these newer antibiotics appear to be effective against multi-resistant organisms including MRSA.
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Affiliation(s)
- Milind Khare
- Dept. of Medical Microbiology, Leicester Royal Infirmary, Aylestone Street, Leicester LE1 5WW, UK.
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28
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Pea F, Bertolissi M, Di Silvestre A, Poz D, Giordano F, Furlanut M. TDM coupled with Bayesian forecasting should be considered an invaluable tool for optimizing vancomycin daily exposure in unstable critically ill patients. Int J Antimicrob Agents 2002; 20:326-32. [PMID: 12431867 DOI: 10.1016/s0924-8579(02)00188-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A randomized two-arm prospective study was planned to assess the role of therapeutic drug monitoring (TDM) coupled with a Bayesian approach in tailoring vancomycin dosages in unstable critically ill patients. Group A (n=16) had their regimen adjusted day-by-day according to TDM and Bayesian forecasting (D(a)); group B (n=16) had their regimen adjusted day-by-day according to Moellering's nomogram (D(M)). Blood samples were collected every 1-2 days to assess the trough and peak plasma concentrations. In group A, the tailored D(a) required for optimizing vancomycin exposure were considerably higher than the D(M) in 7/16 cases, and lower than the D(M) in 1/16 cases. In group B, standard D(M) caused under-treatment in 3/16 cases and over-treatment in 4/16 cases. Most of these patients concomitantly had some conditions that might have altered vancomycin disposition. The TDM-guided Bayesian-based approach should be considered an invaluable tool for clinicians to handle appropriately on real-time vancomycin therapy in critically ill patients.
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Affiliation(s)
- Federico Pea
- Institute of Clinical Pharmacology and Toxicology, Chair of Pharmacology, Department of Experimental and Clinical Pathology and Medicine, Medical School, University of Udine, Udine, Italy.
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Bertolissi M, Bassi F, Cecotti R, Capelli C, Giordano F. Pruritus: a useful sign for predicting the haemodynamic changes that occur following administration of vancomycin. Crit Care 2002; 6:234-9. [PMID: 12133184 PMCID: PMC125312 DOI: 10.1186/cc1495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2002] [Accepted: 04/03/2002] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the haemodynamic changes that follow the appearance of pruritus during vancomycin administration. METHODS We studied 50 patients scheduled for coronary artery bypass surgery, and we compared data from patients who exhibited pruritus with those from patients who did not. After the monitoring devices had been positioned, vancomycin (15 mg/kg) was continuously infused at a constant rate over 30 min, before induction of anaesthesia. Haemodynamic profiles were recorded before vancomycin infusion (time point 1); at 15 (time point 2) and 30 min (time point 3) after the beginning of vancomycin infusion; and 15 min after vancomycin infusion had been stopped (time point 4). At each time arterial and mixed venous blood samples were drawn to calculate the shunt fraction (Qsp/Qt). RESULTS In patients who exhibited pruritus (group A, n = 17) at time point 3 versus time point 1, systemic vascular resistance index (SVRI) and arterial oxygen tension (PaO2) decreased significantly; cardiac index (CI), stroke volume index (SVI) and Qsp/Qt increased significantly; and mean systemic pressure and heart rate were stable. Those changes were observed only in patients not treated with a beta-blocker before surgery, whereas no change occurred in patients treated with the drug. In the patients who were free from pruritus (group B, n = 28), we did not observe any significant change. CONCLUSION The appearance of pruritus during vancomycin administration indicates that SVRI is declining, thus exposing the patient to risk for hypotension. Therapy with a beta-blocker appears to confer protection against this hemodynamic reaction.
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Affiliation(s)
- Massimo Bertolissi
- Second Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera, S, Maria della Misericordia, Udine, Italy.
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Abstract
Central nervous system (CNS) infections are diverse. CNS infections can cause significant morbidity and mortality and are markedly different from systemic infections. The closed anatomic space of the CNS, its immunologic isolation from the rest of the body, and the often nonspecific nature of the key manifestations present a challenge to the clinician. Early recognition and aggressive management are essential to patient recovery and prevention of long-term neurologic sequelae. This review discusses the major types of CNS infections and focuses on critical care management, with emphasis on current epidemiologic trends.
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Affiliation(s)
- W C Ziai
- Neurosciences Critical Care Division, Johns Hopkins Hospital, Meyer 8-140, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Benkert SC, Sinnett MJ, Amodio-Groton M. Impact of Monitoring Vancomycin Peak and Trough Concentrations versus Trough Concentrations Alone on Dose Adjustments: An Outcomes Analysis. J Pharm Technol 2000. [DOI: 10.1177/875512250001600603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine whether monitoring both steady-state peak and trough serum vancomycin concentrations or steady-state trough serum vancomycin concentrations alone resulted in differences between two groups of patients in terms of dose adjustment, clinical outcome, and toxicity. Design: The study was a retrospective chart review of patients treated with vancomycin during two time periods. Group 1 represented patients hospitalized between July 1, 1996, and January 31, 1997. These patients routinely had vancomycin peak and trough concentrations measured. Group 2 represented patients hospitalized from July 1, 1997, to January 31, 1998, who were monitored with trough vancomycin concentrations only. Setting: A university teaching hospital. Patients: Adults at least 18 years of age who received a constant dose of intravenous vancomycin for at least three consecutive days were eligible for inclusion in the study. Patients were selected from lists generated by the Microbiology Department. The lists contained vancomycin serum concentrations measured during those time frames. Main Outcome Measures: The main outcome measure was to assess whether dose adjustments by prescribers were influenced by both vancomycin peak and trough concentrations or by the trough concentration alone. Results: Forty-nine and 37 patients met the criteria for inclusion into group 1 and group 2, respectively. The mean duration of therapy in group 1 (15 ± 10 d) was not statistically different from that of group 2 (14 ± 12 d). Patients in both groups received a mean daily vancomycin dose of approximately 1,500 mg. In analyzing treatment decisions, trough concentration was the only significant factor influencing a change in total daily dose of vancomycin (p = 0.038). Furthermore, although the method of vancomycin serum concentration monitoring varied between the two groups, the mean clinical outcome parameters were comparable. Conclusions: Prescribers tended to adjust vancomycin regimens based only on trough serum concentrations; monitoring peak serum vancomycin concentrations did not enhance patient care. Mean outcome parameters in the two groups were comparable.
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Lundstrom TS, Sobel JD. Antibiotics for gram-positive bacterial infections. Vancomycin, teicoplanin, quinupristin/dalfopristin, and linezolid. Infect Dis Clin North Am 2000; 14:463-74. [PMID: 10829266 DOI: 10.1016/s0891-5520(05)70258-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vancomycin is a safe, effective antibiotic for a variety of serious gram-positive infections. Because of emerging resistance in enterococci and staphylococci and the emerging threat of spread of vancomycin-resistant genes to other gram-positive organisms, judicious use of vancomycin should be promoted. Quinupristin/dalfopristin, a streptogramin antibiotic, and linezolid, an oxazolidinone, show promise against some strains of gram-positive bacteria that are resistant to vancomycin.
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Affiliation(s)
- T S Lundstrom
- Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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Pea F, Furlanut M, Bianchi L. Systemic vancomycin overexposure in a patient with spinal cord injury who had Staphylococcal sepsis and Clostridium difficile colitis. Ther Drug Monit 2000; 22:233-4. [PMID: 10774640 DOI: 10.1097/00007691-200004000-00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pea F, Porreca L, Baraldo M, Furlanut M. High vancomycin dosage regimens required by intensive care unit patients cotreated with drugs to improve haemodynamics following cardiac surgical procedures. J Antimicrob Chemother 2000; 45:329-35. [PMID: 10702552 DOI: 10.1093/jac/45.3.329] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to evaluate retrospectively the importance of a Bayesian pharmacokinetic approach for predicting vancomycin concentrations to individualize its dosing regimen in 18 critically ill patients admitted to intensive care units following cardiothoracic surgery. The possible influence of some coadministered drugs with important haemodynamic effects (dopamine, dobutamine, frusemide) on vancomycin pharmacokinetics was assessed. Vancomycin serum concentrations were measured by fluorescence polarization immunoassay. Vancomycin dosage regimens predicted by the Bayesian method (D(a)) were compared retrospectively with Moellering's nomogram-based dosages (D(M)) to assess possible major differences in vancomycin dosing. D(a) values were similar to D(M) in 10 patients (D(a) approximately D(M) group) (20.52 +/- 8.40 mg/kg/day versus 18.81 +/- 7.24 mg/kg; P = 0.15), whereas much higher dosages were required in the other eight patients (D(a) >> D(M) group) (26.78 +/- 3.01 mg/kg/day versus 18.95 +/- 3.41 mg/kg/day; P < 0.0001) despite no major difference in attained vancomycin steady-state trough concentration (C(min ss)) (9.22 +/- 1. 33 mg/L versus 8.99 +/- 1.26 mg/L; = 0.75) or estimated creatinine clearance (1.23 +/- 0.49 mL/min/kg versus 1.21 +/- 0.24 mL/min/kg; P = 0.95) being found between the two groups. The ratio between D(a) and D(M) was significantly higher in the D(a) >> D(M) group than in the D(a) approximately D(M) group (1.44 +/- 0.18 versus 1.10 +/- 0. 21; P < 0.01). In four D(a) >> D(M) patients the withdrawal of cotreatment with haemodynamically active drugs was followed by a sudden substantial increase in the vancomycin C(min ss) (13.30 +/- 1. 13 mg/L versus 8.79 +/- 0.87 mg/L; P < 0.01), despite no major change in bodyweight or estimated creatinine clearance being observed. We postulate that these drugs with important haemodynamic effects may enhance vancomycin clearance by inducing an improvement in cardiac output and/or renal blood flow, and/or by interacting with the renal anion transport system, and thus by causing an increased glomerular filtration rate and renal tubular secretion. Given the wide simultaneous use of vancomycin and dopamine and/or dobutamine and/or frusemide in patients admitted to intensive care units, clinicians must be aware of possible subtherapeutic serum vancomycin concentrations when these drugs are coadministered. Therefore, therapeutic drug monitoring (TDM) for the pharmacokinetic optimization of vancomycin therapy is strongly recommended in these situations.
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Affiliation(s)
- F Pea
- Institute of Clinical Pharmacology and Toxicology, DPMSC, University of Udine, P. le S. Maria della Misericordia 3, 33100 Udine.
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Pea F, Poz D, Baraldo M, Furlanut M. Optimisation of Vancomycin Regimen in Neutropenic Haematological Patients with Normal Renal Function. Clin Drug Investig 2000. [DOI: 10.2165/00044011-200019030-00006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Glover ML, Cole E, Wolfsdorf J. Vancomycin dosage requirements among pediatric intensive care unit patients with normal renal function. J Crit Care 2000; 15:1-4. [PMID: 10757191 DOI: 10.1053/jcrc.2000.0150001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to determine a vancomycin dosage regimen among pediatric intensive care unit (PICU) patients with normal renal function resulting in desired peak and trough serum concentration and to determine the predictability of vancomycin peak concentrations based on reported trough concentrations. MATERIALS AND METHODS The medical records of all PICU patients who received vancomycin over a 12-month period were identified through a hospital computer search and were obtained from the hospital's Department of Medical Records. Demographic and laboratory data as well as the patient's vancomycin dosing history were recorded. Patients who lacked appropriately timed vancomycin peak and trough concentrations or who exhibited renal dysfunction were excluded from the study population. The optimal vancomycin dose and the predictability of peak concentrations based on trough concentrations were assessed. RESULTS A total of 135 patients were identified as having received vancomycin therapy during their PICU hospitalization between June 1997 and June 1998. Fifty-nine patients were excluded due to renal dysfunction or inappropriate vancomycin concentrations resulting in 76 patients representing our study population. The initial mean dose of vancomycin was 47 mg/kg/day resulting in a mean peak and trough serum concentration of 19 and 6 microg/mL, respectively. A mean of 2.2 (range, 1 to 5) and 2.1 (range, 1 to 5) peak and trough serum concentrations were reported for each patient, respectively. A mean of 1.1 (range, 0 to 4) dosing changes per patient was noted resulting in a final mean dose of 60 mg/kg/day corresponding to a mean peak and trough serum concentration of 26 and 8 microg/mL, respectively. A vancomycin trough concentration >5 microg/mL was highly predictive for a corresponding peak concentration >20 microg/mL (P > .0001). Eighty percent of the trough concentrations <5 microg/mL were associated with peak concentrations <20 microg/mL, whereas 81% of trough concentrations >5 microg/mL were associated with corresponding peak concentrations >20 microg/mL. CONCLUSIONS PICU patients required higher doses of vancomycin than are typically prescribed to achieve conventionally accepted peak and trough vancomycin serum concentrations. In the absence of renal impairment, we recommend an initial dosage regimen of 60 mg/kg/day divided every 8 hours. Vancomycin trough concentrations are highly predictive of corresponding peak concentrations and therefore may negate the need to obtain routine peak concentrations.
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Affiliation(s)
- M L Glover
- Division of Critical Care Medicine, Miami Children's Hospital, FL 33155-3009, USA
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37
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Affiliation(s)
- D E Palmer-Toy
- Department of Pathology, Massachusetts General Hospital, Boston, Mass, USA.
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38
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Pecora Fulco P, Raney CR. Should once-daily vancomycin in the treatment of infective endocarditis be reassessed? Pharmacotherapy 1999; 19:1183-4. [PMID: 10512070 DOI: 10.1592/phco.19.15.1183.30583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- P Pecora Fulco
- Department of Pharmacy Services, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond 23298-0042, USA
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Abstract
Recognized since 1883 as a common cause of infection, Staphylococcus aureus' preantimicrobial-era bacteremia mortality rate was 82%. The mortality of that era threatens to return as evidence of growing vancomycin resistance undermines the utility of vancomycin therapy. Successful treatment of S. aureus infections requires knowledge of its antimicrobial resistance capacity.
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Affiliation(s)
- T L Smith
- Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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40
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Affiliation(s)
- D Müller
- University Children's Hospital, Kiel, Germany
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Westrum PJ, Koo JM, Carson PJ. Association of Serum Vancomycin Concentration with Renal Dysfunction. J Pharm Technol 1999. [DOI: 10.1177/875512259901500405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the association of vancomycin-related renal dysfunction with age; serum vancomycin trough concentration; baseline serum creatinine concentration; duration of vancomycin treatment; comorbid medical conditions of congestive heart failure, chronic renal failure, diabetes mellitus, and hepatic cirrhosis; and the concurrent use of drugs that can cause impairment of renal function. Design: A retrospective analysis of medical records of hospitalized patients who received intravenous vancomycin was conducted. Setting: This study was conducted in a 125-bed, tertiary care, government teaching hospital. Methods: Data were collected on 122 men, ranging in age from 41 to 95 years, who received vancomycin during a five-year period starting in 1991. Vancomycin-related renal dysfunction, defined as an increase of ≥0.5 mg/dL in serum creatinine concentration from the baseline value, was examined for an association with age; baseline serum creatinine concentration; duration of vancomycin treatment; serum vancomycin trough concentrations >15 μg/mL; and comorbid conditions of congestive heart failure, chronic renal failure, diabetes mellitus, and hepatic cirrhosis. The concurrent use of aminoglycosides, amphotericin B, diuretics, angiotensin-converting enzyme (ACE) inhibitors, Cimetidine, and intravenously administered contrast medium was also analyzed. Results: Stepwise logistic regression and odds ratio analyses failed to identify an association between vancomycin-related renal dysfunction and any factor examined except concurrent use of diuretics and ACE inhibitors. Conclusions: Patients receiving intravenous vancomycin concurrently with diuretics or ACE inhibitors have a higher risk of renal impairment. No incident of renal dysfunction was attributed to vancomycin alone.
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Embil JM, Nicolle LE. Antimicrobial Agents. Phys Med Rehabil Clin N Am 1999. [DOI: 10.1016/s1047-9651(18)30203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Heuermann KG, Romero JR, Abromowitch MA, Gordon BG, Gross TG. Fatal coagulase-negative staphylococci infection after bone marrow transplantation in a patient with persistent adverse reactions to vancomycin. J Pediatr Hematol Oncol 1999; 21:80-1. [PMID: 10029821 DOI: 10.1097/00043426-199901000-00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dunn AS, Peterson KL, Schechter CB, Rabito P, Gotlin AD, Smith LG. The utility of an in-hospital observation period after discontinuing intravenous antibiotics. Am J Med 1999; 106:6-10. [PMID: 10320111 DOI: 10.1016/s0002-9343(98)00359-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether observing patients overnight in the hospital after intravenous antibiotics have been discontinued is a useful way to identify important clinical events. SUBJECTS AND METHODS We performed a retrospective chart review of patients admitted during a 6-month period to a tertiary care teaching hospital with a primary diagnosis of either pneumonia, urinary tract infection, or cellulitis who were treated with intravenous antibiotics. Charts were abstracted for patient characteristics, including comorbid illnesses and laboratory values, as well as for evidence of recurrent infection or other adverse events. RESULTS Of the 374 patients in the study, 63 (17%) were discharged on the day intravenous antibiotics were discontinued. These patients were 10 years younger (P = 0.0009) and had fewer comorbid illnesses (P = 0.02) than those who were observed in the hospital. Recurrent infection was noted in 3 (1%; 95% confidence interval 0.2% to 3%) of the 308 patients who were observed. A mild adverse antibiotic reaction was also noted in three observed patients. The readmission rate to the same institution for recurrent infection was 3% for patients with an observation period and 2% for patients without an observation period (P = 0.70). CONCLUSIONS Observing patients overnight in the hospital after discontinuing intravenous antibiotics is a common clinical practice. There was an extremely low incidence of adverse events during the observation period, and the events that did occur would have been discovered in an outpatient setting. In-hospital observation after discontinuing intravenous antibiotics is unnecessary for most patients with pneumonia, urinary tract infection, or cellulitis and greatly increases health-care costs.
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Affiliation(s)
- A S Dunn
- Department of Medicine, Mount Sinai Medical Center, New York, New York 10029, USA
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Yan H, Cheng X, He B. Calculation of concentrations of equilibrium components in an in vitro activity test of vancomycin antibiotics and the possible mode of action. Biophys Chem 1998; 74:107-15. [PMID: 9760722 DOI: 10.1016/s0301-4622(98)00172-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The vancomycin group of antibiotics is considered to act by binding the bacterial cell wall mucopeptide precursor terminating in -L-Lys-D-Ala-D-Ala. The dimerization of these antibiotics is also believed to play a role in the action. In this paper, we analyzed the equilibria in the in vitro antibacterial activity test of the vancomycin antibiotics both with and without the cell wall precursor analogue di-acetyl-L-Lys-D-Ala-D-Ala (DALAA). Based on the equilibria and concentration balance, we obtained 10 equations (seven quadratic equations and three linear equations) containing 10 equilibrium concentrations which relate to the antibiotic, cell wall precursor and DALAA. A computer program was written to solve these equations from known dimerization constant and the binding constants (both monomer and dimer) with DALAA of the antibiotic. The concentrations in the test for vancomycin and eremomycin were obtained. The antibiotic activity of these antibiotics may be quantitatively correlated with their dimerization constants and the binding constants through the calculation. By analyzing the calculated results, we concluded that the cell wall-bound dimer may be the major contributor to the antibiotic activity in the case of eremomycin, while the cell wall-bound monomer is possibly the determinant for the activity of vancomycin.
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Affiliation(s)
- H Yan
- Institute of Polymer Chemistry, State Key Laboratory of Functional Polymer Materials for Adsorption and Separation, Nankai University, Tianjin, People's Republic of China
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Azzazy HM, Chou PP, Tsushima JH, Troxil S, Gordon M, Avers RJ, Chiappetta E, Duh SH, Christenson RH. Abbott AxSYM Vancomycin II assay: multicenter evaluation and interference studies. Ther Drug Monit 1998; 20:202-8. [PMID: 9558135 DOI: 10.1097/00007691-199804000-00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors evaluated the performance characteristics of the Abbott AxSYM Vancomycin II immunoassay in sera of patients with (n = 93 samples) and without (n = 327 patients) renal dysfunction. Correlation of vancomycin measurements with the Abbott AxSYM Vancomycin, Abbott TDx/TDxFLx, Syva enzyme-multiplied immunoassay technique (EMIT), DuPont automated chemistry analyzer (ACA), and high-performance liquid chromatography methods showed acceptable correlation as indicated by: slope values >0.95, r-values >0.97, y-intercepts <1.7 microg/ml, and S(y/x) ranging from 9% to 15% of the average vancomycin value. The AxSYM Vancomycin II assay showed acceptable correlation with AxSYM vancomycin, TDx/TDxFLx, and high-performance liquid chromatography methods in 93 samples from patients with renal dysfunction. This monoclonal antibody-based assay showed no apparent interference from the presence of human antimouse antibody (HAMA) or the microbiologically inactive vancomycin crystalline degradation product (CDP). The authors conclude that the AxSYM Vancomycin II assay showed satisfactory agreement with other methods tested in this study.
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Affiliation(s)
- H M Azzazy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
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Affiliation(s)
- A Ahmed
- St. John's Mercy Medical Center, St. Louis, MO, USA
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Haldimann A, Fisher SL, Daniels LL, Walsh CT, Wanner BL. Transcriptional regulation of the Enterococcus faecium BM4147 vancomycin resistance gene cluster by the VanS-VanR two-component regulatory system in Escherichia coli K-12. J Bacteriol 1997; 179:5903-13. [PMID: 9294451 PMCID: PMC179483 DOI: 10.1128/jb.179.18.5903-5913.1997] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
An Escherichia coli K-12 model system was developed for studying the VanS-VanR two-component regulatory system required for high-level inducible vancomycin resistance in Enterococcus faecium BM4147. Our model system is based on the use of reporter strains with lacZ transcriptional and translational fusions to the PvanR or PvanH promoter of the vanRSHAX gene cluster. These strains also express vanR and vanS behind the native PvanR promoter, the arabinose-inducible ParaB promoter, or the rhamnose-inducible PrhaB promoter. Our reporter strains have the respective fusions stably recombined onto the chromosome in single copy, thereby avoiding aberrant regulatory effects that may occur with plasmid-bearing strains. They were constructed by using allele replacement methods or a conditionally replicative attP plasmid. Using these reporter strains, we demonstrated that (i) the response regulator VanR activates PvanH, but not PvanR, expression upon activation (phosphorylation) by the partner kinase VanS, the noncognate kinase PhoR, or acetyl phosphate, indicating that phospho-VanR (P-VanR) is a transcriptional activator; (ii) VanS interferes with activation of VanR by PhoR or acetyl phosphate, indicating that VanS also acts as a P-VanR phosphatase; and (iii) the conserved, phosphate-accepting histidine (H164) of VanS is required for activation (phosphorylation) of VanR but not for deactivation (dephosphorylation) of P-VanR. Similar reporter strains may be useful in new studies on these and other interactions of the VanS-VanR system (and other systems), screening for inhibitors of these interactions, and deciphering the molecular logic of the signal(s) responsible for activation of the VanS-VanR system in vivo. Advantages of using an E. coli model system for in vivo studies on VanS and VanR are also discussed.
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Affiliation(s)
- A Haldimann
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana 47907, USA
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Hamilton AJ, Orozco J, Narotam P, Bowersock T. Efficacy of vancomycin/tri-iododecyclemethyl ammonium chloride-coated ventriculostomy catheters in reducing infection. Neurosurgery 1997; 40:1043-9. [PMID: 9149263 DOI: 10.1097/00006123-199705000-00031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The biotoxicity of tri-iododecyclemethyl ammonium chloride (TDMAC)-coated catheters in the brain was tested, as was the efficacy of the vancomycin-bonded, TDMAC-coated catheters to inhibit staphylococcal growth in vitro and to delay the onset of clinical manifestations of catheter-related staphylococcal ventriculitis in rabbit experimental model. METHODS The brain toxicity of the TDMAC-coated catheters was tested in New Zealand White rabbits. The efficacy of the vancomycin-bonded, TDMAC-coated catheters in the inhibition of staphylococcal growth was tested in agar seeded with Staphylococcus aureus and Staphylococcus epidermidis strains. Sections of vancomycin-bonded, TDMAC-coated catheters were placed in saline solution for testing of drug release over time. Stereotactic placement of ventriculostomy catheters was performed in two groups of New Zealand White rabbits. In the experimental group, vancomycin-bonded, TDMAC-coated catheters were used. In the control group, TDMAC-coated catheters were used. Staphylococcal colonies were inoculated at the exit site of the catheters. Culture of the catheter tips was performed at the time of death of the animals. RESULTS No toxic reactions were seen at the implantation sites or in surrounding brain. Significant inhibition of growth of both S. aureus and S. epidermidis was noted with the vancomycin-bonded catheters (P = 0.01). Vancomycin continued to be released from catheters for the full 6 days of the study. The median interval to development of clinical manifestations of ventriculitis among the experimental group of rabbits was 53 days; among the control group, the interval was 27 days (P < 0.001). CONCLUSION Vancomycin-bonded, TDMAC-coated ventriculostomy catheters bind and release the drug at levels exceeding the minimum inhibitory concentration for S. aureus and S. epidermidis for at least 6 days and can significantly delay the onset of infectious ventriculitis in a rabbit model.
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Affiliation(s)
- A J Hamilton
- Department of Surgery, University of Arizona Health Sciences Center, Tucson, USA
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Oparaoji EC, Siram S, Anosike R, Pippalla RS, Mezghebe HM. Cost Benefit Analysis of Monitoring Serum Vancomycin Concentrations in a Teaching Hospital. J Pharm Pract 1997. [DOI: 10.1177/089719009701000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the economic benefits of routine monitoring of serum vancomycin concentrations and recommend monitoring guidelines. Design: An IRB approved 5-months retrospective chart review. Setting: The study was conducted using patients' medical records in a Teaching hospital. Patients: All patients on intravenous vancomycin, who have stable serum creatinine at the time of initiating vancomycin. Main Outcome Measures: Benefit-to-cost ratio and Return-on-investment were calculated. Benefits were determined using costs avoided that would have occurred in managing SVC-related toxicity, while the cost was the hospital charge for determining SVC. Interventions: Using a computer-generated list of patients on vancomycin from August to December 1995, thirty-one patients' charts were randomly retrieved from the medical records department and reviewed. We extracted and recorded pertinent data on a data collection sheet. The data extracted included SVCs, frequency of SVC determination, dose and duration of vancomycin treatment, and vancomycin untoward effects. Other data recorded were age, weight, height, sex, status of renal function, and other concurrent nephrotoxic or ototoxic drugs. Result: The Benefit-to-cost ratio was 0.696, and the Return-on-investment was -30.4%. A mean of 2.83 ± 3.1 SVCs was obtained per patient during a mean therapy duration of 10.2 ± 6.8 days. The mean daily dose (27.8 ± 7.0 mg/kg), peak (21.7 ± 6.54 mcg/mL), and trough (7.4 ± 5.98 mcg/mL) were within recommended standards. Also, two (8.3%) patients experienced increased serum creatinine. Conclusion: Our results show that the routine monitoring of SVCs is not cost beneficial. We recommend only one trough SVC for patients with normal or stable renal functions for a course of treatment. Patients with unstable renal function may require more than one trough SVC determination and should be evaluated on a case-by-case basis. Peak and trough SVCs should be reserved for patients with other risk factors for ototoxicity.
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Affiliation(s)
- Edward C. Oparaoji
- College of Pharmacy and Pharmaceutical Sciences, Howard University, Washington, DC 20059
| | - Suryanarayana Siram
- Division of Surgical Critical Care, Howard University Hospital, Washington, DC 20059
| | - Rofina Anosike
- College of Pharmacy and Pharmaceutical Sciences, Howard University, Washington, DC 20059
| | - Rao S. Pippalla
- College of Pharmacy and Pharmaceutical Sciences, Howard University, Washington, DC 20059
| | - Haile M. Mezghebe
- Department of Surgery, Division of Trauma Critical Care, Howard University Hospital, Washington, DC 20059
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