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Boutet-Dubois A, Magnan C, Lienard A, Pouget C, Bouchet F, Marchandin H, Larcher R, Lavigne JP, Pantel A. In Vivo-Acquired Resistance to Daptomycin during Methicillin-Resistant Staphylococcus aureus Bacteremia. Antibiotics (Basel) 2023; 12:1647. [PMID: 38136681 PMCID: PMC10740961 DOI: 10.3390/antibiotics12121647] [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: 09/28/2023] [Revised: 11/11/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
Daptomycin (DAP) represents an interesting alternative to treat methicillin-resistant Staphylococcus aureus (MRSA) infections. Different mechanisms of DAP resistance have been described; however, in vivo-acquired resistance is uncharacterized. This study described the phenotypic and genotypic evolution of MRSA strains that became resistant to DAP in two unrelated patients with bacteremia under DAP treatment, in two hospitals in the South of France. DAP MICs were determined using broth microdilution method on the pairs of isogenic (DAP-S/DAP-R) S. aureus isolated from bloodstream cultures. Whole genome sequencing was carried out using Illumina MiSeq Sequencing system. The two cases revealed DAP-R acquisition by MRSA strains within three weeks in patients treated by DAP. The isolates belonged to the widespread ST5 (patient A) and ST8 (patient B) lineages and were of spa-type t777 and t622, respectively. SNP analysis comparing each DAP-S/DAP-R pair confirmed that the isolates were isogenic. The causative mutations were identified in MprF (Multiple peptide resistance Factor) protein: L826F (Patient A) and S295L (Patient B), and in Cls protein: R228H (Patient B). These proteins encoded both proteins of the lipid biosynthetic enzymes. The resistance to DAP is particularly poorly described whereas DAP is highly prescribed to treat MRSA. Our study highlights the non-systematic cross-resistance between DAP and glycopeptides and the importance of monitoring DAP MIC in persistent MRSA bacteremia.
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Affiliation(s)
- Adeline Boutet-Dubois
- VBIC, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (A.B.-D.); (C.M.); (C.P.); (A.P.)
| | - Chloé Magnan
- VBIC, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (A.B.-D.); (C.M.); (C.P.); (A.P.)
| | - Alexi Lienard
- Laboratory of Medical Biology, CH Bassin de Thau, 34207 Sète, France;
| | - Cassandra Pouget
- VBIC, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (A.B.-D.); (C.M.); (C.P.); (A.P.)
| | - Flavien Bouchet
- Department of Internal Medicine-Infectiology, CH Bassin de Thau, 34207 Sète, France;
| | - Hélène Marchandin
- HydroSciences Montpellier, Department of Microbiology and Hospital Hygiene, University of Montpellier, CNRS, IRD, CHU Nîmes, 30029 Nîmes, France;
| | - Romaric Larcher
- Department of Infectious Diseases, CHU Nîmes, 30029 Nîmes, France;
| | - Jean-Philippe Lavigne
- VBIC, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (A.B.-D.); (C.M.); (C.P.); (A.P.)
| | - Alix Pantel
- VBIC, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (A.B.-D.); (C.M.); (C.P.); (A.P.)
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García de la Mària C, Cañas MA, Fernández-Pittol M, Dahl A, García-González J, Hernández-Meneses M, Cuervo G, Moreno A, Miró JM, Marco F. Emerging issues on Staphylococcus aureus endocarditis and the role in therapy of daptomycin plus fosfomycin. Expert Rev Anti Infect Ther 2023; 21:281-293. [PMID: 36744387 DOI: 10.1080/14787210.2023.2174969] [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] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Methicillin-resistant and -susceptible Staphylococcus aureus (MRSA/MSSA) infections are a major global health-care problem. Bacteremia with S. aureus exhibits high rates of morbidity and mortality and can cause complicated infections such as infective endocarditis (IE). The emerging resistance profile of S. aureus is worrisome, and several international agencies have appealed for new treatment approaches to be developed. AREAS COVERED Daptomycin presents a rapid bactericidal effect against MRSA and has been considered at least as effective as vancomycin in treating MRSA bacteremia. However, therapy failure is often related to deep-seated infections, e.g. endocarditis, with high bacterial inocula and daptomycin regimens <10 mg/kg/day. Current antibiotic options for treating invasive S. aureus infections have limitations in monotherapy. Daptomycin in combination with other antibiotics, e.g. fosfomycin, may be effective in improving clinical outcomes in patients with MRSA IE. EXPERT OPINION Exploring therapeutic combinations has shown fosfomycin to have a unique mechanism of action and to be the most effective option in preventing the onset of resistance to and optimizing the efficacy of daptomycin, suggesting the synergistic combination of fosfomycin with daptomycin is a useful alternative treatment option for MSSA or MRSA IE.
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Affiliation(s)
- Cristina García de la Mària
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Maria-Alexandra Cañas
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | | | - Anders Dahl
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain.,Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Javier García-González
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain.,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc Marco
- Microbiology Department, Centre Diagnòstic Biomèdic (CDB) Hospital Clínic, Barcelona, Spain.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Cottagnoud P, Sprenker F, Cottagnoud M, Collaud A, Ashkbus R, Perreten V. Addition of daptomycin to levofloxacin increased the efficacy of levofloxacin monotherapy against a methicillin-susceptible Staphylococcus aureus strain in experimental meningitis and prevented development of resistance in vitro. J Med Microbiol 2022; 71. [PMID: 35108179 DOI: 10.1099/jmm.0.001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Daptomycin and levofloxacin were tested as monotherapies and in combination against the antibiotic-susceptible
S. aureus
strain MSSA 1112 in a rabbit meningitis model and the effect of the combination on induction of resistance was determined in vitro.
Hypothesis/Gap Statement. Treatment combination might be more efficacious than the monotherapies regarding antibacterial efficacy in vivo and development of resistance.
Aim. To demonstrate a synergy of the antibiotic combination daptomycin and levofloxacin in experimental meningitis, and also its ability to reduce the emergence of resistance against the antibiotics in vitro.
Methodology. Changes of the susceptibility to fluoroquinolones and daptomycin were determined by the measurement of the MIC and mutations were detected by whole genome sequence comparison of the mutants with the parent strain MSSA 1112. Meningitis was induced by intracisternal inoculation of 105 c.f.u. (colony forming unit) of MSSA 1112 and treatment was started 10 h later by injection of daptomycin (15 mg kg−1) and levofloxacin (10 mg kg−1) standard doses. Cerebrospinal fluid (CSF) samples were repeatedly collected during therapy in order to determine killing rates and results of bactericidal activity were expressed in Δlog10c.f.u. ml-1 over 8 h.
Results. The combination of daptomycin with levofloxacin was significantly (P<0.001) superior to levofloxacin monotherapy and increased the antibacterial activity of daptomycin. In vitro, MSSA 1112 was cycled over 6 days with either increasing concentrations of levofloxacin or daptomycin or with a combination of levofloxacin with half of the MIC of daptomycin or daptomycin with half of the MIC of levofloxacin leading to mutations in target genes as identified by whole genome sequence analysis. Addition of low concentration of daptomycin (0.25 mg l−1) reduced levofloxacin-induced resistance in vitro. Addition of levofloxacin in low concentration (0.125 mg l−1) did not influence daptomycin-induced resistance.
Conclusion. These findings highlight the lack of reciprocal interference of antibiotics in combination with regard to the development of resistance.
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Affiliation(s)
| | | | | | - Alexandra Collaud
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Vincent Perreten
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Therapeutic Drug Monitoring of Antibiotics in the Elderly: A Narrative Review. Ther Drug Monit 2021; 44:75-85. [PMID: 34750337 DOI: 10.1097/ftd.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Antibiotic dosing adaptation in elderly patients is frequently complicated by age-related changes affecting the processes of drug absorption, distribution, metabolism, and/or elimination. These events eventually result in treatment failure and/or development of drug-related toxicity. Therapeutic drug monitoring (TDM) can prevent suboptimal antibiotic exposure in adult patients regardless of age. However, little data are available concerning the specific role of TDM in the elderly. METHODS This review is based on a PubMed search of the literature published in the English language. The search involved TDM studies of antibiotics in the elderly performed between 1990 and 2021. Additional studies were identified from the reference lists of the retrieved articles. Studies dealing with population pharmacokinetic modeling were not considered. RESULTS Only a few studies, mainly retrospective and with observational design, have specifically dealt with appropriate antibiotic dosing in the elderly based on TDM. Nevertheless, some clinical situations in which the selection of optimal antibiotic dosing in the elderly was successfully guided by TDM were identified. CONCLUSIONS Elderly patients are at an increased risk of bacterial infections and inadequate drug dosing compared to younger patients. Therefore, the availability of TDM services can improve the appropriateness of antibiotic prescriptions in this population.
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Kussmann M, Obermueller M, Karer M, Kriz R, Chen RY, Hohl L, Schneider L, Burgmann H, Traby L, Vossen MG. Synergistic Effect of Cefazolin Plus Fosfomycin Against Staphylococcus aureus in vitro and in vivo in an Experimental Galleria mellonella Model. Front Pharmacol 2021; 12:685807. [PMID: 34045971 PMCID: PMC8144499 DOI: 10.3389/fphar.2021.685807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study investigated the synergistic in vitro and in vivo activity of cefazolin plus fosfomycin against methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA) to provide the basis for a potential treatment alternative. Methods: Antimicrobial susceptibility and in vitro synergy tests were performed with five MSSA and five MRSA isolates using the broth microdilution and chequerboard assays, respectively. The in vivo efficacy of cefazolin plus fosfomycin for the treatment of MRSA infections was assessed using the Galleria mellonella survival assay. Results: Using fractional inhibitory concentration index (FICI), the evaluated combination of cefazolin plus fosfomycin showed synergistic in vitro activity against all MSSA and MRSA isolates tested. In addition, cefazolin susceptibility was recovered in all MRSA isolates except one fosfomycin-resistant strain when combined with fosfomycin at readily achievable concentrations. The G. mellonella survival assay demonstrated highly synergistic in vivo activity of cefazolin plus fosfomycin, resulting in a 44–52% reduction in mortality when compared to cefazolin-alone and fosfomycin-alone, respectively. Conclusion: If susceptibility to fosfomycin is either confirmed or can be assumed based on local resistance patterns, combination therapy with cefazolin plus fosfomycin could be a valuable treatment option for empirical as well as targeted therapy of S. aureus and MRSA infections. Future studies proving the clinical significance of this combination therapy are therefore warranted.
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Affiliation(s)
- Manuel Kussmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Obermueller
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Karer
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Richard Kriz
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Rui-Yang Chen
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Lena Hohl
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Lisa Schneider
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Ludwig Traby
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias G Vossen
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
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Jorgensen SCJ, Zasowski EJ, Trinh TD, Lagnf AM, Bhatia S, Sabagha N, Abdul-Mutakabbir JC, Alosaimy S, Mynatt RP, Davis SL, Rybak MJ. Daptomycin Plus β-Lactam Combination Therapy for Methicillin-resistant Staphylococcus aureus Bloodstream Infections: A Retrospective, Comparative Cohort Study. Clin Infect Dis 2021; 71:1-10. [PMID: 31404468 DOI: 10.1093/cid/ciz746] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/02/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mounting evidence suggests the addition of a β-lactam (BL) to daptomycin (DAP) results in synergistic in vitro activity against methicillin-resistant Staphylococcus aureus (MRSA) and bolsters the innate immune response to infection. This study's objective was to provide clinical translation to these experimental data and determine if DAP+BL combination therapy results in improved clinical outcomes compared with treatment with DAP alone in patients with MRSA bloodstream infections (BSIs). METHODS This was a retrospective, comparative cohort study conducted at 2 academic medical centers between 2008 and 2018. Adults with MRSA BSI treated with DAP for ≥72 hours and initiated ≤5 days of culture collection were included. Patients who received a BL for ≥24 hours and initiated ≤24 hours of DAP comprised the DAP+BL group. The primary outcome was composite clinical failure (60-day all-cause mortality and/or 60-day recurrence). Analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW). RESULTS A total of 229 patients were included (72 DAP+BL and 157 DAP). In unadjusted and IPTW-adjusted analyses, DAP+BL was associated with significantly reduced odds of clinical failure (odds ratio [OR], 0.362; 95% confidence interval [CI], .164-.801; adjusted OR, 0.386; 95% CI, .175-.853). Adjusted analyses restricted to prespecified subgroups based on infection complexity and baseline health status were consistent with the main analysis. CONCLUSIONS The addition of a BL to DAP was associated with improved clinical outcomes in patients with MRSA BSI. This study provides support to ongoing and future studies evaluating the impact of combination therapy for invasive MRSA infections.Patients treated with daptomycin plus a β-lactam for MRSA bloodstream infection had lower odds of composite clinical failure defined as 60-day all-cause mortality and/or 60-day recurrence compared with patients treated with daptomycin monotherapy after adjusting for confounding variables using inverse probability of treatment weighting.
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Affiliation(s)
- Sarah C J Jorgensen
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Evan J Zasowski
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Clinical Pharmacy, Touro University California College of Pharmacy, Vallejo, California, USA
| | - Trang D Trinh
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sahil Bhatia
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Noor Sabagha
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Jacinda C Abdul-Mutakabbir
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Ryan P Mynatt
- Department of Pharmacy, Detroit Medical Center, Detroit, Michigan, USA
| | - Susan L Davis
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Henry Ford Hospital, Detroit; and
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Detroit Medical Center, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
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Kimmig A, Hagel S, Weis S, Bahrs C, Löffler B, Pletz MW. Management of Staphylococcus aureus Bloodstream Infections. Front Med (Lausanne) 2021; 7:616524. [PMID: 33748151 PMCID: PMC7973019 DOI: 10.3389/fmed.2020.616524] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
Staphylococcus aureus bloodstream infections are associated with a high morbidity and mortality. Nevertheless, significance of a positive blood culture with this pathogen is often underestimated or findings are misinterpreted as contamination, which can result in inadequate diagnostic and therapeutic consequences. We here review and discuss current diagnostic and therapeutic key elements and open questions for the management of Staphylococcus aureus bloodstream infections.
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Affiliation(s)
- Aurelia Kimmig
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sebastian Weis
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christina Bahrs
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Jagadale V, Achilike R, Nord KM. Daptomycin-Tobramycin Cement Beads have Lethal Local Antibacterial Effect in Resistant Periprosthetic Joint Infections. Cureus 2019; 11:e5726. [PMID: 31723490 PMCID: PMC6825458 DOI: 10.7759/cureus.5726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/22/2019] [Indexed: 11/05/2022] Open
Abstract
Background Resistant periprosthetic joint infection (PJI) can be a devastating complication of surgery and is difficult to treat. We attempted to identify the utility of Daptomycin/Tobramycin-impregnated polymethylmethacrylate (PMMA) beads in resistant PJIs. Methods Charts of patients with hip or knee PJI at a single academic medical center, with surgeries performed from May 2008 through May 2018, were reviewed retrospectively. The diagnosis of PJI was consistent with the Musculoskeletal Infection Society recommendations. Prosthetic joints underwent radical anterior-posterior synovectomy and placement of antibiotic cement beads in the infected joint. Clinical cure rate and local intraarticular antibiotic concentration were measured. Results Forty-four patients experienced 53 episodes of PJI, requiring 88 surgeries. There was a fairly even split between hip and knee PJI. The cure rate was 92% (11/12) for patients who had any infection with methicillin-resistant staphylococci during the evaluation period, compared with 62% (13/21) for patients with methicillin-susceptible Staphylococci. On days one and seven, the addition of tobramycin increased daptomycin concentrations by 47% and 3374%, respectively, for beads made onsite compared to elution of daptomycin alone. Elution increased by 44% and 8394%, respectively, for commercial beads compared to beads fabricated onsite. Conclusions Daptomycin-Tobramycin-loaded PMMA beads are safe and powerful bactericidal agents in prosthetic joint infections.
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Affiliation(s)
- Vivek Jagadale
- Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Robert Achilike
- Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Keith M Nord
- Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
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Duss FR, Garcia de la Mària C, Croxatto A, Giulieri S, Lamoth F, Manuel O, Miró JM. Successful treatment with daptomycin and ceftaroline of MDR Staphylococcus aureus native valve endocarditis: a case report. J Antimicrob Chemother 2019; 74:2626-2630. [PMID: 31298264 DOI: 10.1093/jac/dkz253] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/02/2019] [Accepted: 05/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The best therapeutic approach for treating MRSA endocarditis remains unknown, particularly in cases of high vancomycin MICs. We report here a case of daptomycin-non-susceptible, ceftaroline-resistant and fosfomycin-resistant MRSA native left valve endocarditis that was successfully treated with valve repair and a combination of high-dose daptomycin and ceftaroline. METHODS Antimicrobial testing of the clinical strain was performed using Etest and microdilution broth methods. Time-kill and chequerboard methodologies were used to test the activity of antibiotic combinations. RESULTS By Etest, the MIC of vancomycin was 2 mg/L, the MIC of daptomycin was 2 mg/L, the MIC of fosfomycin was 1024 mg/L and the MIC of ceftaroline was 1.5 mg/L. At the standard inoculum (105 cfu/mL), the three combinations of daptomycin plus ceftaroline, cloxacillin or fosfomycin were synergistic and bactericidal. However, when these combinations were tested using a higher inoculum (108 cfu/mL), all combinations were synergistic, but only daptomycin plus ceftaroline had bactericidal activity. CONCLUSIONS These results confirmed a synergistic effect between daptomycin plus ceftaroline and increased bactericidal activity against MRSA, suggesting that this combination may be effective for the treatment of invasive MRSA infection. Our experience highlights the potential clinical use of synergy testing to guide difficult treatment decisions in patients with MDR MRSA infection.
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Affiliation(s)
- François-Régis Duss
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Antony Croxatto
- Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stefano Giulieri
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
- Transplantation Center, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Current Perspectives on Treatment of Gram-Positive Infections in India: What Is the Way Forward? Interdiscip Perspect Infect Dis 2019; 2019:7601847. [PMID: 31080476 PMCID: PMC6475552 DOI: 10.1155/2019/7601847] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/27/2019] [Indexed: 12/29/2022] Open
Abstract
The emerging antimicrobial resistance leading to gram-positive infections (GPIs) is one of the major public health threats worldwide. GPIs caused by multidrug resistant bacteria can result in increased morbidity and mortality rates along with escalated treatment cost and hospitalisation stay. In India, GPIs, particularly methicillin-resistant Staphylococcus aureus (MRSA) prevalence among invasive S. aureus isolates, have been reported to increase exponentially from 29% in 2009 to 47% in 2014. Apart from MRSA, rising prevalence of vancomycin-resistant enterococci (VRE), which ranges from 1 to 9% in India, has raised concerns. Moreover, the overall mortality rate among patients with multidrug resistant GPIs in India is reported to be 10.8% and in ICU settings, the mortality rate is as high as 16%. Another challenge is the spectrum of adverse effects related to the safety and tolerability profile of the currently available drugs used against GPIs which further makes the management and treatment of these multidrug resistant organisms a complex task. Judicious prescription of antimicrobial agents, implementation of antibiotic stewardship programmes, and antibiotic policies in hospitals are essential to reduce the problem of drug-resistant infections in India. The most important step is development of newer antimicrobial agents with novel mechanisms of action and favourable pharmacokinetic profile. This review provides a synopsis about the current burden, treatment options, and the challenges faced by the clinicians in the management of GPIs such as MRSA, Quinolone-resistant Staphylococcus, VRE, and drug-resistant pneumococcus in India.
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Hagiya H, Sugawara Y, Kimura K, Hamaguchi S, Nishi I, Hayashi M, Akeda Y, Tomono K. Emergence of daptomycin non-susceptible coagulase-negative Staphylococci in patients with cardiovascular device infections: Two cases report investigated by whole genome analysis. Medicine (Baltimore) 2018; 97:e13487. [PMID: 30544442 PMCID: PMC6310605 DOI: 10.1097/md.0000000000013487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Daptomycin (DAP) is a key drug for treating severe Staphylococcus infections. The emergence of DAP non-susceptible Staphylococcus aureus has been widely recognized in clinical situations, although the clinical status of DAP non-susceptible coagulase-negative Staphylococcus (CoNS) infections is unclear. We encountered 2 cases of cardiovascular device infections that were associated with DAP non-susceptible CoNS. PATIENT CONCERNS The first case involved a 60-year-old woman with a pump pocket infection in a left ventricular assist device. DAP non-susceptible Staphylococcus capitis subsp. ureolyticus was isolated from a blood culture after treatment using vancomycin (10 days) and DAP (6 days). The second case involved a 71-year-old man with an aortic graft infection. DAP non-susceptible S capitis subsp. ureolyticus was detected in pus after treatment using vancomycin (2 weeks) and DAP (1 week) without complete removal and debridement. DIAGNOSIS Cardiovascular device infections caused by DAP non-susceptible CoNS. INTERVENTIONS AND OUTCOMES Whole genome sequencing of these strains revealed multiple mutations in genes that are related to DAP-non-susceptibility in S aureus, which created amino acid substitutions in mprF, dltAB, dltD, rpoC, yycG, cls2, pgsA, and vraSR. To the very best of our knowledge, the substitution patterns were not identical to those previously reported in DAP non-susceptibile S aureus. LESSONS Clinicians should be cautious regarding the emergence of DAP non-susceptible CoNS, especially in cases with implanted prosthetic devices, inadequate debridement, and prior usage of vancomycin and DAP. Further studies are needed to understand the relevance of these genetic changes and DAP-non-susceptibility in CoNS strains.
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Affiliation(s)
- Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital
| | - Yo Sugawara
- Japan-Thailand Research Collaboration Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka
| | - Shigeto Hamaguchi
- Division of Infection Control and Prevention, Osaka University Hospital
| | - Isao Nishi
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka
| | - Masahiro Hayashi
- Center for Conservation of Microbial Genetic Resource, Gifu University, Gifu, Japan
| | - Yukihiro Akeda
- Division of Infection Control and Prevention, Osaka University Hospital
- Japan-Thailand Research Collaboration Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital
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Maeda N, Hagiya H, Takiuchi T, Kusakabe S, Maeda T, Kimura K, Iwai S, Kawasaki K, Hori Y, Morii E, Kanakura Y, Kimura T, Tomono K. Persistent methicillin-resistant Staphylococcus aureus bacteremia owing to placental abscess. J Infect Chemother 2018; 24:975-979. [PMID: 29804839 DOI: 10.1016/j.jiac.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/05/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022]
Abstract
Staphylococcus aureus as a pathogen in human gestational membranes, a rather rare phenomenon, has recently been the focus of several researches. S. aureus forms biofilms on these membranes and potentially causes chorioamnionitis in pregnant women. We report a case of persistent methicillin-resistant S. aureus (MRSA) bacteremia owing to placental infection, causing chorioamnionitis and preterm birth. A 29-year-old Japanese woman at the 27th gestational week was diagnosed with acute promyelocytic leukemia and underwent all-trans retinoic acid therapy. Soon after hospitalization, the patient presented with persistent MRSA bacteremia of unknown origin. Despite various antimicrobial therapies, she experienced 12 MRSA bacteremia episodes over 6 weeks. However, after child birth, MRSA bacteremia disappeared without any complications. A pathologic examination of her placenta revealed placenta abscess, resulting in a diagnosis of MRSA-associated chorioamnionitis. Molecular analysis proved that a single MRSA strain (SCCmec Type IVa), which tested negative for Panton-Valentine leukocidin and toxic shock syndrome toxin-1, caused the obstinate infection. We should be aware that persistent MRSA bacteremia in pregnant women can originate from placental abscess.
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Affiliation(s)
- Naomi Maeda
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Japan.
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Hospital, Japan
| | | | - Tetsuo Maeda
- Department of Hematology, Osaka University Hospital, Japan
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Sayuri Iwai
- Department of Obstetrics and Gynecology, Osaka University Hospital, Japan
| | | | - Yumiko Hori
- Department of Pathology, Osaka University Hospital, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Hospital, Japan
| | | | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Hospital, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
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13
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Roch M, Gagetti P, Davis J, Ceriana P, Errecalde L, Corso A, Rosato AE. Daptomycin Resistance in Clinical MRSA Strains Is Associated with a High Biological Fitness Cost. Front Microbiol 2017; 8:2303. [PMID: 29259579 PMCID: PMC5723333 DOI: 10.3389/fmicb.2017.02303] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/08/2017] [Indexed: 01/24/2023] Open
Abstract
Daptomycin remains as one of the main treatment options for Methicillin-Resistant Staphylococcus aureus (MRSA). Sporadic resistance cases reported in patients treated with either daptomycin or glycopeptides are a growing concern. In a previous study, we described a clinical case of a patient with a community-acquired MRSA infection resistant to daptomycin and with intermediate resistance to vancomycin who developed a recurrent infection with a susceptible isogenic strain. In the present work, we further investigated the sequential events to determine whether the switch from a daptomycin resistance to a susceptible phenotype was due to a phenomenon of resistance reversion or recurrent infection with a susceptible strain. Pairwise competition experiments showed that the susceptible clinical recurrent SA6850 strain had increased fitness when compared to the resistant counterpart SA6820 strain. In fact, although we have demonstrated that reversion of daptomycin resistance to daptomycin susceptible can occur in vitro after serial passages in drug-free media, phylogenetic analysis suggested that the in vivo process was the result of a recurrent infection with a previous susceptible isolate carried by the patient rather than a resistance reversion of the strain. Whole genome sequence of evolved strains showed that daptomycin resistance in MRSA is associated with a high fitness cost mediated by mutations in mprF gene, revealed as a key element of the biological cost. Moreover, we determined that daptomycin resistance-associated fitness cost was independent of vancomycin intermediate resistance phenotype, as demonstrated in additional clinical MRSA vancomycin susceptible strains. This study highlights important observations as, despite daptomycin offers a useful treatment option for the patients with persistent infections, it has to be carefully monitored. The high fitness cost associated to daptomycin resistance may explain the reduced dissemination of daptomycin resistance and the absence of daptomycin reported outbreaks.
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Affiliation(s)
- Melanie Roch
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Paula Gagetti
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, United States.,Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud, Buenos Aires, Argentina
| | - James Davis
- Argonne National Laboratory (DOE), Lemont, IL, United States.,Computation Institute, University of Chicago, Chicago, IL, United States
| | - Paola Ceriana
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud, Buenos Aires, Argentina
| | - Laura Errecalde
- Departamento de Microbiologia, Hospital General de Agudos Juan Fernandez, Buenos Aires, Argentina
| | - Alejandra Corso
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud, Buenos Aires, Argentina
| | - Adriana E Rosato
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, United States
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14
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Chang YJ, Lee MS, Lee CH, Lin PC, Kuo FC. Daptomycin treatment in patients with resistant staphylococcal periprosthetic joint infection. BMC Infect Dis 2017; 17:736. [PMID: 29187163 PMCID: PMC5707892 DOI: 10.1186/s12879-017-2842-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/21/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Resistant staphylococcal organisms remain a serious problem in the treatment of periprosthetic joint infection (PJI). Higher failure rates have been reported when vancomycin was used. The purpose of this study was to assess the clinical dosage, effect, and safety of daptomycin in patients with resistant staphylococcal PJI. METHODS We retrospectively enrolled patients with hip or knee PJI who were treated with daptomycin in our institution (n = 16) from January 2013 to December 2014 with a minimum follow-up of 2 years. The patients received daptomycin when glycopeptide could not be used due to multiple resistance, any adverse reaction, chronic kidney disease stage 3 or worse, and previous treatment failure with glycopeptide or empirical therapy. RESULTS These patients received daptomycin at a median dose of 8.3 mg∕kg per day for a median duration of 14 days. The overall treatment success rate was 87.5% (14 of 16 cases) after a median follow-up period of 27 months. In the subgroups of acute and chronic PJI, the success rate was 80% and 91%, respectively. One patient developed asymptomatic transient serum aspartate transaminase (AST) elevation. No severe side effects such as myositis, acute renal failure due to rhabdomyolysis or eosinophilic pneumonia were found in our series. CONCLUSION Relatively high daptomycin doses combined with adequate surgical intervention were effective in treating resistant staphylococcal PJI. Daptomycin is an option worthy of consideration in PJI patients for whom glycopeptide treatment is unsuitable. Further prospective randomized comparative study is needed in the future.
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Affiliation(s)
- Yu-Jui Chang
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Mel S Lee
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- College of Medicine, Chang Gung University, Kaohsiung, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Po-Chun Lin
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. .,College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
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15
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Nam EY, Yang SJ, Kim ES, Cho JE, Park KH, Jung SI, Yoon N, Kim DM, Lee CS, Jang HC, Park Y, Lee KS, Kwak YG, Lee JH, Park SY, Hwang JH, Kim M, Song KH, Kim HB. Emergence of Daptomycin-Nonsusceptible Methicillin-Resistant Staphylococcus aureus Clinical Isolates Among Daptomycin-Naive Patients in Korea. Microb Drug Resist 2017; 24:534-541. [PMID: 29863982 DOI: 10.1089/mdr.2017.0212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study was conducted to assess emergence of daptomycin-nonsusceptible (DAP-NS) phenotype in DAP-naive patients with invasive Staphylococcus aureus (ISA) infections in Korea. A total of 208 S. aureus clinical isolates were selected from a previous prospective study on ISA infections and evaluated for DAP-NS. Although DAP has never been introduced in Korea, five DAP-NS S. aureus strains (2.4%) were identified among 208 S. aureus strains collected from ISA infections. The DAP-NS phenotype was observed only in methicillin-resistant S. aureus (MRSA) strains, but not in methicillin-susceptible S. aureus strains. One DAP-NS MRSA strain belonged to sequence type 72 (ST72) and four were ST5 MRSA strains, three of which were heteroresistant vancomycin (VAN)-intermediate S. aureus. All these five DAP-NS MRSA strains were from healthcare-associated infections without prior exposure to VAN within 30 days. While the ST72 MRSA strain exhibited DAP-NS phenotype via charge repulsion mechanism, four ST5 DAP-NS S. aureus strains had charge-independent DAP-NS mechanism. None of the five DAP-NS strains displayed significant increase in cell wall thickness, indicating that altered cell wall thickness was not associated with the observed DAP-NS phenotype.
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Affiliation(s)
- Eun Young Nam
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Soo-Jin Yang
- 3 School of Bioresources and Bioscience, Chung-Ang University , Anseong, Republic of Korea
| | - Eu Suk Kim
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Jeong Eun Cho
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Kyung-Hwa Park
- 4 Department of Internal Medicine, Chonnam National University Hospital , Gwangju, Republic of Korea
| | - Sook-In Jung
- 4 Department of Internal Medicine, Chonnam National University Hospital , Gwangju, Republic of Korea
| | - Nara Yoon
- 5 Department of Internal Medicine, Chosun University Hospital , Gwangju, Republic of Korea
| | - Dong-Min Kim
- 5 Department of Internal Medicine, Chosun University Hospital , Gwangju, Republic of Korea
| | - Chang-Seop Lee
- 6 Department of Internal Medicine, Chonbuk National University , Jeonju, Republic of Korea
| | - Hee-Chang Jang
- 7 Department of Internal Medicine, Chonnam National University Hwasun Hospital , Hwasun, Republic of Korea
| | - Yoonseon Park
- 8 Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital , Goyang, Republic of Korea
| | - Kkot Sil Lee
- 9 Department of Internal Medicine, Myongji Hospital , Goyang, Republic of Korea
| | - Yee Gyung Kwak
- 10 Department of Internal Medicine, Inje University Ilsan Paik Hospital , Goyang, Republic of Korea
| | - Jae Hoon Lee
- 11 Department of Internal Medicine, Wonkwang University Hospital , Iksan, Republic of Korea
| | - Seong Yeon Park
- 12 Department of Internal Medicine, Dongguk University Ilsan Hospital , Goyang, Republic of Korea
| | - Joo-Hee Hwang
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Moonsuk Kim
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Kyoung-Ho Song
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Hong Bin Kim
- 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
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16
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Identification of Staphylococcus aureus Cellular Pathways Affected by the Stilbenoid Lead Drug SK-03-92 Using a Microarray. Antibiotics (Basel) 2017; 6:antibiotics6030017. [PMID: 28892020 PMCID: PMC5617981 DOI: 10.3390/antibiotics6030017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/25/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022] Open
Abstract
The mechanism of action for a new lead stilbene compound coded SK-03-92 with bactericidal activity against methicillin-resistant Staphylococcus aureus (MRSA) is unknown. To gain insight into the killing process, transcriptional profiling was performed on SK-03-92 treated vs. untreated S. aureus. Fourteen genes were upregulated and 38 genes downregulated by SK-03-92 treatment. Genes involved in sortase A production, protein metabolism, and transcriptional regulation were upregulated, whereas genes encoding transporters, purine synthesis proteins, and a putative two-component system (SACOL2360 (MW2284) and SACOL2361 (MW2285)) were downregulated by SK-03-92 treatment. Quantitative real-time polymerase chain reaction analyses validated upregulation of srtA and tdk as well as downregulation of the MW2284/MW2285 and purine biosynthesis genes in the drug-treated population. A quantitative real-time polymerase chain reaction analysis of MW2284 and MW2285 mutants compared to wild-type cells demonstrated that the srtA gene was upregulated by both putative two-component regulatory gene mutants compared to the wild-type strain. Using a transcription profiling technique, we have identified several cellular pathways regulated by SK-03-92 treatment, including a putative two-component system that may regulate srtA and other genes that could be tied to the SK-03-92 mechanism of action, biofilm formation, and drug persisters.
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17
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Vanegas Múnera JM, Ocampo Ríos AM, Urrego DM, Jiménez Quiceno JN. In vitro susceptibility of methicillin-resistant Staphylococcus aureus isolates from skin and soft tissue infections to vancomycin, daptomycin, linezolid and tedizolid. Braz J Infect Dis 2017; 21:493-499. [PMID: 28432878 PMCID: PMC9425527 DOI: 10.1016/j.bjid.2017.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 01/12/2023] Open
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18
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D'Avolio A, Pensi D, Baietto L, Pacini G, Di Perri G, De Rosa FG. Daptomycin Pharmacokinetics and Pharmacodynamics in Septic and Critically Ill Patients. Drugs 2017; 76:1161-74. [PMID: 27412121 DOI: 10.1007/s40265-016-0610-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Infections, including sepsis, are associated with high mortality rates in critically ill patients in the intensive care unit (ICU). Appropriate antibiotic selection and adequate dosing are important for improving patient outcomes. Daptomycin is bactericidal in bloodstream infections caused by Staphylococcus aureus and other Gram-positive pathogens cultured in ICU patients. The drug has concentration-dependent activity, and the area under the curve/minimum inhibitory concentration ratio is the pharmacokinetic/pharmacodynamic (PK/PD) index that best correlates with daptomycin activity, whereas toxicity correlates well with daptomycin plasma trough concentrations (or minimum concentration [C min]). Adequate daptomycin exposure can be difficult to achieve in ICU patients; multiple PK alterations can result in highly variable plasma concentrations, which are difficult to predict. For this reason, therapeutic drug monitoring could help clinicians optimize daptomycin dosing, thus improving efficacy while decreasing the likelihood of serious adverse events. This paper reviews the literature on daptomycin in ICU patients with sepsis, focusing on dosing and PK and PD parameters.
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Affiliation(s)
- Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
| | - Debora Pensi
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Lorena Baietto
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | | | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
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19
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Burnett YJ, Echevarria K, Traugott KA. Ceftaroline as Salvage Monotherapy for Persistent MRSA Bacteremia. Ann Pharmacother 2016; 50:1051-1059. [PMID: 27520326 DOI: 10.1177/1060028016664361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To summarize published data regarding the use of ceftaroline as salvage monotherapy for persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. DATA SOURCES PubMed (January 1980-June 2016) was searched using combinations of the search terms methicillin-resistant Staphylococcus aureus, MRSA, bacteremia, ceftaroline, refractory, and persistent Supplemental references were generated through review of identified literature citations. STUDY SELECTION AND DATA EXTRACTION Available English-language, full-text articles pertaining to the use of ceftaroline for persistent MRSA bacteremia (MRSAB) were included. DATA SYNTHESIS The PubMed search yielded 23 articles for evaluation. There are no randomized controlled trials to date-only case series and reports. Four retrospective case series detailing the use of ceftaroline as monotherapy for persistent MRSAB were included. Most patients received at least 4 days of an appropriate anti-MRSA antimicrobial prior to ceftaroline and were able to clear bacteremia within 3 days. The most common rationales for ceftaroline use were progression of disease or nonresponse to current therapy. Higher off-label dosing of ceftaroline is often utilized to achieve optimal pharmacokinetic/pharmacodynamic parameters. Adverse events are not well described due to lack of follow-up; however, neutropenia has been associated with prolonged use. CONCLUSIONS Treatment options for persistent MRSAB remain few and far between. Ceftaroline is an effective agent for the salvage treatment of MRSAB. Off-label doses up to 600 mg every 8 hours are often used to achieve optimal pharmacokinetic/pharmacodynamic parameters. Because of lack of follow-up in these reports, the incidence of adverse effects of prolonged use of ceftaroline is not well defined.
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Affiliation(s)
- Yvonne J Burnett
- St. Louis College of Pharmacy, MO, USA
- Washington University School of Medicine, St. Louis, MO, USA
| | - Kelly Echevarria
- South Texas Veterans Health Care System, San Antonio, TX, USA
- University of Texas at Austin, TX, USA
- University of Texas Health Science Center at San Antonio, TX, USA
| | - Kristi A Traugott
- University of Texas at Austin, TX, USA
- University of Texas Health Science Center at San Antonio, TX, USA
- University Health System, San Antonio, TX, USA
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20
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Garonzik SM, Lenhard JR, Forrest A, Holden PN, Bulitta JB, Tsuji BT. Defining the Active Fraction of Daptomycin against Methicillin-Resistant Staphylococcus aureus (MRSA) Using a Pharmacokinetic and Pharmacodynamic Approach. PLoS One 2016; 11:e0156131. [PMID: 27284923 PMCID: PMC4902307 DOI: 10.1371/journal.pone.0156131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022] Open
Abstract
Our objective was to study the pharmacodynamics of daptomycin in the presence of varying concentrations of human serum (HS) in vitro to quantify the fraction of daptomycin that is ‘active’. Time kill experiments were performed with daptomycin (0 to 256 mg/L) against two MRSA strains at log-phase growth, in the presence of HS (0%, 10%, 30%, 50%, 70%) combined with Mueller-Hinton broth. Daptomycin ≥ 2 mg/L achieved 99.9% kill within 8 h at all HS concentrations; early killing activity was slightly attenuated at higher HS concentrations. After 1 h, bacterial reduction of USA300 upon exposure to daptomycin 4 mg/L ranged from -3.1 to -0.5 log10CFU/mL in the presence of 0% to 70% HS, respectively. Bactericidal activity was achieved against both strains at daptomycin ≥ 4 mg/L for all fractions of HS exposure. A mechanism-based mathematical model (MBM) was developed to estimate the active daptomycin fraction at each %HS, comprising 3 bacterial subpopulations differing in daptomycin susceptibility. Time-kill data were fit with this MBM with excellent precision (r2 >0.95). The active fraction of daptomycin was estimated to range from 34.6% to 25.2% at HS fractions of 10% to 70%, respectively. Despite the reported low unbound fraction of daptomycin, the impact of protein binding on the activity of daptomycin was modest. The active fraction approach can be utilized to design in vitro experiments and to optimize therapeutic regimens of daptomycin in humans.
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Affiliation(s)
- Samira M. Garonzik
- Laboratory for Antimicrobial Pharmacodynamics, School of Pharmacy and Pharmaceutical Sciences Buffalo, Buffalo, NY, United States of America
| | - Justin R. Lenhard
- Laboratory for Antimicrobial Pharmacodynamics, School of Pharmacy and Pharmaceutical Sciences Buffalo, Buffalo, NY, United States of America
- New York State Center of Excellence in Bioinformatics & Life Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Alan Forrest
- Laboratory for Antimicrobial Pharmacodynamics, School of Pharmacy and Pharmaceutical Sciences Buffalo, Buffalo, NY, United States of America
- Department of Pharmacotherapy and Experimental Therapeutics, School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
| | - Patricia N. Holden
- Laboratory for Antimicrobial Pharmacodynamics, School of Pharmacy and Pharmaceutical Sciences Buffalo, Buffalo, NY, United States of America
- New York State Center of Excellence in Bioinformatics & Life Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Jϋrgen B. Bulitta
- Laboratory for Antimicrobial Pharmacodynamics, School of Pharmacy and Pharmaceutical Sciences Buffalo, Buffalo, NY, United States of America
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, United States of America
| | - Brian T. Tsuji
- Laboratory for Antimicrobial Pharmacodynamics, School of Pharmacy and Pharmaceutical Sciences Buffalo, Buffalo, NY, United States of America
- New York State Center of Excellence in Bioinformatics & Life Sciences, University at Buffalo, Buffalo, NY, United States of America
- * E-mail:
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21
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Capone A, Cafiso V, Campanile F, Parisi G, Mariani B, Petrosillo N, Stefani S. In vivo development of daptomycin resistance in vancomycin-susceptible methicillin-resistant Staphylococcus aureus severe infections previously treated with glycopeptides. Eur J Clin Microbiol Infect Dis 2016; 35:625-31. [PMID: 26815434 DOI: 10.1007/s10096-016-2581-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/11/2016] [Indexed: 11/25/2022]
Abstract
Our aim was to describe the clinical and microbiological features of four cases of severe vancomycin-susceptible methicillin-resistant Staphylococcus aureus (MRSA) infections in which the vancomycin non-susceptibility development and daptomycin resistance occurred under therapy with teicoplanin (three cases) and daptomycin switched to vancomycin (one case). Clinical data were retrospectively reviewed. On nine clinical epidemiologically unrelated daptomycin-susceptible (DAP-S) and daptomycin-resistant (DAP-R) MRSA, we performed: (i) DAP-VAN-TEC-CFX-RIF minimum inhibitory concentrations (MICs); (ii) glycopeptide resistance detection (GRD) by δ-hemolysis; (iii) glycopeptide population analysis; (iv) molecular characterization by PFGE-MLST-SCCmec-agr-typing; (v) rpoB and mprF single nucleotide polymorphisms (SNPs); (vi) dltA-mprF-atl-sceD expression by real-time quantitative polymerase chain reaction (qPCR). Three out of the four patients did not survive despite salvage treatment; two died with active MRSA infection and one died because of Stenotrophomonas maltophilia sepsis. The fourth patient, in which a reversion to a DAP-S phenotype occurred, survived with daptomycin plus trimethoprim/sulfamethoxazole and oxacillin treatment, and endovascular device removal. Daptomycin resistance development was preceded by a stable heterogeneous vancomycin-intermediate S. aureus (hVISA) or VISA phenotype acquisition, while in one case, daptomycin resistance was preceded by an unstable daptomycin heteroresistance (hDAP) behavior reverting to DAP-S during vancomycin plus rifampin therapy followed by high doses of daptomycin. All DAP-R strains showed hVISA or DAP-R traits, including mutations and/or up-regulation of genes involved in cell wall turnover and cell membrane perturbation. In our study, daptomycin resistance arose during glycopeptide therapy. The emergence of DAP-R isolates was preceded by a stable VISA or hVISA phenotype or by instability reverting to a DAP-S heteroresistant phenotype. Daptomycin, as first-line therapy for the treatment of severe MRSA infections, should be used at optimal dosage combined with other agents such as beta-lactams, to prevent daptomycin resistance occurrence.
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Affiliation(s)
- A Capone
- National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - V Cafiso
- Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy.
| | - F Campanile
- Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy
| | - G Parisi
- Department of Microbiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - B Mariani
- Department of Microbiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - N Petrosillo
- National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - S Stefani
- Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy
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Hagiya H, Haruki Y, Uchida T, Wada T, Shiota S, Ishida T, Ogawa H, Murase T, Otsuka F. Emergence of Daptomycin-Resistant Staphylococcus aureus during Treatment. Intern Med 2016; 55:73-8. [PMID: 26726090 DOI: 10.2169/internalmedicine.55.4763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old man with persistent bacteremia accompanying a large iliopsoas abscess, vertebral osteomyelitis, discitis and central venous port infection caused by methicillin-resistant Staphylococcus aureus (MRSA) was admitted to our hospital. During the course of treatment, the emergence of a daptomycin (DAP)-resistant MRSA strain was confirmed; the minimum inhibitory concentration was 1 to 2 μg/mL for vancomycin and more than 1 μg/mL for DAP. Although the bacterial cell wall was not significantly thickened, an increased positive surface charge and single-nucleotide polymorphism within mprF have been confirmed in DAP-resistant strains. Still rare, but clinicians need to be cautious of the emergence of DAP-resistant MRSA during treatment.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Souli M, Karaiskos I, Galani L, Maraki S, Perivolioti E, Argyropoulou A, Charissiadou A, Zachariadou L, Tsiplakou S, Papaioannou V, Tsorlini H, Katsifa H, Baka V, Pantazi P, Paschali A, Kyratsa A, Trikka-Graphakos E, Giannopoulou P, Vogiatzakis E, Moraitou H, Papadogeorgaki H, Avgerinou H, Panagea T, Pantazatou A, Petinaki E, Stamatopoulou G, Toutouza M, Karatzoglou I, Kontopoulou K, Orfanidou M, Karantani I, Fytas P, Tzanetou K, Platsouka E, Kazila P, Chli A, Statiri N, Giamarellou H. Nationwide surveillance of resistance rates ofStaphylococcus aureusclinical isolates from Greek hospitals, 2012–2013. Infect Dis (Lond) 2015; 48:287-292. [DOI: 10.3109/23744235.2015.1110858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Kullar R, Sakoulas G, Deresinski S, van Hal SJ. When sepsis persists: a review of MRSA bacteraemia salvage therapy. J Antimicrob Chemother 2015; 71:576-86. [PMID: 26565015 DOI: 10.1093/jac/dkv368] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
MRSA bacteraemia (MRSAB), including infective endocarditis, carries a high mortality rate, with up to 50% of patients failing initial therapy with vancomycin and requiring salvage therapy. Persistent MRSAB can be difficult to successfully eliminate, especially when source control is not possible due to an irremovable focus or the bacteraemia still persists despite surgical intervention. Although vancomycin and daptomycin are the only two antibiotics approved by the US FDA for the treatment of patients with MRSAB as monotherapy, the employment of novel strategies is required to effectively treat patients with persistent MRSAB and these may frequently involve combination drug therapy. Treatment strategies that are reviewed in this manuscript include vancomycin combined with a β-lactam, daptomycin-based therapy, ceftaroline-based therapy, linezolid-based therapy, quinupristin/dalfopristin, telavancin, trimethoprim/sulfamethoxazole-based therapy and fosfomycin-based therapy. We recommend that combination antibiotic therapy be considered for use in MRSAB salvage treatment.
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Affiliation(s)
- Ravina Kullar
- Global Center for Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ, USA
| | - George Sakoulas
- Division of Paediatric Pharmacology & Drug Discovery, University of California San Diego School of Medicine, La Jolla, CA, USA Sharp Rees-Stealy Medical Group, San Diego, CA, USA
| | - Stan Deresinski
- Department of Medicine, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, USA
| | - Sebastiaan J van Hal
- Department of Microbiology & Infectious Diseases, Royal Prince Alfred Hospital, Camperdown, Australia
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25
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Duration of prior vancomycin therapy and subsequent daptomycin treatment outcomes in methicillin-resistant Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis 2015; 83:193-7. [DOI: 10.1016/j.diagmicrobio.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/24/2015] [Accepted: 06/06/2015] [Indexed: 11/24/2022]
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26
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Shoji H, Maeda M, Shirakura T, Takuma T, Ugajin K, Fukuchi K, Ishino K, Niki Y. More accurate measurement of vancomycin minimum inhibitory concentration indicates poor outcomes in meticillin-resistant Staphylococcus aureus bacteraemia. Int J Antimicrob Agents 2015; 46:532-7. [PMID: 26364848 DOI: 10.1016/j.ijantimicag.2015.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 07/14/2015] [Accepted: 07/19/2015] [Indexed: 02/04/2023]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) is an important pathogen associated with community-acquired and nosocomial infections. The aim of this study was to validate the vancomycin (VAN) minimum inhibitory concentration (MIC) and administration of VAN that may affect the prognosis of patients with MRSA bacteraemia. In total, 140 clinical MRSA strains from blood cultures were collected from January 2009 to December 2013 at a university hospital in Tokyo (Japan). Patient background, their clinical situation and the susceptibility of isolates to anti-MRSA agents in all cases were reviewed, and factors contributing to 30-day mortality were analysed. Susceptibility to anti-MRSA agents was measured by a microdilution susceptibility testing method. The VAN MIC was further evaluated at 0.25 μg/mL intervals from 0.5 μg/mL to 2.0 μg/mL. Multiple logistic regression analysis revealed a 4-fold increase in mortality of patients with a VAN MIC ≥1.5 μg/mL [odds ratio (OR)=3.952, 95% confidence interval (CI) 1.471-10.614; P=0.006]. A one-score increase in the Charlson co-morbidity index resulted in a 1.2-fold increase in the risk of death (OR=1.199, 95% CI 1.054-1.364; P=0.006). However, no significant difference was found in the ratio of the VAN 24-h area under the concentration-time curve to MIC between VAN MIC ≥1.5 μg/mL and <1.5 μg/mL. A significant increase in the MICs of teicoplanin and daptomycin was observed in strains with high VAN MICs. For patients with high VAN MICs, administration of these anti-MRSA antibiotics may have a poor outcome owing to cross-resistance.
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Affiliation(s)
- Hisashi Shoji
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, 1-4-5 Hatanodai, Shinagawa, Tokyo 142-0064, Japan.
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa, Tokyo, Japan
| | - Tetsuro Shirakura
- Department of Microbiology, School of Medicine, Showa University, 1-4-5 Hatanodai, Shinagawa, Tokyo, Japan
| | - Takahiro Takuma
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, 1-4-5 Hatanodai, Shinagawa, Tokyo 142-0064, Japan
| | - Kazuhisa Ugajin
- Showa University Hospital, 1-4-5 Hatanodai, Shinagawa, Tokyo, Japan
| | - Kunihiko Fukuchi
- Showa University, Graduate School, 1-4-5 Hatanodai, Shinagawa, Tokyo, Japan
| | - Keiko Ishino
- Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa, Tokyo, Japan
| | - Yoshihito Niki
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, 1-4-5 Hatanodai, Shinagawa, Tokyo 142-0064, Japan
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Ross JL, Rankin S, Marshik P, Mercier RC, Brett M, Walraven CJ. Antimicrobial Stewardship Intervention and Feedback to Infectious Disease Specialists: A Case Study in High-Dose Daptomycin. Antibiotics (Basel) 2015; 4:309-20. [PMID: 27025626 PMCID: PMC4790287 DOI: 10.3390/antibiotics4030309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022] Open
Abstract
Infectious Diseases specialists have used high-dose daptomycin (≥6 mg/kg/day) in select patients with difficult to treat methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) infections to optimize outcomes. Antimicrobial stewardship programs enforce antimicrobial formulary restrictions; however, interventions specifically aimed at Infectious Disease specialists can be particularly challenging. The purpose of this study was to create a high-dose daptomycin algorithm for Infectious Disease specialists that are consistent with best-practices. Daptomycin prescribing habits pre- and post-daptomycin algorithm implementation were evaluated using a quasi-experimental study design. Patients were included if ≥18 years of age and received daptomycin for ≥48 h. Patients were excluded if daptomycin was initiated on an outpatient setting. During the 12-month pre-intervention phase, 112 patients were included, with 73 patients in the 12-month post-intervention phase. A statistically significant decrease in the mean daptomycin dose from 9.01 mg/kg to 7.51 mg/kg (p < 0.005) was observed, resulting in an annual drug cost-savings of over $75,000 without adversely affecting readmission rates due to infection. Creation of a daptomycin algorithm with consideration of pathogen, disease state, and prior treatment, is an effective means of influencing prescribing habits of Infectious Disease specialists.
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Affiliation(s)
- Jennifer L Ross
- Department of Pharmaceutical Services, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
| | - Shannon Rankin
- Department of Pharmaceutical Services, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
| | - Patricia Marshik
- College of Pharmacy, University of New Mexico Health Sciences Center, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Renée-Claude Mercier
- College of Pharmacy, University of New Mexico Health Sciences Center, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Meghan Brett
- Division of Infectious Diseases, Department of Internal Medicine, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Carla J Walraven
- Department of Pharmaceutical Services, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
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Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603-61. [PMID: 26016486 PMCID: PMC4451395 DOI: 10.1128/cmr.00134-14] [Citation(s) in RCA: 2701] [Impact Index Per Article: 300.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.
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Affiliation(s)
- Steven Y C Tong
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Joshua S Davis
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Emily Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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29
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Morales-Cartagena A, Lalueza A, López-Medrano F, Juan RS, Aguado JM. Treatment of methicillin-resistant Staphylococcus aureus infections: Importance of high vancomycin minumum inhibitory concentrations. World J Clin Infect Dis 2015; 5:14-29. [DOI: 10.5495/wjcid.v5.i2.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/30/2014] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus (SA) infections remain a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics. This organism is responsible for both nosocomial and community-acquired infections ranging from relatively minor skin and soft tissue infections to life-threatening systemic infections. The increasing incidence of methicillin-resistant strains has granted an increasing use of vancomycin causing a covert progressive increase of its minimum inhibitory concentration (MIC) (dubbed the MIC “creep”). In this way, the emergence of vancomycin-intermediate SA (VISA) strains and heteroresistant-VISA has raised concern for the scarcity of alternative treatment options. Equally alarming, though fortunately less frequent, is the emergence of vancomycin-resistant SA. These strains show different mechanisms of resistance but have similar problems in terms of therapeutic approach. Ultimately, various debate issues have arisen regarding the emergence of SA strains with a minimum inhibitory concentration sitting on the superior limit of the sensitivity range (i.e., MIC = 2 μg/mL). These strains have shown certain resilience to vancomycin and a different clinical behaviour regardless of vancomycin use, both in methicillin-resistant SA and in methicillin-sensitive SA. The aim of this text is to revise the clinical impact and consequences of the emergence of reduced vancomycin susceptibility SA strains, and the different optimal treatment options known.
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Diagnosis and treatment of bacteremia and endocarditis due to Staphylococcus aureus. A clinical guideline from the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC). Enferm Infecc Microbiol Clin 2015; 33:625.e1-625.e23. [PMID: 25937457 DOI: 10.1016/j.eimc.2015.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 01/30/2023]
Abstract
Both bacteremia and infective endocarditis caused by Staphylococcus aureus are common and severe diseases. The prognosis may darken not infrequently, especially in the presence of intracardiac devices or methicillin-resistance. Indeed, the optimization of the antimicrobial therapy is a key step in the outcome of these infections. The high rates of treatment failure and the increasing interest in the influence of vancomycin susceptibility in the outcome of infections caused by both methicillin-susceptible and -resistant isolates has led to the research of novel therapeutic schemes. Specifically, the interest raised in recent years on the new antimicrobials with activity against methicillin-resistant staphylococci has been also extended to infections caused by susceptible strains, which still carry the most important burden of infection. Recent clinical and experimental research has focused in the activity of new combinations of antimicrobials, their indication and role still being debatable. Also, the impact of an appropriate empirical antimicrobial treatment has acquired relevance in recent years. Finally, it is noteworthy the impact of the implementation of a systematic bundle of measures for improving the outcome. The aim of this clinical guideline is to provide an ensemble of recommendations in order to improve the treatment and prognosis of bacteremia and infective endocarditis caused by S. aureus, in accordance to the latest evidence published.
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Impact of the combination of daptomycin and trimethoprim-sulfamethoxazole on clinical outcomes in methicillin-resistant Staphylococcus aureus infections. Antimicrob Agents Chemother 2015; 59:1969-76. [PMID: 25605354 DOI: 10.1128/aac.04141-14] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Complicated Staphylococcus aureus infections, including bacteremia, are often associated with treatment failures, prolonged hospital stays, and the emergence of resistance to primary and even secondary therapies. Daptomycin is commonly used as salvage therapy after vancomycin failure for the treatment of methicillin-resistant S. aureus (MRSA) infections. Unfortunately, the emergence of daptomycin resistance, especially in deep-seated infections, has been reported, prompting the need for alternative or combination therapy. Numerous antibiotic combinations with daptomycin have been investigated clinically and in vitro. Of interest, the combination of daptomycin and trimethoprim-sulfamethoxazole (TMP-SMX) has proved to be rapidly bactericidal in vitro to strains that are both susceptible and nonsusceptible to daptomycin. However, to date, there is limited clinical evidence supporting the use of this combination. This was a multicenter, retrospective case series of patients treated with the combination of daptomycin and TMP-SMX for at least 72 h. The objective of this study was to describe the safety and effectiveness of this regimen in clinical practice. The most commonly stated reason that TMP-SMX was added to daptomycin was persistent bacteremia and/or progressive signs and symptoms of infection. After the initiation of combination therapy, the median time to clearance of bacteremia was 2.5 days. Microbiological eradication was demonstrated in 24 out of 28 patients, and in vitro synergy was demonstrated in 17 of the 17 recovered isolates. Further research with this combination is necessary to describe the optimal role and its impact on patient outcomes.
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32
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Risk factors associated with the onset of daptomycin non-susceptibility in Staphylococcus aureus infections in critically ill patients. Intensive Care Med 2014; 41:366-8. [DOI: 10.1007/s00134-014-3571-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
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33
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Therapeutic Options for Resistant Gram Positives. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2014. [DOI: 10.1007/s40506-014-0028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Dhand A, Sakoulas G. Daptomycin in combination with other antibiotics for the treatment of complicated methicillin-resistant Staphylococcus aureus bacteremia. Clin Ther 2014; 36:1303-16. [PMID: 25444563 DOI: 10.1016/j.clinthera.2014.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/09/2014] [Accepted: 09/14/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as one of the most important nosocomial pathogens. Resistance to antibiotic therapy has been known to emerge especially in clinically complex scenarios, resulting in challenges in determining optimal treatment of serious MRSA. Daptomycin, in combination with other antibiotics, has been successfully used in the treatment of these infections, with the aims of resulting in reducing the prevention of antimicrobial resistance and increased killing compared with daptomycin monotherapy. METHODS This article reviews all the published studies that used daptomycin combination therapy for the treatment of bacteremia and associated complicated infections caused by gram-positive organisms, including MRSA. We discuss the rationale of combination antibiotics and the mechanisms that enhance the activity of daptomycin, with special focus on the role of β-lactam antibiotics. FINDINGS There are limited clinical data on the use of daptomycin in combination with other antibiotics. Most of this use was as successful salvage therapy in the setting of failing primary, secondary, or tertiary therapy and/or relapsing infection. Synergy between β-lactams and daptomycin is associated with several characteristics, including increased daptomycin binding and β-lactam-mediated potentiation of innate immunity, but the precise molecular mechanism is unknown. IMPLICATIONS Use of daptomycin in combination with other antibiotics, especially β-lactams, offers a promising treatment option for complicated MRSA bacteremia in which emergence of resistance during treatment may be anticipated. Because it is currently not possible to differentiate complicated from uncomplicated bacteremia at the time of presentation, combination therapy may be considered as first-line therapy, with de-escalation to monotherapy in uncomplicated cases and cases with stable pharmacologic and surgical source control.
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Affiliation(s)
- Abhay Dhand
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - George Sakoulas
- University of California, San Diego School of Medicine, La Jolla, California.
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35
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del Río A, Gasch O, Moreno A, Peña C, Cuquet J, Soy D, Mestres CA, Suárez C, Pare JC, Tubau F, Garcia de la Mària C, Marco F, Carratalà J, Gatell JM, Gudiol F, Miró JM, del Rio A, Moreno A, Pericas JM, Cervera C, Gatell JM, Marco F, de la Maria CG, Armero Y, Almela M, Mestres CA, Pare JC, Fuster D, Cartana R, Ninot S, Azqueta M, Sitges M, Heras M, Pomar JL, Ramirez J, Brunet M, Soy D, Llopis J, Gasch O, Suarez C, Pena C, Pujol M, Ariza J, Carratala J, Gudiol F, Cuquet J, Marti C, Mijana M. Efficacy and safety of fosfomycin plus imipenem as rescue therapy for complicated bacteremia and endocarditis due to methicillin-resistant Staphylococcus aureus: a multicenter clinical trial. Clin Infect Dis 2014; 59:1105-12. [PMID: 25048851 DOI: 10.1093/cid/ciu580] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is an urgent need for alternative rescue therapies in invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA). We assessed the clinical efficacy and safety of the combination of fosfomycin and imipenem as rescue therapy for MRSA infective endocarditis and complicated bacteremia. METHODS The trial was conducted between 2001 and 2010 in 3 Spanish hospitals. Adult patients with complicated MRSA bacteremia or endocarditis requiring rescue therapy were eligible for the study. Treatment with fosfomycin (2 g/6 hours IV) plus imipenem (1 g/6 hours IV) was started and monitored. The primary efficacy endpoints were percentage of sterile blood cultures at 72 hours and clinical success rate assessed at the test-of-cure visit (45 days after the end of therapy). RESULTS The combination was administered in 12 patients with endocarditis, 2 with vascular graft infection, and 2 with complicated bacteremia. Therapy had previously failed with vancomycin in 9 patients, daptomycin in 2, and sequential antibiotics in 5. Blood cultures were negative 72 hours after the first dose of the combination in all cases. The success rate was 69%, and only 1 of 5 deaths was related to the MRSA infection. Although the combination was safe in most patients (94%), a patient with liver cirrhosis died of multiorgan failure secondary to sodium overload. There were no episodes of breakthrough bacteremia or relapse. CONCLUSIONS Fosfomycin plus imipenem was an effective and safe combination when used as rescue therapy for complicated MRSA bloodstream infections and deserves further clinical evaluation as initial therapy in these infections.
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Affiliation(s)
- Ana del Río
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Oriol Gasch
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell
| | - Asunción Moreno
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Carmen Peña
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - Jordi Cuquet
- Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona
| | - Dolors Soy
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Carlos A Mestres
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Cristina Suárez
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - Juan C Pare
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Fe Tubau
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat CIBERES (CIBER de Enfermedades Respiratorias), ISCIII, Madrid
| | | | - Francesc Marco
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Spain
| | - Jordi Carratalà
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - José M Gatell
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Francisco Gudiol
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - José M Miró
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
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High doses of daptomycin (10 mg/kg/d) plus rifampin for the treatment of staphylococcal prosthetic joint infection managed with implant retention: a comparative study. Diagn Microbiol Infect Dis 2014; 80:66-71. [DOI: 10.1016/j.diagmicrobio.2014.05.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/19/2022]
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Exposure of Staphylococcus aureus to subinhibitory concentrations of β-lactam antibiotics induces heterogeneous vancomycin-intermediate Staphylococcus aureus. Antimicrob Agents Chemother 2014; 58:5306-14. [PMID: 24957836 DOI: 10.1128/aac.02574-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Glycopeptides are known to select for heterogeneous vancomycin-intermediate Staphylococcus aureus (h-VISA) from susceptible strains. In certain clinical situations, h-VISA strains have been isolated from patients without previous exposure to glycopeptides, such as cystic fibrosis patients, who frequently receive repeated treatments with beta-lactam antibiotics. Our objective was to determine whether prolonged exposure to beta-lactam antibiotics can induce h-VISA. We exposed 3 clinical vancomycin-susceptible methicillin-resistant Staphylococcus aureus (MRSA) strains to ceftazidime, ceftriaxone, imipenem, and vancomycin (as a control) at subinhibitory concentrations for 18 days in vitro. Population analyses showed progressive increases in vancomycin resistance; seven of the 12 derived strains obtained after induction were classified as h-VISA according to the following criteria: area under the curve (AUC) on day 18/AUC of Mu3 of ≥90% and/or growth on brain heart infusion (BHI) agar with 4 mg/liter vancomycin. The derived isolates had thickened cell walls proportional to the level of glycopeptide resistance. Genes known to be associated with glycopeptide resistance (vraSR, yvqF, SA1703, graRS, walKR, and rpoB) were PCR sequenced; no de novo mutations were observed upon beta-lactam exposure. To determine whether trfA, a gene encoding a glycopeptide resistance factor, was essential in the selection of h-VISA upon beta-lactam pressure, a trfA-knockout strain was generated by allelic replacement. Indeed, beta-lactam exposure of this mutated strain showed no capacity to induce vancomycin resistance. In conclusion, these results showed that beta-lactam antibiotics at subinhibitory concentrations can induce intermediate vancomycin resistance in vitro. This induction required an intact trfA locus. Our results suggest that prior use of beta-lactam antibiotics can compromise vancomycin efficacy in the treatment of MRSA infections.
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Interplay between Candida albicans and the antimicrobial peptide armory. EUKARYOTIC CELL 2014; 13:950-7. [PMID: 24951441 DOI: 10.1128/ec.00093-14] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Antimicrobial peptides (AMPs) are key elements of innate immunity, which can directly kill multiple bacterial, viral, and fungal pathogens. The medically important fungus Candida albicans colonizes different host niches as part of the normal human microbiota. Proliferation of C. albicans is regulated through a complex balance of host immune defense mechanisms and fungal responses. Expression of AMPs against pathogenic fungi is differentially regulated and initiated by interactions of a variety of fungal pathogen-associated molecular patterns (PAMPs) with pattern recognition receptors (PRRs) on human cells. Inflammatory signaling and other environmental stimuli are also essential to control fungal proliferation and to prevent parasitism. To persist in the host, C. albicans has developed a three-phase AMP evasion strategy, including secretion of peptide effectors, AMP efflux pumps, and regulation of signaling pathways. These mechanisms prevent C. albicans from the antifungal activity of the major AMP classes, including cathelicidins, histatins, and defensins leading to a basal resistance. This minireview summarizes human AMP attack and C. albicans resistance mechanisms and current developments in the use of AMPs as antifungal agents.
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Abstract
Daptomycin is a lipopeptide antimicrobial with in vitro bactericidal activity against Gram-positive bacteria that was first approved for clinical use in 2004 in the United States. Since this time, significant data have emerged regarding the use of daptomycin for the treatment of serious infections, such as bacteremia and endocarditis, caused by Gram-positive pathogens. However, there are also increasing reports of daptomycin nonsusceptibility, in Staphylococcus aureus and, in particular, Enterococcus faecium and Enterococcus faecalis. Such nonsusceptibility is largely in the context of prolonged treatment courses and infections with high bacterial burdens, but it may occur in the absence of prior daptomycin exposure. Nonsusceptibility in both S. aureus and Enterococcus is mediated by adaptations to cell wall homeostasis and membrane phospholipid metabolism. This review summarizes the data on daptomycin, including daptomycin's unique mode of action and spectrum of activity and mechanisms for nonsusceptibility in key pathogens, including S. aureus, E. faecium, and E. faecalis. The challenges faced by the clinical laboratory in obtaining accurate susceptibility results and reporting daptomycin MICs are also discussed.
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Kaur S, Harjai K, Chhibber S. Local delivery of linezolid from poly-D,L-lactide (PDLLA)-linezolid-coated orthopaedic implants to prevent MRSA mediated post-arthroplasty infections. Diagn Microbiol Infect Dis 2014; 79:387-92. [PMID: 24809862 DOI: 10.1016/j.diagmicrobio.2014.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/25/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
The present study focuses on the use of linezolid as local delivery agent for direct administration of the drug at the orthopaedic implant site. Local drug delivery system with linezolid added to the Poly D, L-(Lactide) polymer solution was used to coat the orthopaedic grade K-wires. Bacterial adherence on K-wires was then determined to evaluate the effect of the coated drug on the adherence of MRSA. A significant decrease in bacterial adherence as compared to naked wires was observed on all the coated K-wires (2.5, 5 and 10% w/w linezolid coated) with maximum decrease of 60%. This represents an aggressive early approach to prevent initial adherence of bacterial population. With the rise in MRSA mediated orthopaedic device related infections, the use of linezolid loaded polymer coated implants is definitely an attractive strategy against drug resistant strains of S. aureus.
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Affiliation(s)
- Sandeep Kaur
- Department of Microbiology, Panjab University, Chandigarh 160014, India
| | - Kusum Harjai
- Department of Microbiology, Panjab University, Chandigarh 160014, India
| | - Sanjay Chhibber
- Department of Microbiology, Panjab University, Chandigarh 160014, India.
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Gasch O, Camoez M, Domínguez MA, Padilla B, Pintado V, Almirante B, Martín C, López-Medrano F, de Gopegui ER, Blanco JR, García-Pardo G, Calbo E, Montero M, Granados A, Jover A, Dueñas C, Pujol M. Emergence of resistance to daptomycin in a cohort of patients with methicillin-resistant Staphylococcus aureus persistent bacteraemia treated with daptomycin. J Antimicrob Chemother 2014; 69:568-71. [PMID: 24107389 DOI: 10.1093/jac/dkt396] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- O Gasch
- Hospital Universitari de Bellvitge, Barcelona, Spain
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Rodvold KA, McConeghy KW. Methicillin-Resistant Staphylococcus aureus Therapy: Past, Present, and Future. Clin Infect Dis 2013; 58 Suppl 1:S20-7. [DOI: 10.1093/cid/cit614] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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McDaneld PM, Spooner LM, Mohr JF, Belliveau PP. Use of Daptomycin to Treat Infections With Methicillin-Resistant Staphylococcus aureus Isolates Having Vancomycin Minimum Inhibitory Concentrations of 1.5 to 2 µg/mL. Ann Pharmacother 2013; 47:1654-65. [DOI: 10.1177/1060028013508272] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Patrick M. McDaneld
- Massachusetts College of Pharmacy and Health Sciences, Worcester/Manchester Lexington, MA, USA
- Cubist Pharmaceuticals, Lexington, MA, USA
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX USA
| | - Linda M. Spooner
- Massachusetts College of Pharmacy and Health Sciences, Worcester/Manchester Lexington, MA, USA
| | | | - Paul P. Belliveau
- Massachusetts College of Pharmacy and Health Sciences, Worcester/Manchester Lexington, MA, USA
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44
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Frequency of susceptibility testing for patients with persistent methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 2013; 52:357-61. [PMID: 24153125 DOI: 10.1128/jcm.02081-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Currently, no standards exist for determining the optimal frequency of repeat antimicrobial susceptibility testing (AST) when an organism is recurrently isolated from the same specimen source. Although testing every 2 to 5 days is thought sufficient, we present three cases of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia where current laboratory protocol for repeating AST every 5 days was inadequate to identify resistant organisms.
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Impact of reduced vancomycin MIC on clinical outcomes of methicillin-resistant Staphylococcus aureus bacteremia. Antimicrob Agents Chemother 2013; 57:5536-42. [PMID: 23979741 DOI: 10.1128/aac.01137-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Vancomycin has been a key antibiotic agent for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. However, little is known about the relationship between vancomycin MIC values at the higher end of the susceptibility range and clinical outcomes. The aim of this study was to determine the impact of MRSA bacteremia on clinical outcomes in patients with a vancomycin MIC near the upper limit of the susceptible range. Patients with MRSA bacteremia were divided into a high-vancomycin-MIC group (2 μg/ml) and a low-vancomycin-MIC group (≤1.0 μg/ml). We examined the relationship between MIC, genotype, primary source of bacteremia, and mortality. Ninety-four patients with MRSA bacteremia, including 31 with a high vancomycin MIC and 63 with a low MIC were analyzed. There was no significant difference between the presence of agr dysfunction and SCCmec type between the two groups. A higher vancomycin MIC was not found to be associated with mortality. In contrast, high-risk bloodstream infection sources (hazard ratio [HR], 4.63; 95% confidence interval [CI] = 1.24 to 17.33) and bacterial eradication after treatment (HR, 0.06; 95% CI = 0.02 to 0.17), irrespective of vancomycin MIC, were predictors of all-cause 30-day mortality. Our study suggests that a high-risk source of bacteremia is likely to be associated with unfavorable clinical outcomes, but a high vancomycin MIC in a susceptible range, as well as genotype characteristics, are not associated with mortality.
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Rybak JM, Barber KE, Rybak MJ. Current and prospective treatments for multidrug-resistant gram-positive infections. Expert Opin Pharmacother 2013; 14:1919-32. [PMID: 23876168 DOI: 10.1517/14656566.2013.820276] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Staphylococcus aureus and Enterococcus spp. are two of the most common organisms causing nosocomial infections today; and are consistently associated with high mortality rates (approximately 20 and 44%, respectively). Resistance among these pathogens to first line agents such as methicillin and vancomycin continues to rise while isolates with reduced susceptibility to newer agents including linezolid and daptomycin continue to emerge, representing a serious concern for clinicians. AREAS COVERED Mechanisms of action and resistance as well as in vitro and clinical experience in the treatment of resistant staphylococci and enterococci with currently available agents are discussed. Additionally, novel combination regimens showing enhanced efficacy and available data pertaining to prospective therapies including solithromycin, tedizolid, dalbavancin and oritavancin will be covered. EXPERT OPINION With an increase in organisms displaying reduced susceptibility to vancomycin and the associated treatment failures, the significance of alternative therapies such as daptomycin, linezolid, ceftaroline, and prospective anti-gram-positive agents is on the rise. As our understanding of antimicrobial pharmacokinetic-pharmacodynamics principles continues to evolve, the selection of highly effective agents and optimization of dosages may lead to improved patient outcomes and delay the development of resistance.
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Affiliation(s)
- Jeffrey M Rybak
- University of Kentucky HealthCare, Department of Pharmacy , 800 Rose Street Room H110, Lexington KY 40536 , USA
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47
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Lawes T, Edwards B, Gould IM. Comment on: Lack of upward creep of glycopeptide MICs for methicillin-resistant Staphylococcus aureus (MRSA) isolated in the UK and Ireland 2001-07. J Antimicrob Chemother 2013; 68:1691-2. [DOI: 10.1093/jac/dkt070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Howden BP, Peleg AY, Stinear TP. The evolution of vancomycin intermediate Staphylococcus aureus (VISA) and heterogenous-VISA. INFECTION GENETICS AND EVOLUTION 2013; 21:575-82. [PMID: 23567819 DOI: 10.1016/j.meegid.2013.03.047] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/20/2013] [Accepted: 03/29/2013] [Indexed: 12/01/2022]
Abstract
Resistance to new antimicrobials is generally recognized in Staphylococcus aureus soon after they are released for clinical use. In the case of vancomycin, which was first released in the 1950s, resistance was not reported until the mid 1990s, with the description of vancomycin-intermediate S. aureus (VISA), and heterogenous-VISA (hVISA). Unraveling the complex genetic and cell wall structural changes conferring low-level vancomycin resistance in S. aureus has proved challenging. However the recent advances in high throughput whole-genome sequencing has played a key role in determining the breadth of bacterial chromosomal changes linked with resistance. Diverse mutations in a small number of staphylococcal regulatory genes, in particular walKR, graRS, vraSR and rpoB, have been associated with hVISA and VISA. Only a small number of these mutations have been experimentally proven to confer the resistance phenotype and some of these only partially contribute to resistance. It also appears that the evolution of VISA from VSSA is a step-wise process. Transcriptomics studies, and analysis of host pathogen interactions, indicate that the evolution of vancomycin-susceptible S. aureus to VISA is associated not only with antibiotic resistance, but with other changes likely to promote persistent infection. These include predicted alterations in central metabolism, altered expression of virulence associated factors, attenuated virulence in vivo, and alterations in susceptibility to host innate immune responses, together with reduced susceptibility to other antibiotics. In fact, current data suggests that hVISA and VISA represent a bacterial evolutionary state favoring persistence in the face of not only antibiotics, but also the host environment. The additional knowledge of staphylococcal biology that has been uncovered during the study of hVISA and VISA is significant. The present review will detail the current understanding of the evolutionary process in the generation of hVISA and VISA, and explore the diverse additional changes that occur in these strains.
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Affiliation(s)
- Benjamin P Howden
- Austin Centre for Infection Research (ACIR), Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia; Microbiology Department, Austin Health, Heidelberg, Victoria, Australia; Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia; Department of Microbiology, Monash University, Wellington Rd, Clayton, Victoria, Australia.
| | - Anton Y Peleg
- Department of Microbiology, Monash University, Wellington Rd, Clayton, Victoria, Australia; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia; Department of Microbiology, Monash University, Wellington Rd, Clayton, Victoria, Australia
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49
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van Hal SJ, Fowler VG. Is it time to replace vancomycin in the treatment of methicillin-resistant Staphylococcus aureus infections? Clin Infect Dis 2013; 56:1779-88. [PMID: 23511300 DOI: 10.1093/cid/cit178] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
For more than 4 decades, vancomycin has been the antibiotic of choice for methicillin-resistant Staphylococcus aureus (MRSA) infections. Recently, infections due to isolates with high but susceptible vancomycin minimum inhibitory concentrations have been associated with additional treatment failures and patient mortality. These poorer outcomes may in part be explained by the inability of attaining appropriate vancomycin levels in these patients. However, assumptions that these poor outcomes are solely due to failure to achieve optimal serum levels of vancomycin are premature. The availability of effective alternatives further erodes the position of vancomycin as first-line therapy. The emergence of resistance and cost considerations, however, favor a more measured approach when using alternative antimicrobials. Collectively, the current available data suggest that the optimal therapy for MRSA infections remains unclear. In the absence of further data, the Infectious Diseases Society of America guidelines remain relevant and inform clinicians of best practice for treating patients with MRSA infections.
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Affiliation(s)
- Sebastiaan J van Hal
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
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50
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den Heijer CDJ, van Bijnen EME, Paget WJ, Pringle M, Goossens H, Bruggeman CA, Schellevis FG, Stobberingh EE. Prevalence and resistance of commensal Staphylococcus aureus, including meticillin-resistant S aureus, in nine European countries: a cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2013; 13:409-15. [PMID: 23473661 DOI: 10.1016/s1473-3099(13)70036-7] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Information about the prevalence of Staphylococcus aureus resistance to antimicrobial drugs has mainly been obtained from invasive strains, although the commensal microbiota is thought to be an important reservoir of resistance. We aimed to compare the prevalence of nasal S aureus carriage and antibiotic resistance, including meticillin-resistant S aureus (MRSA), in healthy patients across nine European countries. METHODS In this cross-sectional study, nasal swabs were obtained from 32,206 patients recruited by family doctors participating in existing nationwide family doctor networks in Austria, Belgium, Croatia, France, Hungary, Spain, Sweden, the Netherlands, and the UK. Eligible patients were aged 4 years or older (≥ 18 years in the UK) and presented with a non-infectious disorder. Swabs were sent to national microbiological laboratories for identification and isolation of S aureus. Antibiotic resistance testing was done at one central microbiological laboratory. We established the genotypic structure of the isolated MRSA strains with the spa typing method. FINDINGS S aureus was isolated from 6956 (21 · 6%) of 32,206 patients swabbed. The adjusted S aureus prevalence for patients older than 18 years ranged from 12 · 1% (Hungary) to 29 · 4% (Sweden). Except for penicillin, the highest recorded resistance rate was to azithromycin (from 1 · 6% in Sweden to 16 · 9% in France). In total, 91 MRSA strains were isolated, and the highest MRSA prevalence was reported in Belgium (2 · 1%). 53 different spa types were detected-the most prevalent were t002 (n = 9) and t008 (n = 8). INTERPRETATION The prevalence of S aureus nasal carriage differed across the nine European countries assessed, even after correction for age, sex, and family doctor. Generally, the prevalence of resistance, including that of MRSA, was low. The MRSA strains recorded showed genotypic heterogeneity, both within and between countries. FUNDING European Commission, 7th Framework Programme(grant agreement 223083).
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Affiliation(s)
- Casper D J den Heijer
- Department of Medical Microbiology, Maastricht University Medical Centre/CAPHRI, Maastricht, Netherlands
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