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Khan SS, Ullah I, Zada S, Ahmad A, Ahmad W, Xu H, Ullah S, Liu L. Functionalization of Se-Te Nanorods with Au Nanoparticles for Enhanced Anti-Bacterial and Anti-Cancer Activities. MATERIALS 2022; 15:ma15144813. [PMID: 35888280 PMCID: PMC9316951 DOI: 10.3390/ma15144813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022]
Abstract
The use of medical devices for therapeutic and diagnostic purpose is globally increasing; however, bacterial colonization on therapeutic devices can occur, causing severe infections in the human body. It has become an issue for public health. It is necessary to develop a nanomaterial based on photothermal treatment to kill toxic bacterial strains. Appropriately, high photothermal conversion and low-cost powerful photothermal agents have been investigated. Recently, gold nanocomposites have attracted great interest in biological applications. Here, we prepared rod-shaped Se-Te@Au nanocomposites of about 200 nm with uniform shape and surface-coated with gold nanoparticles for the first time showing high anti-bacterial and anti-cancer activities. Se-Te@Au showed proper structural consistency and natural resistance to bacterial and cancer cells. The strong absorption and high photothermal conversion efficacy made it a good photothermal agent material for the photothermal treatment of bacterial and cancer cells. The Se-Te@Au rod showed excellent anti-bacterial efficacy against Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus, with highest recorded inhibition zones of 25 ± 2 mm and 22 ± 2 mm, respectively. More than 99% of both types of strains were killed after 5 min with a near-infrared (NIR) laser at the very low concentration of 48 µg/mL. The Se-Te@Au rod’s explosion in HeLa cells was extensively repressed and demonstrated high toxicity at 100 µg/mL for 5 min when subjected to an NIR laser. As a result of its high photothermal characteristics, the exceptional anti-bacterial and anti-cancer effects of the Se-Te@Au rod are considerably better than those of other methods previously published in articles. This study could open a new framework for sterilization applications on the industrial level.
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Affiliation(s)
- Shahin Shah Khan
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China; (S.S.K.); (I.U.); (A.A.); (W.A.); (H.X.)
| | - Irfan Ullah
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China; (S.S.K.); (I.U.); (A.A.); (W.A.); (H.X.)
| | - Shah Zada
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Research Center for Bioengineering and Sensing Technology, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China;
| | - Aftab Ahmad
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China; (S.S.K.); (I.U.); (A.A.); (W.A.); (H.X.)
| | - Waqar Ahmad
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China; (S.S.K.); (I.U.); (A.A.); (W.A.); (H.X.)
| | - Haijun Xu
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China; (S.S.K.); (I.U.); (A.A.); (W.A.); (H.X.)
| | - Sadeeq Ullah
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China; (S.S.K.); (I.U.); (A.A.); (W.A.); (H.X.)
- Correspondence: (S.U.); (L.L.)
| | - Luo Liu
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China; (S.S.K.); (I.U.); (A.A.); (W.A.); (H.X.)
- Correspondence: (S.U.); (L.L.)
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Khan SS, Ullah I, Ullah S, An R, Xu H, Nie K, Liu C, Liu L. Recent Advances in the Surface Functionalization of Nanomaterials for Antimicrobial Applications. MATERIALS (BASEL, SWITZERLAND) 2021; 14:6932. [PMID: 34832332 PMCID: PMC8623114 DOI: 10.3390/ma14226932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 12/16/2022]
Abstract
Innovations in nanotechnology have had an immense impact on medicine, such as in drug delivery, tissue engineering, and medical devices that combat different pathogens. The pathogens that may cause biofilm-associated nosocomial diseases are multidrug-resistant (MDR) bacteria, such as Escherichia coli (E. coli), Pseudomonas aeruginosa (P. aeruginosa), Staphylococcus aureus (S. aureus), including both Gram-positive and Gram-negative bacterial species. About 65-80% of infections are caused by biofilm-associated pathogens creating a move in the international community toward developing antimicrobial therapies to eliminate such pathogenic infections. Several nanomaterials (NMs) have been discovered and significantly employed in various antipathogenic therapies. These NMs have unique properties of singlet oxygen production, high absorption of near-infrared irradiation, and reasonable conversion of light to heat. In this review, functionalized NPs that combat different pathogenic infections are introduced. This review highlights NMs that combat infections caused by multidrug-resistant (MDR) and other pathogenic microorganisms. It also highlights the biomedical application of NPs with regard to antipathogenic activities.
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Affiliation(s)
| | | | | | | | | | | | | | - Luo Liu
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China; (S.S.K.); (I.U.); (S.U.); (R.A.); (H.X.); (K.N.); (C.L.)
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Lambregts M, Rump B, Ropers F, Sijbom M, Petrignani M, Visser L, de Vries M, de Boer M. Antimicrobial guidelines in clinical practice: incorporating the ethical perspective. JAC Antimicrob Resist 2021; 3:dlab074. [PMID: 34235435 PMCID: PMC8254525 DOI: 10.1093/jacamr/dlab074] [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: 12/16/2020] [Accepted: 04/23/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Guidelines on antimicrobial therapy are subject to periodic revision to anticipate changes in the epidemiology of antimicrobial resistance and new scientific knowledge. Changing a policy to a broader spectrum has important consequences on both the individual patient level (e.g. effectiveness, toxicity) and population level (e.g. emerging resistance, costs). By combining both clinical data evaluation and an ethical analysis, we aim to propose a comprehensive framework to guide antibiotic policy dilemmas. Methods A preliminary framework for decision-making on antimicrobial policy was constructed based on existing literature and panel discussions. Antibiotic policy themes were translated into specific elements that were fitted into this framework. The adapted framework was evaluated in two moral deliberation groups. The moral deliberation sessions were analysed using ATLAS.ti statistical software to categorize arguments and evaluate completeness of the final framework. Results The final framework outlines the process of data evaluation, ethical deliberation and decision-making. The first phase is a factual data exploration. In the second phase, perspectives are weighed and the policy of moral preference is formulated. Judgments are made on three levels: the individual patient, the patient population and society. In the final phase, feasibility, implementation and re-evaluation are addressed. Conclusions The proposed framework facilitates decision-making on antibiotic policy by structuring existing data, identifying knowledge gaps, explicating ethical considerations and balancing interests of the individual and current and future generations.
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Affiliation(s)
- Merel Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Babette Rump
- National Institute of Public Health and the Environment, Centre for Infectious Diseases Control (RIVM-LCI), Antonie van Leeuwenhoeklaan 9, 3721MA, Bilthoven, The Netherlands
| | - Fabienne Ropers
- Department of Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Martijn Sijbom
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Mariska Petrignani
- Department of Infectious Diseases, Haaglanden Municipal Health Service, Westeinde 128, 2512HE Den Haag, The Netherlands
| | - Leo Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Martine de Vries
- Leiden University Medical Center, Department of Medical Ethics and Law, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Mark de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
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Diaconescu B, Uranues S, Fingerhut A, Vartic M, Zago M, Kurihara H, Latifi R, Popa D, Leppäniemi A, Tilsed J, Bratu M, Beuran M. The Bucharest ESTES consensus statement on peritonitis. Eur J Trauma Emerg Surg 2020; 46:1005-1023. [PMID: 32303796 DOI: 10.1007/s00068-020-01338-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Peritonitis is still an important health problem associated with high morbidity and mortality. A multidisciplinary approach to the management of patients with peritonitis may be an important factor to reduce the risks for patients and improve efficiency, outcome, and the cost of care. METHODS Expert panel discussion on Peritonitis was held in Bucharest on May 2017, during the 17th ECTES Congress, involving surgeons, infectious disease specialists, radiologists and intensivists with the goal of defining recommendations for the optimal management of peritonitis. CONCLUSION This document is an updated presentation of management of peritonitis and represents the summary of the final recommendations approved by a panel of experts.
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Affiliation(s)
- Bogdan Diaconescu
- Anatomy Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania.
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.,Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China
| | - Mihaela Vartic
- Intensive Care Unit, Emergency Clinic Hospital Bucharest, Bucharest, Romania
| | - Mauro Zago
- General and Emergency Surgery Division, Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Hayato Kurihara
- Emergency Surgery and Trauma Section, Department of General Surgery, Humanitas Clinical and Research Hospital Head, Milan, Italy
| | - Rifat Latifi
- Westchester Medical Center, Valhalla, New York, USA
| | - Dorin Popa
- Surgery Department, University Hospital Linkoping, Linköping, Sweden
| | - Ari Leppäniemi
- Division of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Jonathan Tilsed
- Honorary Senior Lecturer Hull York Medical School, Chairman UEMS Division of Emergency Surgery, Heslington, UK
| | - Matei Bratu
- Anatomy Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania
| | - Mircea Beuran
- Surgery Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania
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Grotelueschen R, Luetgehetmann M, Erbes J, Heidelmann LM, Grupp K, Karstens K, Ghadban T, Reeh M, Izbicki JR, Bachmann K. Microbial findings, sensitivity and outcome in patients with postoperative peritonitis a retrospective cohort study. Int J Surg 2019; 70:63-69. [PMID: 31437641 DOI: 10.1016/j.ijsu.2019.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/25/2019] [Accepted: 08/15/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute postoperative peritonitis resulting from previous abdominal surgery is still a severe and potentially fatal disease, which is associated with high morbidity and mortality. The aim of the present study was to evaluate patients' outcome after postoperative peritonitis and identify the most effective empiric antibiotic regimes. METHODS 422 patients with acute postoperative peritonitis as a result to earlier abdominal operation (e.g. anastomotic leakage) were analyzed retrospectively focusing on the origin of the peritonitis, microbial flora and resistance patterns. Furthermore, mortality was estimated according to sensitivity results of the tested antibiotics. RESULTS In 50% of the patients, anastomotic leakage was located in the colon. The predominantly cultured microorganisms were Escherichia coli and Enterobacteriaceae. The combination of meropenem and vancomycin was effective in 96% of these microbes. The frequently used combinations of piperacillin/sulbactam and cefotaxime/metronidazole were effective in only 67% and 43%, respectively. CONCLUSIONS We were able to show that the currently used antibiotic regimes with piperacillin/sulbactam and cefotaxime/metronidazole are ineffective in a relevant number of patients with anastomotic leakage. Only meropenem or meropenem/vancomycin cover most of the microbes predominant in postoperative peritonitis.
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Affiliation(s)
- Rainer Grotelueschen
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Marc Luetgehetmann
- Institute for Medical Microbiology, Virology and Hygiene, Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Johannes Erbes
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Lena M Heidelmann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Katharina Grupp
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Karl Karstens
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Kai Bachmann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
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de Miguel I, Prieto I, Albornoz A, Sanz V, Weis C, Turon P, Quidant R. Plasmon-Based Biofilm Inhibition on Surgical Implants. NANO LETTERS 2019; 19:2524-2529. [PMID: 30860848 DOI: 10.1021/acs.nanolett.9b00187] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The insertion of an implant in the body of a patient raises the risk of a posterior infection and formation of a biofilm, which can have critical consequences on the patient's health and be associated with a high sanitary cost. While antibacterial agents can be used to prevent the infection, such a strategy is time-limited and causes bacteria resistance. As an alternative to biochemical approaches, we propose here to use light-induced local hyperthermia with plasmonic nanoparticles. This strategy is implemented on surgical meshes, extensively used in the context of hernia repairing, one of the most common general surgeries. Surgical meshes were homogeneously coated with gold nanorods designed to efficiently convert near-infrared light into heat. The modified mesh was exposed to a biofilm of Staphylococcus aureus ( S. aureus) bacteria before being treated with a train of light pulses. We systematically study how the illumination parameters, namely fluence, peak intensity and pulse length, influence the elimination of attached bacteria. Additionally, fluorescence confocal microscopy provides us some insight on the mechanism involved in the degradation of the biofilm. This proof-of-principle study opens a new set of opportunities for the development of novel disinfection approaches combining light and nanotechnology.
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Affiliation(s)
- Ignacio de Miguel
- ICFO-Institut de Ciències Fotòniques , The Barcelona Institute of Science and Tehcnology , 08860 Castelldefels (Barcelona) , Spain
| | - Irene Prieto
- Department of Research and Development , B. Braun Surgical, S.A. , 08191 Rubí, Barcelona , Spain
| | - Arantxa Albornoz
- ICFO-Institut de Ciències Fotòniques , The Barcelona Institute of Science and Tehcnology , 08860 Castelldefels (Barcelona) , Spain
| | - Vanesa Sanz
- Department of Research and Development , B. Braun Surgical, S.A. , 08191 Rubí, Barcelona , Spain
| | - Christine Weis
- Department of Research and Development , B. Braun Surgical, S.A. , 08191 Rubí, Barcelona , Spain
| | - Pau Turon
- Department of Research and Development , B. Braun Surgical, S.A. , 08191 Rubí, Barcelona , Spain
| | - Romain Quidant
- ICFO-Institut de Ciències Fotòniques , The Barcelona Institute of Science and Tehcnology , 08860 Castelldefels (Barcelona) , Spain
- ICREA -Institució Catalana de Recerca i Estudis Avançats , 08010 Barcelona , Spain
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Pochhammer J, Kramer A, Schäffer M. [Enterococci and surgical site infections : Causal agent or harmless commensals?]. Chirurg 2018; 88:377-384. [PMID: 28233041 DOI: 10.1007/s00104-017-0388-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The role of enterococci in the context of peritonitis and surgical site infections (SSI) has not yet been definitively clarified but enterococci are being detected more frequently. Numerous resistances reduce the available antibiotic options. OBJECTIVE This article gives an overview of the pathogenic importance of enterococci and of current recommendations for therapy and prophylaxis. On the basis of our own data we discuss the relevance of enterococci for SSI. MATERIAL AND METHODS All colorectal resections carried out between January 2008 and September 2016 were retrospectively documented. Revision surgery, SSI and intra-abdominally or subcutaneously detected pathogens were recorded. RESULTS A total of 2713 interventions were evaluated with 28.3% having primary peritonitis. In 587 patients (21.6%) SSI followed, and pathogen determination was possible in 431 cases (73.4%). Enterococci were frequently found in re-operations (58.4%) and SSI (46.1%), with E. faecalis and E. faecium in approximately equal proportions. If intra-abdominal enterococci were detectable in patients with primary peritonitis, it was more common to develop SSI and enterococci were more frequently detected subcutaneously. Enterococci in SSI were found to be significantly more frequent in left hemicolectomies as well as in pre-existing renal insufficiency. CONCLUSION It can be inferred that enterococci are not adequately covered by commonly used perioperative antibiotic therapy or preoperative prophylaxis, which increases the risk for SSI by enterococci. This could be favored by selection of these pathogens due to the use of antibiotics without enterococcal efficacy (e. g. cephalosporins). The consideration in the choice of perioperative antibiotic prophylaxis by the additional administration of ampicillin or vancomycin could be advantageous.
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Affiliation(s)
- J Pochhammer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Böheimstr. 39, 70199, Stuttgart, Deutschland.
| | - A Kramer
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - M Schäffer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Böheimstr. 39, 70199, Stuttgart, Deutschland
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8
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Wu H, Xie S, Yu J, Chen Y, Wu J, Guo B, Zhu Z, Zhou Y, Wang Z, Zhang J. Pharmacokinetics and Pharmacodynamics of Levornidazole in Patients With Intra-abdominal Anaerobic Infection. Clin Ther 2018; 40:1548-1555. [DOI: 10.1016/j.clinthera.2018.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
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Abstract
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections. Optimizing antibiotic dosing through prolonged infusions can be beneficial in intensive care populations with altered pharmacokinetics. Antimicrobial stewardship teams can assist ICU providers in managing and implementing these tactics. This review will discuss the current literature on antibiotic use in the ICU applying antimicrobial stewardship strategies. Based upon the most recent evidence, ICUs would benefit from employing empiric guidelines for antibiotic use, collecting appropriate specimens and implementing molecular diagnostics, optimizing the dosing of antibiotics, and reducing the duration of total therapy. These strategies for antibiotic use have the potential to enhance patient care while preventing adverse outcomes.
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Affiliation(s)
- Maureen Campion
- 1 Division of Infectious Disease, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Gail Scully
- 1 Division of Infectious Disease, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
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Abstract
PURPOSE To investigate and analyze the clinical and etiological characteristics of community-acquired intraabdominal infections (CIAIs) and hospital-acquired or nosocomial intraabdominal infections (NIAIs) in a comprehensive hospital, to understand the characteristics, pathogen composition, and drug resistance of CIAIs as well as NIAIs, and to provide a reference for clinical treatment. METHODS We collected the clinical data of patients with intraabdominal infections admitted to our hospital from June 2013 to June 2014. In vitro drug sensitivity tests were conducted to separate pathogens, and the data were analyzed using the WHONET 5.4 software and SPSS 13.0 software. RESULTS A total of 221 patients were enrolled in the study, including 144 with CIAIs (55 mild-moderate and 89 severe) and 77 with NIAIs. We isolated 322 pathogenic strains, including 234 strains of gram-negative bacteria, 82 strains of gram-positive bacteria, and 6 strains of fungi. Based on clinical features, NIAIs and severe CIAIs presented significantly higher values in age, length of hospital stay, mortality, and the incidence of severe intra-abdominal infection than mild-moderate CIAIs (p < 0.05). There was no significant difference in the prognosis between NIAIs and severe CIAIs. Primary diseases leading to CIAIs and NIAIs mostly were hepatobiliary diseases and gastrointestinal diseases respectively. Bacteria isolated from various types of IAIs mainly were Enterobacteriaceae; mild-moderate CIAIs mostly were mono-infection of gram-negative bacteria; NIAIs mostly were mixed infections of gram-negative and gram-positive bacteria; and severe CIAIs were from either type of infection. The rate of Extended Spectrum b-Lactamase-producing Escherichia coli and Klebsiella pneumoniae was much higher in NIAIs than in CIAIs (p < 0.05). The antimicrobial drug sensitivity of gram-negative bacteria isolated from NIAIs was significantly lower than that of CIAIs. CONCLUSION CIAIs and NIAIs have their own unique clinical features and epidemiological features of pathogens which should be considered during the initial empiric therapy for the rational use of antimicrobial drugs. Regional IAIs pathogenic bacteria have their own features in drug resistance, slightly different from some recommendations of 2010 Infectious Diseases Society of America guidelines.
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Affiliation(s)
- Shu Zhang
- Department of Infectious Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400013, China
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Sanders JM, Tessier JM, Sawyer RG, Lipsett PA, Miller PR, Namias N, O'Neill PJ, Dellinger EP, Coimbra R, Guidry CA, Cuschieri J, Banton KL, Cook CH, Moore BJ, Duane TM. Inclusion of Vancomycin as Part of Broad-Spectrum Coverage Does Not Improve Outcomes in Patients with Intra-Abdominal Infections: A Post Hoc Analysis. Surg Infect (Larchmt) 2016; 17:694-699. [PMID: 27483362 DOI: 10.1089/sur.2016.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Management of complicated intra-abdominal infections (cIAIs) includes broad-spectrum antimicrobial coverage and commonly includes vancomycin for the empiric coverage of methicillin-resistant Staphylococcus aureus (MRSA). Ideally, culture-guided de-escalation follows to promote robust antimicrobial stewardship. This study assessed the impact and necessity of vancomycin in cIAI treatment regimens. PATIENTS AND METHODS A post hoc analysis of the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial was performed. Patients receiving piperacillin-tazobactam (P/T) and/or a carbapenem were included with categorization based on use of vancomycin. Univariate and multivariable analyses evaluated effects of including vancomycin on individual and the composite of undesirable outcomes (recurrent IAI, surgical site infection [SSI], or death). RESULTS The study cohort included 344 patients with 110 (32%) patients receiving vancomycin. Isolation of MRSA occurred in only eight (2.3%) patients. Vancomycin use was associated with a similar composite outcome, 29.1%, vs. no vancomycin, 22.2% (p = 0.17). Patients receiving vancomycin had (mean [standard deviation]) higher Acute Physiology and Chronic Health Evaluation II scores (13.1 [6.6] vs. 9.4 [5.7], p < 0.0001), extended length of stay (12.6 [10.2] vs. 8.6 [8.0] d, p < 0.001), and prolonged antibiotic courses (9.1 [8.0] vs. 7.1 [4.9] d, p = 0.02). After risk adjustment in a multivariate model, no significant difference existed for the measured outcomes. CONCLUSIONS This post hoc analysis reveals that addition of vancomycin occurred in nearly one third of patients and more often in sicker patients. Despite this selection bias, no appreciable differences in undesired outcomes were demonstrated, suggesting limited utility for adding vancomycin to cIAI treatment regimens.
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Affiliation(s)
| | | | - Robert G Sawyer
- 2 Departments of Surgery and Public Health Sciences, University of Virginia , Charlottesville, Virginia
| | - Pam A Lipsett
- 3 Departments of Surgery, Anesthesiology, Critical Care Medicine, and Nursing, The Johns Hopkins University Schools of Medicine and Nursing , Baltimore, Maryland
| | - Preston R Miller
- 4 Department of Surgery, Wake Forest-Baptist Health , Winston-Salem, North Carolina
| | - Nicholas Namias
- 5 Department of Surgery, University of Miami Health System , Miami, Florida
| | | | - E P Dellinger
- 7 Department of Surgery, University of Washington , Seattle, Washington
| | - Raul Coimbra
- 8 Department of Surgery, University of California-San Diego , San Diego, California
| | - Chris A Guidry
- 9 Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Joseph Cuschieri
- 10 Department of Surgery, University of Washington , Seattle, Washington
| | - Kaysie L Banton
- 11 Department of Surgery, University of Minnesota , Minneapolis, Minnesota
| | - Charles H Cook
- 12 Department of Surgery, Beth Israel Deaconess-Harvard Medical School , Boston, Massachusetts
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12
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Zhang Z, Tang J, Wang H, Xia Q, Xu S, Han CC. Controlled Antibiotics Release System through Simple Blended Electrospun Fibers for Sustained Antibacterial Effects. ACS APPLIED MATERIALS & INTERFACES 2015; 7:26400-26404. [PMID: 26596498 DOI: 10.1021/acsami.5b09820] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Implantation of sustained antibacterial system after abdominal surgery could effectively prevent complicated intra-abdominal infection. In this study, a simple blended electrospun membrane made of poly(D,L-lactic-co-glycolide) (PLGA)/poly(dioxanone) (PDO)/Ciprofloxacin hydrochloride (CiH) could easily result in approximately linear drug release profile and sustained antibacterial activity against both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The addition of PDO changed the stack structure of PLGA, which in turn influenced the fiber swelling and created drug diffusion channels. It could be a good candidate for reducing postoperative infection or be associated with other implant to resist biofilm formation.
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Affiliation(s)
- Zixin Zhang
- State Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory of Polymer Science and Materials, Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190, P. R. China
- University of Chinese Academy of Sciences , Beijing 100049, P. R. China
| | - Jianxiong Tang
- Huadong Hospital affiliated to Fudan University , Shanghai 200040, P. R. China
| | - Heran Wang
- Torch High Technology Industry Development Center, Ministry of Science and Technology , Beijing 100045, P. R. China
| | - Qinghua Xia
- State Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory of Polymer Science and Materials, Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190, P. R. China
- University of Chinese Academy of Sciences , Beijing 100049, P. R. China
| | - Shanshan Xu
- State Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory of Polymer Science and Materials, Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190, P. R. China
| | - Charles C Han
- State Key Laboratory of Polymer Physics and Chemistry, Joint Laboratory of Polymer Science and Materials, Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190, P. R. China
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Maseda E, Gimenez MJ, Gilsanz F, Aguilar L. Basis for selecting optimum antibiotic regimens for secondary peritonitis. Expert Rev Anti Infect Ther 2015; 14:109-24. [PMID: 26568097 DOI: 10.1586/14787210.2016.1120669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Adequate management of severely ill patients with secondary peritonitis requires supportive therapy of organ dysfunction, source control of infection and antimicrobial therapy. Since secondary peritonitis is polymicrobial, appropriate empiric therapy requires combination therapy in order to achieve the needed coverage for both common and more unusual organisms. This article reviews etiological agents, resistance mechanisms and their prevalence, how and when to cover them and guidelines for treatment in the literature. Local surveillances are the basis for the selection of compounds in antibiotic regimens, which should be further adapted to the increasing number of patients with risk factors for resistance (clinical setting, comorbidities, previous antibiotic treatments, previous colonization, severity…). Inadequate antimicrobial regimens are strongly associated with unfavorable outcomes. Awareness of resistance epidemiology and of clinical consequences of inadequate therapy against resistant bacteria is crucial for clinicians treating secondary peritonitis, with delicate balance between optimization of empirical therapy (improving outcomes) and antimicrobial overuse (increasing resistance emergence).
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Affiliation(s)
- Emilio Maseda
- a Anesthesiology and Surgical Critical Care Department , Hospital Universitario La Paz , Madrid , Spain
| | | | - Fernando Gilsanz
- a Anesthesiology and Surgical Critical Care Department , Hospital Universitario La Paz , Madrid , Spain
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14
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Membrilla-Fernández E, Sancho-Insenser JJ, Girvent-Montllor M, Álvarez-Lerma F, Sitges-Serra A. Effect of initial empiric antibiotic therapy combined with control of the infection focus on the prognosis of patients with secondary peritonitis. Surg Infect (Larchmt) 2015; 15:806-14. [PMID: 25397738 DOI: 10.1089/sur.2013.240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In patients with intra-abdominal infection, inappropriate initial empiric antibiotic therapy is associated with greater morbidity. We evaluated the impact of adequate empiric antibiotic treatment together with control of the infection focus on the morbidity and mortality rates of patients with secondary peritonitis. METHODS This was a prospective, observational study with the participation of 24 Spanish hospitals and 362 patients with secondary peritonitis (262 community-acquired, 100 post-operative). Therapeutic failure (infectious complications or death) was classified into four categories according to whether empiric antibiotic treatment was appropriate and the infection focus was controlled. RESULTS The rates of therapeutic failure, re-operation, and mortality were 48%, 13%, and 8%, respectively. Empiric antibiotic treatment was inappropriate in 39% of cases, which was associated with a higher rate of surgical site infection (53% vs. 40%; p=0.031) and death (12% vs. 5%; p=0.021) than was observed in patients receiving appropriate initial empiric therapy. Eight percent of patients in whom control of the infection focus was not obtained suffered from more infectious complications (76% vs. 52%; p=0.01) and surgical site infections (69% vs. 44%; p=0.01); and in this group, both therapeutic failure and mortality rates were similar, independent of whether the empiric antibiotic therapy was appropriate. CONCLUSION Inappropriate initial empiric antibiotic therapy was associated with higher rates of therapeutic failure, surgical site infection, re-operation, and death. Classification of therapeutic failure into four categories according to the appropriateness of empiric antibiotic therapy and the success of infection control provided excellent discrimination of morbidity and death.
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Affiliation(s)
- Estela Membrilla-Fernández
- 1 Unit of Emergency Surgery and Service of General and Digestive Surgery, Universitat Autònoma de Barcelona , Barcelona, Spain
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Hennessy SA, Shah PM, Guidry CA, Davies SW, Hranjec T, Sawyer RG. Can Nasal Methicillin-Resistant Staphylococcus aureus Screening Be Used to Avoid Empiric Vancomycin Use in Intra-Abdominal Infection? Surg Infect (Larchmt) 2015; 16:396-400. [PMID: 26069990 DOI: 10.1089/sur.2014.211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vancomycin is used widely as empiric therapy for gram-positive organisms in patients with an intra-abdominal infection (IAI), even in those with no history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization. Potential adverse effects of vancomycin include nephrotoxicity, increased cost, and bacterial resistance. We hypothesized that MRSA nasal screening could be used to predict patients with a MRSA IAI and used to avoid unnecessary empiric vancomycin use. METHODS A surgical infections database collected prospectively from a single institution was reviewed for all IAIs between January 1, 2000-December 31, 2011. Patients with and without MRSA obtained from abdominal cultures as either a monomicrobial or polymicrobial isolate were compared by univariate analysis. A multivariable logistic regression was performed to identify independent predictors of MRSA IAI. RESULTS Of 2,591 patients with an IAI, 240 patients had a nasal MRSA screen within 30 d prior to infection and abdominal culture data, with an incidence of 23% for MRSA IAI. Patients with MRSA IAI (n=45) had more healthcare associated infections, lower white blood cell counts and greater rates of positive nasal MRSA screenings compared with those with non-MRSA IAI. By multivariable analysis (C statistic=0.908), the strongest independent predictor of an MRSA IAI was a positive MRSA screen (odds ratio [OR] 40.9, confidence interval [CI] 14.2-118.1). The positive predictive value for a MRSA screen was 53% whereas the negative predictive value of a MRSA screen was 97%. CONCLUSION A negative MRSA nasal screen indicates with near certainty the absence of MRSA as part of an IAI. In the setting of a recent screen, empiric vancomycin can be withheld. Further, rapid MRSA nasal screening could be used to forego or to discontinue vancomycin therapy rapidly in the setting of IAI. This change in empiric antibiotic management of IAI may lead to decreased morbidity, reduction in cost, and a decrease in bacterial resistance.
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Affiliation(s)
- Sara A Hennessy
- 1 Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Puja M Shah
- 1 Department of Surgery, University of Virginia , Charlottesville, Virginia
| | | | - Stephen W Davies
- 1 Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Tjasa Hranjec
- 2 Department of Surgery, University of Texas Southwestern , Dallas, Texas
| | - Robert G Sawyer
- 1 Department of Surgery, University of Virginia , Charlottesville, Virginia
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New insights into the antimicrobial effect of mast cells against Enterococcus faecalis. Infect Immun 2014; 82:4496-507. [PMID: 25114115 DOI: 10.1128/iai.02114-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Enterococcus faecalis has emerged as an important cause of life-threatening multidrug-resistant bacterial infections in the hospital setting. The pathogenesis of enterococcal infections has remained a relatively neglected field despite their obvious clinical relevance. The objective of this study was to characterize the interactions between mast cells (MCs), an innate immune cell population abundant in the intestinal lamina propria, and E. faecalis. This study was conducted with primary bone marrow-derived murine MCs. The results demonstrated that MCs exerted an antimicrobial effect against E. faecalis that was mediated both by degranulation, with the concomitant discharge of the antimicrobial effectors contained in the granules, and by the release of extracellular traps, in which E. faecalis was snared and killed. In particular, the cathelicidin LL-37 released by the MCs had potent antimicrobial effect against E. faecalis. We also investigated the specific receptors involved in the recognition of E. faecalis by MCs. We found that Toll-like receptors (TLRs) are critically involved in the MC recognition of E. faecalis, since MCs deficient in the expression of MyD88, an adaptor molecule required for signaling by most TLRs, were significantly impaired in their capacity to degranulate, to reduce E. faecalis growth as well as to release tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) after encountering this pathogen. Furthermore, TLR2 was identified as the most prominent TLR involved in the recognition of E. faecalis by MCs. The results of this study indicate that MCs may be important contributors to the host innate immune defenses against E. faecalis.
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De Waele J, Lipman J, Sakr Y, Marshall JC, Vanhems P, Barrera Groba C, Leone M, Vincent JL. Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome. BMC Infect Dis 2014; 14:420. [PMID: 25074742 PMCID: PMC4122779 DOI: 10.1186/1471-2334-14-420] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. METHODS EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. RESULTS Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤ 2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. CONCLUSIONS The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.
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Affiliation(s)
- Jan De Waele
- Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
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Mayne D, Dowzicky MJ. In vitro activity of tigecycline and comparators against organisms associated with intra-abdominal infections collected as part of TEST (2004-2009). Diagn Microbiol Infect Dis 2012; 74:151-7. [PMID: 22770774 DOI: 10.1016/j.diagmicrobio.2012.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 05/30/2012] [Accepted: 05/31/2012] [Indexed: 11/17/2022]
Abstract
As part of the Tigecycline Evaluation and Surveillance Trial (TEST), bacterial isolates were collected consecutively from centers globally between 2004 and 2009. MICs were determined locally using Clinical and Laboratory Standards Institute broth microdilution methodology. A total of 3114 anaerobic and 99,256 aerobic isolates were included in this study. The most active agents against Gram-negative anaerobes were metronidazole and meropenem (resistance ranges 0.0-0.5% and 0.0-0.9%, respectively); piperacillin-tazobactam was also active (resistance range 0.5-9.4%). Among Gram-positive anaerobes, resistance rates were lowest for meropenem, piperacillin-tazobactam, and metronidazole (ranges 0.0-0.5%, 0.0-1.8%, and 0.0-3.2% respectively). Tigecycline MIC(90) values for anaerobes ranged from 0.12 to 2 μg/mL. The most active antimicrobial agent against Gram-negative aerobes (excluding Pseudomonas aeruginosa) was tigecycline, with resistance ranging from <0.01% to 1.4%. Resistance was also low for imipenem (0.3-9.4%) and meropenem (0.7-15.1%). Extended-spectrum beta-lactamases were produced by 12.2% and 19.7% of E. coli and K. pneumoniae isolates, respectively.
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Qvist N, Warren B, Leister-Tebbe H, Zito ET, Pedersen R, McGovern PC, Babinchak T. Efficacy of Tigecycline versus Ceftriaxone Plus Metronidazole for the Treatment of Complicated Intra-Abdominal Infections: Results from a Randomized, Controlled Trial. Surg Infect (Larchmt) 2012; 13:102-9. [DOI: 10.1089/sur.2011.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Niels Qvist
- Surgical Department A, Odense University Hospital, Odense, Denmark
| | - Brian Warren
- Division of Surgery, Tygerberg Hospital and the University of Stellenbosch, Tygerberg, South Africa
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Peritonitis terciaria: tan difícil de definir como de tratar. Cir Esp 2012; 90:11-6. [DOI: 10.1016/j.ciresp.2010.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 09/10/2010] [Accepted: 11/01/2010] [Indexed: 12/17/2022]
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Eckmann C, Dryden M, Montravers P, Kozlov R, Sganga G. Antimicrobial treatment of "complicated" intra-abdominal infections and the new IDSA guidelines ? a commentary and an alternative European approach according to clinical definitions. Eur J Med Res 2011; 16:115-26. [PMID: 21486724 PMCID: PMC3352208 DOI: 10.1186/2047-783x-16-3-115] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/25/2011] [Indexed: 01/27/2023] Open
Abstract
Recently, an update of the IDSA guidelines for the treatment of complicated intraabdominal infections has been published. No guideline can cater for all variations in ecology, antimicrobial resistance patterns, patient characteristics and presentation, health care and reimbursement systems in many different countries. In the short time the IDSA guidelines have been available, a number of practical clinical issues have been raised by physicians regarding interpretation of the guidelines. The main debatable issues of the new IDSA guidelines are described as follows: The authors of the IDSA guidelines present recommendations for the following subgroups of "complicated" IAI: community-acquired intra-abdominal infections of mild-to-moderate and high severity and health care-associated intra-abdominal infections (no general treatment recommendations, only information about antimicrobial therapy of specific resistant bacterial isolates). From a clinical point of view, "complicated" IAI are better differentiated into primary, secondary (community-acquired and postoperative) and tertiary peritonitis. Those are the clinical presentations of IAI as seen in the emergency room, the general ward and on ICU. Future antibiotic treatment studies of IAI would be more clinically relevant if they included patients in studies for the efficacy and safety of antibiotics for the treatment of the above mentioned forms of IAI, rather than conducting studies based on the vague term "complicated" intra-abdominal infections. - The new IDSA guidelines for the treatment of resistant bacteria fail to mention many of new available drugs, although clinical data for the treatment of "complicated IAI" with new substances exist. Furthermore, treatment recommendations for cIAI caused by VRE are not included. This group of diseases comprises enough patients (i.e. the entire group of postoperative and tertiary peritonitis, recurrent interventions in bile duct surgery or necrotizing pancreatitis) to provide specific recommendations for such antimicrobial treatment. - A panel of European colleagues from surgery, intensive care, clinical microbiology and infectious diseases has developed recommendations based on the above mentioned clinical entities with the aim of providing clear therapeutic recommendations for specific clinical diagnoses. An individual patient-centered approach for this very important group of diseases with a substantial morbidity and mortality is essential for optimal antimicrobial treatment.
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Affiliation(s)
- Christian Eckmann
- Klinikum Peine gGmbH, Academic Hospital of Medical University Hannover, Virchowstrasse 8h, 31226 Peine, Germany.
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Guirao X. [What should and should not be covered in intraabdominal infection]. Enferm Infecc Microbiol Clin 2011; 28 Suppl 2:32-41. [PMID: 21130928 DOI: 10.1016/s0213-005x(10)70028-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite improvements in our knowledge of the physiopathology of severe infection, diagnostic methods, antibiotic therapy, postoperative care and surgical techniques, a substantial number of patients with intraabdominal infection (IAI) will develop advanced stages of septic insult requiring admission to the intensive care unit. The success of treatment of IAI is multifactorial and the best antibiotic protocol may be insufficient unless adequate control of the focus of infection has been achieved. The present article discusses the appropriacy of empirical antibiotic therapy and the main pathogens associated with treatment failure. We also analyze the patients at risk of infection with microorganisms requiring broad-spectrum antimicrobial coverage. However, excessive antibiotic treatment, in terms of either spectrum or duration, could jeopardize future patients in an environment already threatened by the scarcity of research and development into new molecules required for the emergence of pathogens resistant to current antibiotics.
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Herzog T, Chromik AM, Uhl W. Treatment of complicated intra-abdominal infections in the era of multi-drug resistant bacteria. Eur J Med Res 2011; 15:525-32. [PMID: 21163727 PMCID: PMC3352101 DOI: 10.1186/2047-783x-15-12-525] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The management of severe intra-abdominal infections remains a major challenge facing surgeons and intensive care physicians, because of its association with high morbidity and mortality. Surgical management and intensive care medicine have constantly improved, but in the recent years a rapidly continuing emergence of resistant pathogens led to treatment failure secondary to infections with multi-drug resistant bacteria. In secondary peritonitis the rate of resistant germs at the initial operation is already 30%. The lack of effective antibiotics against these pathogens resulted in the development of new broad-spectrum compounds and antibiotics directed against resistant germs. But so far no "super-drug" with efficacy against all resistant bacteria exists. Even more, soon after their approval, reports on resistance against these novel drugs have been reported, or the drugs were withdrawn from the market due to severe side effects. Since pharmaceutical companies reduced their investigations on antibiotic research, only few new antimicrobial derivates are available. In abdominal surgery you may be in fear that in the future more and more patients with tertiary peritonitis secondary to multi-drug resistant species are seen with an increase of mortality after secondary peritonitis. This article reviews the current treatment modalities for complicated intra-abdominal infections with special reference to the antibiotic treatment of complicated intra-abdominal infections with multi-drug resistant species.
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Affiliation(s)
- T Herzog
- Department of Surgery, St. Josef Hospital Bochum, Hospital of the Ruhr-University, Gudrunstr. 56, 44791 Bochum, Germany
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Kambaroudis AG, Papadopoulos S, Christodoulidou M, Gerasimidis T. Perioperative use of antibiotics in intra-abdominal surgical infections. Surg Infect (Larchmt) 2010; 11:535-44. [PMID: 20969472 DOI: 10.1089/sur.2009.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We created a questionnaire with the aim of evaluating surgeon compliance with the guidelines for antibiotic use in the perioperative period in intra-abdominal surgical infections. We discuss the problems emerging from non-adherence to these guidelines. METHODS In the questionnaire, we tried to correlate the type of intra-abdominal infection with: (1) Time of antibiotic administration commencement; (2) type of antibiotic(s) administered; (c) duration of antibiotic administration; and (4) modification of antibiotic type/duration of administration in the presence of factors increasing the risk of treatment failure. In order to collect and process the data more easily, the patients were divided into four groups-Group A: Community patients with intra-abdominal surgical infections and simple contamination of the peritoneal cavity according to the Surgical Infection Society (SIS) guidelines; Group B: Community patients with an intra-abdominal surgical infection evolving to secondary peritonitis per SIS guidelines; Group C: Community patients with an intra-abdominal surgical infection with a high risk of surgical site infection; and Group D: Patients with recent hospitalization or nosocomial or postoperative intra-abdominal infection. RESULTS The questionnaire was sent to the directors of 43 surgical clinics in northern Greece, and 27 answered (63%). In 81.5% of the clinics (median 22; range 15-24), depending on the type of infection, empirical antibiotic treatment commenced preoperatively. In Group A, on average, 29.6% of the clinics (median 8; range 5-16) administer antibiotics for as long as 24 h, and 11.1% (median 3; range 1-10) use antibiotics not recommended in the SIS guidelines (e.g., third- and fourth-generation cephalosporins, ciprofloxacin, imipenem-cilastatin, meropenem, or piperacillin/tazobactam). In Group B, 22.2% of clinics (median 6; range 2-15) administer antibiotics for three to five days, and 14.8% (median 4; range 1-11) use antibiotics outside SIS guidelines. In Group C, 40.7% of clinics (median 11; range 1-14) administer antibiotics for more than five days, and 14.8% (median 4; range 1-14) use antibiotics that are outside the SIS guidelines. In Group D, 11.1% of clinics (median 3; range 2-5) do not cover Enterococcus with the antibiotics administered. CONCLUSIONS There seems to be confusion in determining the situations with simple contamination of the peritoneal cavity, whose treatment requires short-duration antibiotic administration, and in the type of antibiotics administered to various patient groups, elements that lead to prolonged or erroneous administration of antibiotic drugs. Continuous discussion and surgeon training is imperative and may be the best choice to ensure familiarity with antibiotics and their proper use and thus to minimize serious adverse events and treatment failure.
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Guirao X, Arias J, Badía JM, García-Rodríguez JA, Mensa J, Álvarez-Lerma F, Borges M, Barberán J, Maseda E, Salavert M, Llinares P, Gobernado M, García Rey C. Recomendaciones en el tratamiento antibiótico empírico de la infección intraabdominal. Cir Esp 2010; 87:63-81. [DOI: 10.1016/j.ciresp.2009.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022]
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Park SY, Shin YP, Kim CH, Park HJ, Seong YS, Kim BS, Seo SJ, Lee IH. Immune evasion of Enterococcus faecalis by an extracellular gelatinase that cleaves C3 and iC3b. THE JOURNAL OF IMMUNOLOGY 2009; 181:6328-36. [PMID: 18941224 DOI: 10.4049/jimmunol.181.9.6328] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Enterococcus faecalis (Ef) accounts for most cases of enterococcal bacteremia, which is one of the principal causes of nosocomial bloodstream infections (BSI). Among several virulence factors associated with the pathogenesis of Ef, an extracellular gelatinase (GelE) has been known to be the most common factor, although its virulence mechanisms, especially in association with human BSI, have yet to be demonstrated. In this study, we describe the complement resistance mechanism of Ef mediated by GelE. Using purified GelE, we determined that it cleaved the C3 occurring in human serum into a C3b-like molecule, which was inactivated rapidly via reaction with water. This C3 convertase-like activity of GelE was shown to result in a consumption of C3 and thus inhibited the activation of the complement system. Also, GelE was confirmed to degrade an iC3b that was deposited on the Ag surfaces without affecting the bound C3b. This proteolytic effect of GelE against the major complement opsonin resulted in a substantial reduction in Ef phagocytosis by human polymorphonuclear leukocytes. In addition, we verified that the action of GelE against C3, which is a central component of the complement cascade, was human specific. Taken together, it was suggested that GelE may represent a promising molecule for targeting human BSI associated with Ef.
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Affiliation(s)
- Shin Yong Park
- Department of Biotechnology, Hoseo University, Asan City, Chungnam, South Korea
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Virulent synergistic effect between Enterococcus faecalis and Escherichia coli assayed by using the Caenorhabditis elegans model. PLoS One 2008; 3:e3370. [PMID: 18843374 PMCID: PMC2557124 DOI: 10.1371/journal.pone.0003370] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 09/16/2008] [Indexed: 12/12/2022] Open
Abstract
Background The role of enterococci in the pathogenesis of polymicrobial infections is still debated. The purpose of this study was to evaluate the effect of virulent enterococci in the presence or absence of Escherichia coli strains in the in vivo Caenorhabditis elegans model. Principal Findings This study demonstrated that there was a synergistic effect on virulence when an association of enterococci and E. coli (LT50 = 1.6 days±0.1 according to the tested strains and death of nematodes in 4 days±0.5) was tested in comparison with enterococci alone (LT50 = 4.6 days±0.1 and death in 10.4 days±0.6) or E. coli alone (LT50 = 2.1±0.9 and deaths 6.6±0.6) (p<0.001). In addition, there was a relation between the virulence of E. faecalis strains alone and the virulence potential of the association with E. coli strains. Finally, in the presence of avirulent E. coli strains, enterococci have no effect (LT50 = 4.3±0.5 and deaths in 10.8±0.8), independently of the level of their own virulence, demonstrating that the ‘enterococci effect’ only occurred in the presence of virulent E. coli strains. Conclusion This study allows a better understanding of a bacterial cooperation. Moreover, it could help to optimize the antibiotic regimen during polymicrobial infections.
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Abstract
This review describes the microbiology, diagnosis, and management of intra-abdominal infections. These infections include secondary peritonitis, abdominal abscesses, and cholangitis. The infection generally occurs because enteric microorganisms enter the peritoneal cavity through a defect in the wall of the intestine or other viscus as a result of obstruction, infarction, or direct trauma. Mixed aerobic and anaerobic flora can be recovered. The predominant aerobic isolates are Escherichia coli, etc. The aerobic isolates are Escherichia coli, and enterococci, and the main anaerobic bacteria are Bacteroides fragilis group Peptostreptococcus spp. and Clostridium spp. The treatment of abdominal infection includes surgical correction and drainage of pus and administration of antimicrobials effective against both the aerobic and anaerobic pathogens.
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