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Huang S, He J, Zhang Y, Su L, Tong L, Sun Y, Zhou M, Chen Z. The Correlation Between Biofilm-Forming Ability of Community-Acquired Methicillin-Resistant Staphylococcus aureus Isolated from the Respiratory Tract and Clinical Characteristics in Children. Infect Drug Resist 2022; 15:3657-3668. [PMID: 35855760 PMCID: PMC9288189 DOI: 10.2147/idr.s370755] [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: 04/21/2022] [Accepted: 06/17/2022] [Indexed: 01/09/2023] Open
Abstract
Objective This study aimed to investigate the biofilm-forming ability, molecular typing, and antimicrobial resistance of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains isolated from the respiratory tract of children and their correlation with clinical characteristics. Methods All CA-MRSA strains were isolated from hospitalized children, and their presentation, molecular typing, antimicrobial susceptibility, and biofilm formation were investigated. The clinical characteristics were compared between the strong and weak biofilm producer groups. Results Fifty-three CA-MRSA strains were isolated from the respiratory samples of 53 children, with nearly half of them being young infants (0-12 months). Approximately, 88.7% (47/53) of the isolates were resistant to four or more antibiotics, mainly β-lactam antibiotics, lincosamides, and macrolides. Twelve sequence types (STs) and 20 subtypes of staphylococcal protein A (spa) typing were identified, with ST59-t437 (39.6%, 21/53) as the predominant subtype. All strains showed the ability to form biofilms. When compared to children with weak biofilm-forming CA-MRSA strains, those with strong biofilm-forming strains had higher proportions of lower respiratory tract infections (LRTI) (88.5% vs 59.3%), obvious cough symptoms (84.6% vs 51.9%), and severe chest imaging manifestations (76.9% vs 37.0%). Furthermore, a strong biofilm-forming ability significantly increased the risk of prolonged cough in children with LRTI (44.4% vs 14.3%), and a positive correlation between the duration of cough and the extent of biofilm formation was observed. Medical history investigation revealed that the strong biofilm-forming group had a much higher percentage of macrolides intake than the weak biofilm-forming group in the last month before admission (61.5% vs 14.8%). Conclusion ST59-t437 was the most prevalent clone in CA-MRSA respiratory isolates among the hospitalized children. All CA-MRSA strains formed biofilms. The stronger the biofilm-forming ability, the more serious and prolonged were the respiratory symptoms.
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Affiliation(s)
- Shumin Huang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Jing He
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Yiting Zhang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Lin Su
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Lin Tong
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Ying Sun
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Mingming Zhou
- National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China,Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China
| | - Zhimin Chen
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China,Correspondence: Zhimin Chen, Email
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2
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Esteban P, Redrado S, Comas L, Domingo MP, Millán-Lou MI, Seral C, Algarate S, Lopez C, Rezusta A, Pardo J, Arias M, Galvez EM. In Vitro and In Vivo Antibacterial Activity of Gliotoxin Alone and in Combination with Antibiotics against Staphylococcus aureus. Toxins (Basel) 2021; 13:toxins13020085. [PMID: 33498622 PMCID: PMC7911140 DOI: 10.3390/toxins13020085] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/22/2023] Open
Abstract
Multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causes of hospital-acquired and community infections and pose a challenge to the human health care system. Therefore, it is important to find new drugs that show activity against these bacteria, both in monotherapy and in combination with other antimicrobial drugs. Gliotoxin (GT) is a mycotoxin produced by Aspergillus fumigatus and other fungi of the Aspergillus genus. Some evidence suggests that GT shows antimicrobial activity against S. aureus in vitro, albeit its efficacy against multidrug-resistant strains such as MRSA or vancomycin-intermediate S. aureus (VISA) strainsis not known. This work aimed to evaluate the antibiotic efficacy of GT as monotherapy or in combination with other therapeutics against MRSA in vitro and in vivo using a Caenorhabditis elegans infection model.
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Affiliation(s)
- Patricia Esteban
- Fundacion Instituto de Investigacion Sanitaria Aragon (IIS Aragon), Biomedical Research Centre of Aragon (CIBA), 50009 Zaragoza, Spain; (P.E.); (J.P.)
| | - Sergio Redrado
- Instituto de Carboquımica ICB-CSIC, 50018 Zaragoza, Spain; (S.R.); (L.C.); (M.P.D.)
| | - Laura Comas
- Instituto de Carboquımica ICB-CSIC, 50018 Zaragoza, Spain; (S.R.); (L.C.); (M.P.D.)
| | - M. Pilar Domingo
- Instituto de Carboquımica ICB-CSIC, 50018 Zaragoza, Spain; (S.R.); (L.C.); (M.P.D.)
| | - M. Isabel Millán-Lou
- Department of Microbiology, Hospital Universitario Miguel Servet, IIS Aragón, 50009 Zaragoza, Spain; (M.I.M.-L.); (C.L.); (A.R.)
| | - Cristina Seral
- Department of Microbiology, University Clinic Hospital Lozano Blesa, 50009 Zaragoza, Spain; (C.S.); (S.A.)
- Department of Microbiology, Pediatrics, Radiology and Public Health, University of Zaragoza, 50009 Zaragoza, Spain
| | - Sonia Algarate
- Department of Microbiology, University Clinic Hospital Lozano Blesa, 50009 Zaragoza, Spain; (C.S.); (S.A.)
| | - Concepción Lopez
- Department of Microbiology, Hospital Universitario Miguel Servet, IIS Aragón, 50009 Zaragoza, Spain; (M.I.M.-L.); (C.L.); (A.R.)
| | - Antonio Rezusta
- Department of Microbiology, Hospital Universitario Miguel Servet, IIS Aragón, 50009 Zaragoza, Spain; (M.I.M.-L.); (C.L.); (A.R.)
| | - Julian Pardo
- Fundacion Instituto de Investigacion Sanitaria Aragon (IIS Aragon), Biomedical Research Centre of Aragon (CIBA), 50009 Zaragoza, Spain; (P.E.); (J.P.)
- Department of Microbiology, Pediatrics, Radiology and Public Health, University of Zaragoza, 50009 Zaragoza, Spain
- Aragon I+D Foundation (ARAID), 50018 Zaragoza, Spain
| | - Maykel Arias
- Instituto de Carboquımica ICB-CSIC, 50018 Zaragoza, Spain; (S.R.); (L.C.); (M.P.D.)
- Correspondence: (M.A.); (E.M.G.)
| | - Eva M. Galvez
- Instituto de Carboquımica ICB-CSIC, 50018 Zaragoza, Spain; (S.R.); (L.C.); (M.P.D.)
- Correspondence: (M.A.); (E.M.G.)
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Baral B, Mozafari MR. Strategic Moves of "Superbugs" Against Available Chemical Scaffolds: Signaling, Regulation, and Challenges. ACS Pharmacol Transl Sci 2020; 3:373-400. [PMID: 32566906 PMCID: PMC7296549 DOI: 10.1021/acsptsci.0c00005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Indexed: 12/12/2022]
Abstract
Superbugs' resistivity against available natural products has become an alarming global threat, causing a rapid deterioration in public health and claiming tens of thousands of lives yearly. Although the rapid discovery of small molecules from plant and microbial origin with enhanced bioactivity has provided us with some hope, a rapid hike in the resistivity of superbugs has proven to be the biggest therapeutic hurdle of all times. Moreover, several distinct mechanisms endowed by these notorious superbugs make them immune to these antibiotics subsequently causing our antibiotic wardrobe to be obsolete. In this unfortunate situation, though the time frame for discovering novel "hit molecules" down the line remains largely unknown, our small hope and untiring efforts injected in hunting novel chemical scaffolds with unique molecular targets using high-throughput technologies may safeguard us against these life-threatening challenges to some extent. Amid this crisis, the current comprehensive review highlights the present status of knowledge, our search for bacteria Achilles' heel, distinct molecular signaling that an opportunistic pathogen bestows to trespass the toxicity of antibiotics, and facile strategies and appealing therapeutic targets of novel drugs. Herein, we also discuss multidimensional strategies to combat antimicrobial resistance.
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Affiliation(s)
- Bikash Baral
- Department
of Biochemistry, University of Turku, Tykistökatu 6, Turku, Finland
| | - M. R. Mozafari
- Australasian
Nanoscience and Nanotechnology Initiative, 8054 Monash University LPO, Clayton, Victoria 3168, Australia
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4
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Higgins Hoare A, Tan SP, McLoughlin P, Mulhare P, Hughes H. The Screening and Evaluation of Fucus serratus and Fucus vesiculosus Extracts against Current Strains of MRSA Isolated from a Clinical Hospital Setting. Sci Rep 2019; 9:17911. [PMID: 31784603 PMCID: PMC6884646 DOI: 10.1038/s41598-019-54326-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/31/2019] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial resistant strains of infection are afflicting clinical settings, driving the search for novel antimicrobial compounds. Naturally sourced bioactives, for instance those from seaweeds, have the potential to ameliorate this issue. As such, solvent extracts from the edible Irish seaweeds Fucus serratus and Fucus vesiculosus were screened for antimicrobial activity against 28 clinically isolated strains of MRSA, including one GISA (glycopeptide intermediate S. aureus) and two mecC gene containing strains. The water extract of F. vesiculosus was the most promising extract went on to be tested for biofilm prevention and disruption activity. The disk diffusion method was used to investigate the inhibition of the bacterial pathogens tested while MIC, MBC and biofilm disruption and prevention analyses were performed spectroscopically and by plate counts, respectively. Solvent extracts were found to have a wide array of antimicrobial activity against the strains tested, with the water extract from Fucus vesiculosus being the most promising. This extract was also found to both prevent and disrupt MRSA biofilms indicating the potential extract as new antimicrobials, and raising the possibility of their possible use in therapeutics.
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Affiliation(s)
| | - Shiau Pin Tan
- Waterford Institute of Technology, Cork Road, Waterford, Ireland
| | - Peter McLoughlin
- Waterford Institute of Technology, Cork Road, Waterford, Ireland
| | | | - Helen Hughes
- Waterford Institute of Technology, Cork Road, Waterford, Ireland
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5
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Channabasappa S, Chikkamadaiah R, Durgaiah M, Kumar S, Ramesh K, Sreekanthan A, Sriram B. Efficacy of chimeric ectolysin P128 in drug-resistant Staphylococcus aureus bacteraemia in mice. J Antimicrob Chemother 2019; 73:3398-3404. [PMID: 30215762 DOI: 10.1093/jac/dky365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/15/2018] [Indexed: 01/08/2023] Open
Abstract
Objectives P128 is a recombinant chimeric ectolysin with potent antistaphylococcal activity. P128 was evaluated as monotherapy and in combination with two standard-of-care (SoC) antibiotics, vancomycin and daptomycin, in mouse models of Staphylococcus aureus bacteraemia. Methods Healthy BALB/c mice were challenged (intraperitoneally) with 109 cfu of MRSA strain COL or USA300 and treated with a single dose of P128 (0.2-10 mg/kg). Drug synergy was tested using a single dose of P128 (0.2 or 2.5 mg/kg) along with sub-therapeutic dose levels of vancomycin (27.5 or 55 mg/kg) or daptomycin (12.5 mg/kg). Bacterial load was checked in peritoneal fluid and in blood, at different time intervals. Synergy against drug-resistant strains was tested using the P128/vancomycin combination against vancomycin-resistant S. aureus (VRSA). Results In MRSA bacteraemia, P128, vancomycin and daptomycin monotherapy resulted in 31%, 46% and 46% survival, respectively. The P128/vancomycin and P128/daptomycin combinations afforded increased survival of 85% and 88%, respectively. P128 showed a rapid bactericidal effect with a reduction of cfu in both the peritoneal fluid and the blood within 1 h. In VRSA bacteraemia, a mouse-equivalent therapeutic dose of vancomycin (110 mg/kg) failed to rescue animals. P128 (1-20 mg/kg) as monotherapy resulted in dose-dependent efficacy. Survival (37%) with 2.5 mg/kg P128 increased to 63% with the P128/vancomycin combination. Conclusions P128 exerted a rapid bactericidal effect in vivo and rescued animals from fatal invasive MRSA and VRSA infections. P128/SoC antibiotic combinations exerted a synergistic effect. P128 restored the susceptibility of VRSA to vancomycin. P128 is a novel, potent therapeutic agent for antibiotic-resistant, systemic S. aureus infections.
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Affiliation(s)
- Shankaramurthy Channabasappa
- GangaGen Biotechnologies Pvt Ltd, No. 12, 5th Cross, Raghavendra Layout, Tumkur Road, Yeshwantpur, Bangalore, India
| | - Ravisha Chikkamadaiah
- GangaGen Biotechnologies Pvt Ltd, No. 12, 5th Cross, Raghavendra Layout, Tumkur Road, Yeshwantpur, Bangalore, India
| | - Murali Durgaiah
- GangaGen Biotechnologies Pvt Ltd, No. 12, 5th Cross, Raghavendra Layout, Tumkur Road, Yeshwantpur, Bangalore, India
| | - Senthil Kumar
- GangaGen Biotechnologies Pvt Ltd, No. 12, 5th Cross, Raghavendra Layout, Tumkur Road, Yeshwantpur, Bangalore, India
| | - Keerthi Ramesh
- GangaGen Biotechnologies Pvt Ltd, No. 12, 5th Cross, Raghavendra Layout, Tumkur Road, Yeshwantpur, Bangalore, India
| | - Aparna Sreekanthan
- GangaGen Biotechnologies Pvt Ltd, No. 12, 5th Cross, Raghavendra Layout, Tumkur Road, Yeshwantpur, Bangalore, India
| | - Bharathi Sriram
- GangaGen Biotechnologies Pvt Ltd, No. 12, 5th Cross, Raghavendra Layout, Tumkur Road, Yeshwantpur, Bangalore, India
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6
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Tsai HC, Huang TY, Chen JS, Chen WJ, Lin CY, Hsu BM. Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus in long-term care facilities in eastern Taiwan. Tzu Chi Med J 2019; 31:222-231. [PMID: 31867250 PMCID: PMC6905247 DOI: 10.4103/tcmj.tcmj_136_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/20/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
Objective: The prevention of infections is crucial in long-term care programs. Investigations of the occurrence and sources of pathogens in long-term care facilities (LTCFs) are still lacking, especially in eastern Taiwan. In this study, we conducted a surveillance of two common pathogens, Acinetobacter baumannii (AB) and methicillin-resistant Staphylococcus aureus (MRSA), in LTCFs in Hualien. Materials and Methods: Pathogenic assays including isolation, identification, and antimicrobial susceptibility tests were conducted for AB and MRSA at LTCFs in Eastern Taiwan. Staphylococcal cassette chromosome mec typing assays were done to understand the relatedness of clonal strains of MRSA. Results: All AB-positive samples in the LTCFs were mainly from water-rich samples and were drug susceptible. Our data indicated that the AB strains from LTCFs were similar to those from Puzi River watersheds in Taiwan, which were not drug resistant to commonly used antibiotics. On the other hand, the drug resistance analysis of MRSA indicated that the genotypes from the LTCFs were similar to those from nearby hospitals. Eight strains of MRSA were isolated from four LTCFs, of which five were identified as hospital-acquired strains according to SSCmed typing assays. Conclusion: These findings suggest that MRSA in LTCFs might propagate from hospitals and could be transmitted between hospitals and LTCFs. Health authorities should be aware of this risk. The long-term follow-up of MRSA is recommended in local medical institutions as well as in LTCFs for correlative analysis.
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Affiliation(s)
- Hsin-Chi Tsai
- Department of Psychiatry, School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Tung-Yi Huang
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan
| | - Jung-Sheng Chen
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan
| | - Wen-Jen Chen
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan
| | - Chong-Yen Lin
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan
| | - Bing-Mu Hsu
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan.,Center for Innovative on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan
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7
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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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8
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FUNGICIDAL AND INHIBITORY EFFECTS OF OF MONARDA FISTULOSA ESSENTIAL OIL AND EUGENOL AGAINST FUNGI OF ASPERGILLUS GENUS. WORLD OF MEDICINE AND BIOLOGY 2018. [DOI: 10.26724/2079-8334-2017-4-62-169-173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Kung VL, Chernock RD, Burnham CAD. Diagnostic accuracy of fungal identification in histopathology and cytopathology specimens. Eur J Clin Microbiol Infect Dis 2017; 37:157-165. [DOI: 10.1007/s10096-017-3116-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/27/2017] [Indexed: 12/19/2022]
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10
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Tsiouris CG, Kelesi M, Vasilopoulos G, Kalemikerakis I, Papageorgiou EG. The efficacy of probiotics as pharmacological treatment of cutaneous wounds: Meta-analysis of animal studies. Eur J Pharm Sci 2017; 104:230-239. [PMID: 28392493 DOI: 10.1016/j.ejps.2017.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 11/29/2022]
Abstract
The aim of the current meta-analysis of animal studies was to evaluate the efficacy of probiotics as pharmacological treatment of cutaneous wounds. A systematic electronic literature search was conducted and in total six animal studies which undertake twelve experiments met our inclusion criteria. We used the percentage (%) of wound area at the end of the first week after initial wounding to evaluate the efficacy of the probiotic treatment. The heterogeneity was estimated as statistically significant (p<0.0001) and therefore the meta-analysis was performed with the random-effect model. Based on the estimated Hedges' g (Hedges, 1982), the administration of probiotics was associated with acceleration of the wound contraction (g=-2.55; 95%CI=-3.59, -1.50; p<0.0001). The meta-regression analysis showed that the moderator sterile kefir extract has the greater effect on the overall estimated efficacy of probiotic treatment (g=-5.6983; p=0.0442) with bacteria probiotic therapies (70% kefir gel, L. brevis, L. fermentum, L. plantarum, L. reuteri) following (g=-2.3814; p=0.0003). For bacteria dose moderator, the results showed that increase in bacterial dose corresponds to increase of the estimated overall effect size (g=-10.2056; p=0.0053). The linear regression test of funnel plot asymmetry showed absence of publication bias. In conclusion, the results indicate that probiotics administration is an effective pharmacological treatment of cutaneous wounds. However, due to the heterogeneity among studies, further research is required.
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Affiliation(s)
- Christos G Tsiouris
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece
| | - Martha Kelesi
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece
| | - Georgios Vasilopoulos
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece
| | - Ioannis Kalemikerakis
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece
| | - Effie G Papageorgiou
- Department of Medical Laboratories, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece.
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11
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Zeng D, Debabov D, Hartsell TL, Cano RJ, Adams S, Schuyler JA, McMillan R, Pace JL. Approved Glycopeptide Antibacterial Drugs: Mechanism of Action and Resistance. Cold Spring Harb Perspect Med 2016; 6:cshperspect.a026989. [PMID: 27663982 DOI: 10.1101/cshperspect.a026989] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The glycopeptide antimicrobials are a group of natural product and semisynthetic glycosylated peptides that show antibacterial activity against Gram-positive organisms through inhibition of cell-wall synthesis. This is achieved primarily through binding to the d-alanyl-d-alanine terminus of the lipid II bacterial cell-wall precursor, preventing cross-linking of the peptidoglycan layer. Vancomycin is the foundational member of the class, showing both clinical longevity and a still preferential role in the therapy of methicillin-resistant Staphylococcus aureus and of susceptible Enterococcus spp. Newer lipoglycopeptide derivatives (telavancin, dalbavancin, and oritavancin) were designed in a targeted fashion to increase antibacterial activity, in some cases through secondary mechanisms of action. Resistance to the glycopeptides emerged in delayed fashion and occurs via a spectrum of chromosome- and plasmid-associated elements that lead to structural alteration of the bacterial cell-wall precursor substrates.
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Affiliation(s)
- Daina Zeng
- Agile Sciences, Raleigh, North Carolina 27606
| | | | - Theresa L Hartsell
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins School of Medicine and Nursing, Baltimore, Maryland 21287
| | - Raul J Cano
- ATCC Center for Translational Microbiology, Union, New Jersey 07083.,Biological Sciences Department, California Polytechnic State University, San Luis Obispo, California 93407
| | - Stacy Adams
- Center for Skin Biology, GlaxoSmithKline, Durham, North Carolina 27703
| | | | - Ronald McMillan
- ATCC Center for Translational Microbiology, Union, New Jersey 07083
| | - John L Pace
- ATCC Center for Translational Microbiology, Union, New Jersey 07083.,STEM Program, Kean University, Union, New Jersey 07083.,Biomanufacturing Research Institute and Technology Enterprise, North Carolina Central University, Durham, North Carolina 27707
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12
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Zhou W, Zhang Y, Li YH, Wang S, Zhang JJ, Zhang CX, Zhang ZS. Investigating dysregulated pathways in Staphylococcus aureus (SA) exposed macrophages based on pathway interaction network. Comput Biol Chem 2016; 66:21-25. [PMID: 27866052 DOI: 10.1016/j.compbiolchem.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/02/2016] [Accepted: 11/11/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This work aimed to identify dysregulated pathways for Staphylococcus aureus (SA) exposed macrophages based on pathway interaction network (PIN). METHODS The inference of dysregulated pathways was comprised of four steps: preparing gene expression data, protein-protein interaction (PPI) data and pathway data; constructing a PIN dependent on the data and Pearson correlation coefficient (PCC); selecting seed pathway from PIN by computing activity score for each pathway according to principal component analysis (PCA) method; and investigating dysregulated pathways in a minimum set of pathways (MSP) utilizing seed pathway and the area under the receiver operating characteristics curve (AUC) index implemented in support vector machines (SVM) model. RESULTS A total of 20,545 genes, 449,833 interactions and 1189 pathways were obtained in the gene expression data, PPI data and pathway data, respectively. The PIN was consisted of 8388 interactions and 1189 nodes, and Respiratory electron transport, ATP synthesis by chemiosmotic coupling, and heat production by uncoupling proteins was identified as the seed pathway. Finally, 15 dysregulated pathways in MSP (AUC=0.999) were obtained for SA infected samples, such as Respiratory electron transport and DNA Replication. CONCLUSIONS We have identified 15 dysregulated pathways for SA infected macrophages based on PIN. The findings might provide potential biomarkers for early detection and therapy of SA infection, and give insights to reveal the molecular mechanism underlying SA infections. However, how these dysregulated pathways worked together still needs to be studied.
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Affiliation(s)
- Wei Zhou
- College of Food Science and Technology, Agricultural University of Hebei, Baoding, 071000, Hebei Province, China; Department of Biological Safety Inspection, Hebei Food Inspection and Research Institute, Shijiazhuang, 050091, Hebei Province, China
| | - Yan Zhang
- Department of Biological Safety Inspection, Hebei Food Inspection and Research Institute, Shijiazhuang, 050091, Hebei Province, China
| | - Yue-Hua Li
- Department of Biological Safety Inspection, Hebei Food Inspection and Research Institute, Shijiazhuang, 050091, Hebei Province, China
| | - Shuang Wang
- Department of Biological Safety Inspection, Hebei Food Inspection and Research Institute, Shijiazhuang, 050091, Hebei Province, China
| | - Jing-Jing Zhang
- Department of Biological Safety Inspection, Hebei Food Inspection and Research Institute, Shijiazhuang, 050091, Hebei Province, China
| | - Cui-Xia Zhang
- Department of Biological Safety Inspection, Hebei Food Inspection and Research Institute, Shijiazhuang, 050091, Hebei Province, China
| | - Zhi-Sheng Zhang
- College of Food Science and Technology, Agricultural University of Hebei, Baoding, 071000, Hebei Province, China.
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Varona-Barquín A, Iglesias-Losada JJ, Ezpeleta G, Eraso E, Quindós G. Vancomycin heteroresistant community associated methicillin-resistant Staphylococcus aureus ST72-SCCmecIVa strain colonizing the nostrils of a five-year-old Spanish girl. Enferm Infecc Microbiol Clin 2016; 35:148-152. [PMID: 27590877 DOI: 10.1016/j.eimc.2016.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES During a community methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization study, an MRSA strain with vancomycin hetero-resistance (h-VISA) was isolated from a five year-old girl with tetralogy of Fallot without previous exposure to vancomycin. An extended nasal colonization study was performed on all her close relatives. RESULTS Only the patient and her sister were colonized by an h-VISA MRSA strain (clone USA 700, ST72, t148, agr 1 and SCCmec IVa). Mupirocin decolonisation was effective in the elder sister. A new nasal decolonisation in the younger girl using fusidic acid was also successful. However, after decolonisation both sisters were colonized by a methicillin-susceptible S. aureus (ST30, t012 and agr 3) previously isolated from their mother's nostrils. CONCLUSION As S. aureus have a great capacity to spread among people in close contact, knowledge of a patients' colonization status, tracing contacts, and a correct management are critical issues for the successful containment of multiresistant staphylococci.
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Affiliation(s)
- Aketza Varona-Barquín
- Laboratorio de Micología Médica, UFI 11/25 'Microbios y Salud', Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Spain
| | | | - Guillermo Ezpeleta
- Departamento de Medicina Preventiva y Salud Pública, UFI 11/25 'Microbios y Salud', Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Spain; Servicio de Medicina Preventiva e Higiene Hospitalaria, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elena Eraso
- Laboratorio de Micología Médica, UFI 11/25 'Microbios y Salud', Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Spain
| | - Guillermo Quindós
- Laboratorio de Micología Médica, UFI 11/25 'Microbios y Salud', Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Spain.
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Bernard L, Vaudaux P, Vuagnat A, Stern R, Rohner P, Pittet D, Schrenzel J, Hoffmeyer P. Effect of Vancomycin Therapy for Osteomyelitis on Colonization by Methicillin-ResistantStaphylococcus aureus: Lack of Emergence of Glycopeptide Resistance. Infect Control Hosp Epidemiol 2015; 24:650-4. [PMID: 14510246 DOI: 10.1086/502268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBackground:In treating orthopedic infections, the long-term impact of vancomycin therapy on colonization by methicillin-resistantStaphylococcus aureus(MRSA) and the emergence of vancomycin-intermediate S.aureusis unknown.Design:Prospective surveillance of the effect of long-term vancomycin therapy on colonization by MRSA and the emergence of vancomycin-intermediateS. aureus.Methods:Thirty-four patients with MRSA osteomyelitis that was microbiologically documented were longitudinally observed for the emergence of vancomycin-intermediate S.aureusat 3 body sites (wound, anterior nares, and groin) during the initial period of vancomycin therapy and at the 2-month follow-up. Twenty patients received the standard dose (20 mg/kg/d) for 34 ± 6 days and 14 patients received a high dose (40 mg/kg/d) of vancomycin for 37 ± 9 days.Results:During vancomycin treatment, global MRSA carriage (all body sites) fell from 100% to 25% in the group of patients receiving the standard dose of vancomycin, and from 100% to 40% in the group receiving the high dose. During the 2-month follow-up period after vancomycin therapy, global MRSA carriage increased from 25% to 55% in the group receiving the standard dose and decreased from 43% to 36% in the group receiving the high dose.Conclusion:Therapy with a high dose of vancomycin contributes to the sustained eradication of MRSA carriage without promoting the emergence of glycopeptide resistance.
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Affiliation(s)
- Louis Bernard
- Orthopedic Clinic, Geneva University Hospital, Geneva, Switzerland
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15
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Gardete S, Tomasz A. Mechanisms of vancomycin resistance in Staphylococcus aureus. J Clin Invest 2014; 124:2836-40. [PMID: 24983424 DOI: 10.1172/jci68834] [Citation(s) in RCA: 315] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Vancomycin is a glycopeptide antibiotic used for the treatment of Gram-positive bacterial infections. Traditionally, it has been used as a drug of last resort; however, clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) strains with decreased susceptibility to vancomycin (vancomycin intermediate-resistant S. aureus [VISA]) and more recently with high-level vancomycin resistance (vancomycin-resistant S. aureus [VRSA]) have been described in the clinical literature. The rare VRSA strains carry transposon Tn1546, acquired from vancomycin-resistant Enterococcus faecalis, which is known to alter cell wall structure and metabolism, but the resistance mechanisms in VISA isolates are less well defined. Herein, we review selected mechanistic aspects of resistance in VISA and summarize biochemical studies on cell wall synthesis in a VRSA strain. Finally, we recapitulate a model that integrates common mechanistic features of VRSA and VISA strains and is consistent with the mode of action of vancomycin.
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16
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El Ayoubi MD, Hamze M, Mallat H, Achkar M, Dabboussi F. Glycopeptide intermediate Staphylococcus aureus and prevalence of the luk-PV gene in clinical isolates, in Northern Lebanon. Med Mal Infect 2014; 44:223-8. [PMID: 24835167 DOI: 10.1016/j.medmal.2014.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 01/29/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of our study was to confirm the identification of 113 meticillin-resistant Staphylococcus aureus (MRSA) strains by pyrosequencing, to determine the susceptibility of these clinical isolates to various classes of antibiotics, to determine the minimum inhibitory concentration (MIC) to glycopeptides, and to detect mecA and luk-PV genes. METHODOLOGY The Staphylococcus species was identified by pyrosequencing of the variable region (V3) of the 16SrRNA. The susceptibility of these 113 strains of MRSA to antibiotics was determined by the disk diffusion method on Mueller-Hinton agar. The MIC of glycopeptides was determined by using the dilution method on solid media. mecA gene and luk-PV gene were detected by PCR. RESULTS The disk diffusion method proved full susceptibility to vancomycin, teicoplanin, and linezolid; whereas MIC (dilution method) indicated that 5/113 strains were resistant to teicoplanin, giving a probability of having heterogeneous glycopeptide intermediate S. aureus (hGISA) strains. The mecA gene was detected in all MRSA strains ruling out the probability of having new variants of this gene in the tested strains. The luk-PV gene was detected in 28 out of 113 MRSA strains (24.8%). CONCLUSION The originality of this study was the detection of hGISA strains knowing that they were susceptible to glycopeptides according to the diffusion method. Thus it is necessary to check the level of susceptibility of MRSA clinical isolates to glycopeptides for immunodeficient patients, by determining the MIC.
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Affiliation(s)
- M-D El Ayoubi
- Health and Environment Microbiology Laboratory, Azm Center for Research in Biotechnology and its Applications, Doctoral School of Sciences and Technology, Lebanese University, Mitein street, Tripoli, Lebanon
| | - M Hamze
- Health and Environment Microbiology Laboratory, Azm Center for Research in Biotechnology and its Applications, Doctoral School of Sciences and Technology, Lebanese University, Mitein street, Tripoli, Lebanon; Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
| | - H Mallat
- Health and Environment Microbiology Laboratory, Azm Center for Research in Biotechnology and its Applications, Doctoral School of Sciences and Technology, Lebanese University, Mitein street, Tripoli, Lebanon; Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - M Achkar
- Clinical Laboratory, Nini Hospital, Tripoli, Lebanon
| | - F Dabboussi
- Health and Environment Microbiology Laboratory, Azm Center for Research in Biotechnology and its Applications, Doctoral School of Sciences and Technology, Lebanese University, Mitein street, Tripoli, Lebanon; Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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Hayden SC, Bryant JJ, Mackey MA, Höfer K, Lindner BD, Nguyen VP, Jäschke A, Bunz UHF. Antimicrobial Activity of Water-Soluble Triazole Phenazine Clickamers againstE. coli. Chemistry 2013; 20:719-23. [DOI: 10.1002/chem.201303353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Indexed: 11/08/2022]
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Tascini C, Tagliaferri E, Di Paolo A, Ciofi L, Del Tacca M, Lambelet P, Menichett F. Three-Times Weekly Teicoplanin as Outpatient Treatment of Chronic Osteoarticular Infections. J Chemother 2013; 21:421-5. [DOI: 10.1179/joc.2009.21.4.421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Cationic antimicrobial peptide LL-37 is effective against both extra- and intracellular Staphylococcus aureus. Antimicrob Agents Chemother 2012; 57:1283-90. [PMID: 23274662 DOI: 10.1128/aac.01650-12] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The increasing resistance of bacteria to conventional antibiotics and the challenges posed by intracellular bacteria, which may be responsible for chronic and recurrent infections, have driven the need for advanced antimicrobial drugs for effective elimination of both extra- and intracellular pathogens. The purpose of this study was to determine the killing efficacy of cationic antimicrobial peptide LL-37 compared to conventional antibiotics against extra- and intracellular Staphylococcus aureus. Bacterial killing assays and an infection model of osteoblasts and S. aureus were studied to determine the bacterial killing efficacy of LL-37 and conventional antibiotics against extra- and intracellular S. aureus. We found that LL-37 was effective in killing extracellular S. aureus at nanomolar concentrations, while lactoferricin B was effective at micromolar concentrations and doxycycline and cefazolin at millimolar concentrations. LL-37 was surprisingly more effective in killing the clinical strain than in killing an ATCC strain of S. aureus. Moreover, LL-37 was superior to conventional antibiotics in eliminating intracellular S. aureus. The kinetic studies further revealed that LL-37 was fast in eliminating both extra- and intracellular S. aureus. Therefore, LL-37 was shown to be very potent and prompt in eliminating both extra- and intracellular S. aureus and was more effective in killing extra- and intracellular S. aureus than commonly used conventional antibiotics. LL-37 could potentially be used to treat chronic and recurrent infections due to its effectiveness in eliminating not only extracellular but also intracellular pathogens.
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Synergistic activity of ceftobiprole and vancomycin in a rat model of infective endocarditis caused by methicillin-resistant and glycopeptide-intermediate Staphylococcus aureus. Antimicrob Agents Chemother 2012; 56:1476-84. [PMID: 22232278 DOI: 10.1128/aac.06057-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The therapeutic activity of ceftobiprole medocaril, the prodrug of ceftobiprole, was compared to that of vancomycin, daptomycin, and the combination of a subtherapeutic dose of ceftobiprole and vancomycin in a rat model of infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) (ATCC 43300) or glycopeptide-intermediate Staphylococcus aureus (GISA) (NRS4 and HIP 5836) strains. The minimum bactericidal concentrations of ceftobiprole, vancomycin, and daptomycin at bacterial cell densities similar to those encountered in the cardiac vegetation in the rat endocarditis model were 2, >64, and 8 μg/ml, respectively, for MRSA ATCC 43300 and 4, >64, and 8 μg/ml, respectively, for the GISA strain. Ceftobiprole medocaril administered in doses of 100 mg/kg of body weight given intravenously (i.v.) twice a day (BID) every 8 h (q8h) (equivalent to a human therapeutic dose of ceftobiprole [500 mg given three times a day [TID]) was the most effective monotherapy, eradicating nearly 5 log(10) CFU/g MRSA or 6 log(10) CFU/g GISA organisms from the cardiac vegetation and had the highest incidence of sterile vegetation compared to the other monotherapies in the endocarditis model. In in vitro time-kill studies, synergistic effects were observed with ceftobiprole and vancomycin on MRSA and GISA strains, and in vivo synergy was noted with combinations of subtherapeutic doses of these agents for the same strains. Additionally, sterile vegetations were achieved in 33 and 60%, respectively, of the animals infected with MRSA ATCC 43300 or GISA NRS4 receiving ceftobiprole-vancomycin combination therapy. In summary, ceftobiprole was efficacious both as monotherapy and in combination with vancomycin in treating MRSA and GISA infections in a rat infective endocarditis model and warrants further evaluation.
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Jones M, Ganopolsky JG, Labbé A, Gilardino M, Wahl C, Martoni C, Prakash S. Novel nitric oxide producing probiotic wound healing patch: preparation and in vivo analysis in a New Zealand white rabbit model of ischaemic and infected wounds. Int Wound J 2012; 9:330-43. [PMID: 22221913 DOI: 10.1111/j.1742-481x.2011.00889.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The treatment of chronic wounds poses a significant challenge for clinicians and patients alike. Here we report design and preclinical efficacy of a novel nitric oxide gas (gNO)-producing probiotic patch for wound healing. Specifically, a wound healing patch using lactic acid bacteria in an adhesive gas permeable membrane has been designed and investigated for treating ischaemic and infected full-thickness dermal wounds in a New Zealand white rabbit model for ischaemic wound healing. Kaplan-Meier survival curves showed increased wound closure with gNO-producing patch-treated wounds over 21 days of therapy (log-rank P = 0·0225 and Wilcoxon P = 0·0113). Cox proportional hazard regression showed that gNO-producing patch-treated wounds were 2·52 times more likely to close compared with control patches (hazard P = 0·0375, score P = 0·032 and likelihood ratio P = 0·0355), and histological analysis showed improved wound healing in gNO-producing patch-treated animals. This study may provide an effective, safe and less costly alternative for treating chronic wounds.
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Affiliation(s)
- Mitchell Jones
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering and Physiology, Artificial Cells and Organs Research Centre, Faculty of Medicine, McGill University, Montreal, Quebec H3A 2B4, Canada
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Invasive mold infections: virulence and pathogenesis of mucorales. Int J Microbiol 2011; 2012:349278. [PMID: 22121366 PMCID: PMC3206359 DOI: 10.1155/2012/349278] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 09/16/2011] [Indexed: 01/08/2023] Open
Abstract
Mucorales have been increasingly reported as cause of invasive fungal infections in immunocompromised subjects, particularly in patients with haematological malignancies or uncontrolled diabetes mellitus and in those under deferoxamine treatment or undergoing dialysis. The disease often leads to a fatal outcome, but the pathogenesis of the infection is still poorly understood as well as the role of specific virulence determinants and the interaction with the host immune system. Members of the order Mucorales are responsible of almost all cases of invasive mucormycoses, the majority of the etiological agents belonging to the Mucoraceae family. Mucorales are able to produce various proteins and metabolic products toxic to animals and humans, but the pathogenic role of these potential virulence factors is unknown. The availability of free iron in plasma and tissues is believed to be crucial for the pathogenesis of these mycoses. Vascular invasion and neurotropism are considered common pathogenic features of invasive mucormycoses.
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Filleron A, Chiron R, Reverdy ME, Jean-Pierre H, Dumitrescu O, Aleyrangues L, Counil F, Jumas-Bilak E, Marchandin H. Staphylococcus aureus with decreased susceptibility to glycopeptides in cystic fibrosis patients. J Cyst Fibros 2011; 10:377-82. [DOI: 10.1016/j.jcf.2011.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/23/2011] [Accepted: 05/01/2011] [Indexed: 10/18/2022]
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Efficacy of NZ2114, a novel plectasin-derived cationic antimicrobial peptide antibiotic, in experimental endocarditis due to methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2011; 55:5325-30. [PMID: 21859940 DOI: 10.1128/aac.00453-11] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cationic antimicrobial peptides (CAPs) play important roles in host immune defenses. Plectasin is a defensin-like CAP isolated from the saprophytic fungus Pseudoplectania nigrella. NZ2114 is a novel variant of plectasin with potent activity against Gram-positive bacteria. In this study, we investigated (i) the in vivo pharmacokinetic and pharmacodynamic (PK/PD) characteristics of NZ2114 and (ii) the in vivo efficacy of NZ2114 in comparison with those of two conventional antibiotics, vancomycin or daptomycin, in an experimental rabbit infective endocarditis (IE) model due to a methicillin-resistant Staphylococcus aureus (MRSA) strain (ATCC 33591). All NZ2114 regimens (5, 10, and 20 mg/kg of body weight, intravenously [i.v.], twice daily for 3 days) significantly decreased MRSA densities in cardiac vegetations, kidneys, and spleen versus those in untreated controls, except in one scenario (5 mg/kg, splenic MRSA counts). The efficacy of NZ2114 was clearly dose dependent in all target tissues. At 20 mg/kg, NZ2114 showed a significantly greater efficacy than vancomycin (P < 0.001) and an efficacy similar to that of daptomycin. Of importance, only NZ2114 (in 10- and 20-mg/kg regimens) prevented posttherapy relapse in cardiac vegetations, kidneys, and spleen, while bacterial counts in these target tissues continued to increase in vancomycin- and daptomycin-treated animals. These in vivo efficacies were equivalent and significantly correlated with three PK indices investigated: fC(max)/MIC (the maximum concentration of the free, unbound fraction of a drug in serum divided by the MIC), fAUC/MIC (where AUC is the area under the concentration-time curve), and f%T(>MIC) (%T(>MIC) is the cumulative percentage of a 24-h period that the drug concentration exceeds the MIC under steady-state pharmacokinetic conditions), as analyzed by a sigmoid maximum-effect (E(max)) model (R(2) > 0.69). The superior efficacy of NZ2114 in this MRSA IE model suggests the potential for further development of this compound for treating serious MRSA infections.
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Olivier KS, Van Nieuwenhze MS. Synthetic studies toward the mannopeptimycins: synthesis of orthogonally protected beta-hydroxyenduracididines. Org Lett 2010; 12:1680-3. [PMID: 20232818 DOI: 10.1021/ol100219a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The asymmetric synthesis of the nonproteinogenic amino acids (2S,3S,4'S)-beta-hydroxyenduracididine 3 and (2R,3S,4'S)-beta-hydroxyenduracididine 4 in orthogonally protected form in 15 total steps from Garner's aldehyde is reported. The former and N-glycosylated form of the latter are found in the glycopeptide antibiotic mannopeptimycin.
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Affiliation(s)
- Kevin S Olivier
- Department of Chemistry, Indiana University, 800 East Kirkwood Avenue, Bloomington, Indiana 47405-7102, USA
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Treatment of vancomycin-intermediate Staphylococcus aureus (VISA) endocarditis with linezolid. Int J Infect Dis 2009; 14 Suppl 3:e227-9. [PMID: 20005763 DOI: 10.1016/j.ijid.2009.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 07/16/2009] [Accepted: 07/29/2009] [Indexed: 11/23/2022] Open
Abstract
We report a case of infective endocarditis due to vancomycin-intermediate Staphylococcus aureus (VISA). This was treated with a combination of intravenous linezolid and fusidic acid. Cure was achieved without surgical intervention.
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Stevens DL. Treatments for skin and soft-tissue and surgical site infections due to MDR Gram-positive bacteria. J Infect 2009; 59 Suppl 1:S32-9. [PMID: 19766887 DOI: 10.1016/s0163-4453(09)60006-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Gram-positive aerobes are the most common organisms in hospitalized patients with skin and soft-tissue infections (SSTIs). Staphylococcus aureus is the most common Gram-positive aerobe among these infections with methicillin-resistant S. aureus (MRSA) the most common pathogen. The increased prevalence of MRSA has been noted in the hospital as well in the community setting. In choosing antimicrobial therapy, assessment of the infection and patient characteristics, such as animal exposure, travel history, underlying diseases, recent trauma, bites, burns, and water exposure, must be considered. Community-acquired MRSA strains are showing resistance to more antimicrobial classes, and b-lactam antibiotics can no longer be considered first-line therapy for community-acquired SSTIs. For more serious infections, there are several new antimicrobial options with good MRSA coverage, including linezolid, daptomycin, and tigecycline. Several agents are currently under clinical investigation or are being considered for approval by the US Food and Drug Administration, including ceftobiprole, dalbavancin, iclaprim, oritavancin, and telavancin.
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Affiliation(s)
- Dennis L Stevens
- Infectious Diseases Section, Veterans Administration Medical Center, Boise, Idaho, USA.
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Abstract
OBJECTIVE To review the literature concerning the first Food and Drug Administration-approved lipopeptide antimicrobial, daptomycin. DATA SOURCES A PUBMED search was conducted to identify pertinent English-language journal articles between 1985 and November 2003, and additional references were obtained from the bibliographies of these articles. Abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy meetings from 1985 through 2003 also were reviewed. STUDY SELECTION All studies evaluating any aspect of daptomycin. DATA SYNTHESIS Daptomycin is a semisynthetic lipopeptide, the first such antimicrobial agent to reach the marketplace. Its mechanism of action differs from that of the related agent vancomycin in that much of its effect is not because of inhibition of peptidoglycan biosynthesis, but instead is a result of alterations in cell-membrane electrical charge and transport. It exhibits a broad spectrum of activity against gram-positive aerobes and anaerobes, including methicillin-, penicillin-, aminoglycoside-, and vancomycin-resistant strains. In subjects with normal renal function, the terminal disposition half-life is about 7 to 10 hours. It is principally eliminated as unchanged drug in the urine. Available clinical trial data demonstrate efficacy in complicated skin and skin-structure infections resulting from susceptible gram-positive pathogens, but not in pneumonia. The principal adverse event of concern, although rare, is myotoxicity, manifested by muscle pain and/or weakness and elevated serum creatine phosphokinase (CPK) concentrations. The approved dosage regimen is 4 mg/kg intravenously over 30 minutes once daily for 7 days to 14 days. Studies are underway evaluating doses of up to 8 mg/kg once daily. CONCLUSIONS Daptomycin, the first lipopeptide antimicrobial to be marketed, exhibits activity against multiresistant gram-positive pathogens, including linezolid- and quinupristindalfopristin-resistant strains. As such, it is a potentially valuable agent to treat infections resulting from such pathogens. To preserve its utility, it should not be used indiscriminately for infections resulting from pathogens sensitive to other antimicrobials. It is probably best used with restricted access and used only for multiresistant gram-positive pathogens where alternative agents cannot be employed. If used, careful monitoring for the signs and symptoms of myotoxicity, including obtaining weekly serum CPK levels, is mandatory. In addition, bacterial sensitivities to this agent should be prospectively monitored by national antimicrobial surveillance programs like SENTRY, TRUST, and LIBRA.
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Affiliation(s)
- David R P Guay
- Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
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Koziel J, Maciag-Gudowska A, Mikolajczyk T, Bzowska M, Sturdevant DE, Whitney AR, Shaw LN, DeLeo FR, Potempa J. Phagocytosis of Staphylococcus aureus by macrophages exerts cytoprotective effects manifested by the upregulation of antiapoptotic factors. PLoS One 2009; 4:e5210. [PMID: 19381294 PMCID: PMC2668171 DOI: 10.1371/journal.pone.0005210] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 03/18/2009] [Indexed: 12/26/2022] Open
Abstract
It is becoming increasingly apparent that Staphylococcus aureus are able to survive engulfment by macrophages, and that the intracellular environment of these host cells, which is essential to innate host defenses against invading microorganisms, may in fact provide a refuge for staphylococcal survival and dissemination. Based on this, we postulated that S. aureus might induce cytoprotective mechanisms by changing gene expression profiles inside macrophages similar to obligate intracellular pathogens, such as Mycobacterium tuberculosis. To validate our hypothesis we first ascertained whether S. aureus infection could affect programmed cell death in human (hMDMs) and mouse (RAW 264.7) macrophages and, specifically, protect these cells against apoptosis. Our findings indicate that S. aureus-infected macrophages are more resistant to staurosporine-induced cell death than control cells, an effect partly mediated via the inhibition of cytochrome c release from mitochondria. Furthermore, transcriptome analysis of human monocyte-derived macrophages during S. aureus infection revealed a significant increase in the expression of antiapoptotic genes. This was confirmed by quantitative RT-PCR analysis of selected genes involved in mitochondria-dependent cell death, clearly showing overexpression of BCL2 and MCL1. Cumulatively, the results of our experiments argue that S. aureus is able to induce a cytoprotective effect in macrophages derived from different mammal species, which can prevent host cell elimination, and thus allow intracellular bacterial survival. Ultimately, it is our contention that this process may contribute to the systemic dissemination of S. aureus infection.
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Affiliation(s)
- Joanna Koziel
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland.
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Glycopeptide insensitive Staphylococcus aureus subdural empyema treated with linezolid and rifampicin. J Infect 2008; 57:410-3. [DOI: 10.1016/j.jinf.2008.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 06/23/2008] [Accepted: 06/28/2008] [Indexed: 11/19/2022]
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Kollef M, Napolitano L, Solomkin J, Wunderink R, Bae I, Fowler V, Balk R, Stevens D, Rahal J, Shorr A, Linden P, Micek S. Health Care–Associated Infection (HAI): A Critical Appraisal of the Emerging Threat—Proceedings of the HAI Summit. Clin Infect Dis 2008; 47 Suppl 2:S55-99; quiz S100-1. [DOI: 10.1086/590937] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Majcherczyk PA, Barblan JL, Moreillon P, Entenza JM. Development of glycopeptide-intermediate resistance by Staphylococcus aureus leads to attenuated infectivity in a rat model of endocarditis. Microb Pathog 2008; 45:408-14. [PMID: 18930804 DOI: 10.1016/j.micpath.2008.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 08/27/2008] [Accepted: 09/12/2008] [Indexed: 12/20/2022]
Abstract
Glycopeptide-intermediate resistant Staphylococcus aureus (GISA) are characterized by multiple changes in the cell wall and an altered expression of global virulence regulators. We investigated whether GISA are affected in their infectivity in a rat model of experimental endocarditis. The glycopeptide-susceptible, methicillin-resistant S. aureus M1V2 and its laboratory-derived GISA M1V16 were examined for their ability to (i) adhere to fibrinogen and fibronectin in vitro, (ii) persist in the bloodstream after intravenous inoculation, (iii) colonize aortic vegetations in rats, and (iv) compete for valve colonization by co-inoculation. Both GISA M1V16 and M1V2 adhered similarly to fibrinogen and fibronectin in vitro. In rats, GISA M1V16 was cleared faster from the blood (P < 0.05) and required 100-times more bacteria than parent M1V2 (10(6) versus 10(4)CFU) to infect 90% of vegetations. GISA M1V16 also had 100 to 1000-times lower bacterial densities in vegetations. Moreover, after co-inoculation with GISA M1V16 and M1V2Rif, a rifampin-resistant variant of M1V2 to discriminate them in organ cultures, GISA M1V16 was out-competed by the glycopeptide-susceptible counterpart. Thus, in rats with experimental endocarditis, GISA showed an attenuated virulence, likely due to a faster clearance from the blood and a reduced fitness in cardiac vegetations. The GISA phenotype appeared globally detrimental to infectivity.
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Affiliation(s)
- Paul A Majcherczyk
- Department of Fundamental Microbiology, Faculty of Biology and Medicine, University of Lausanne, CH-1015 Lausanne, Switzerland
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Stepán J, Pantůcek R, Doskar J. Molecular diagnostics of clinically important staphylococci. Folia Microbiol (Praha) 2008; 49:353-86. [PMID: 15530002 DOI: 10.1007/bf03354664] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bacterial species of the genus Staphylococcus known as important human and animal pathogens are the cause of a number of severe infectious diseases. Apart from the major pathogen Staphylococcus aureus, other species until recently considered to be nonpathogenic may also be involved in serious infections. Rapid and accurate identification of the disease-causing agent is therefore prerequisite for disease control and epidemiological surveillance. Modern methods for identification and typing of bacterial species are based on genome analysis and have many advantages compared to phenotypic methods. The genotypic methods currently used in molecular diagnostics of staphylococcal species, particularly of S. aureus, are reviewed. Attention is also paid to new molecular methods with the highest discriminatory power. Efforts made to achieve interlaboratory reproducibility of diagnostic methods are presented.
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Affiliation(s)
- J Stepán
- Department of Genetics and Molecular Biology, Faculty of Science, Masaryk University, 611 37 Brno, Czechia
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Kwakman P, Van den Akker J, Güçlü A, Aslami H, Binnekade J, de Boer L, Boszhard L, Paulus F, Middelhoek P, te Velde A, Vandenbroucke‐Grauls C, Schultz M, Zaat S. Medical‐Grade Honey Kills Antibiotic‐Resistant Bacteria In Vitro and Eradicates Skin Colonization. Clin Infect Dis 2008; 46:1677-82. [DOI: 10.1086/587892] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Lagamayo EN. Antimicrobial resistance in major pathogens of hospital-acquired pneumonia in Asian countries. Am J Infect Control 2008; 36:S101-8. [PMID: 18468549 DOI: 10.1016/j.ajic.2007.10.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 10/15/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
Abstract
Antimicrobial resistance is a worldwide problem. For patients with hospital-acquired or ventilator-associated pneumonia, resistant pathogens pose a significant challenge to successful treatment outcomes and to the cost-effective delivery of health care. In the developing world, antibiotic resistance may be relatively more prevalent compared with Western countries. Common resistant pathogens include methicillin-resistant Staphylococcus aureus, multidrug resistant Pseudomonas aeruginosa, multidrug resistant Acinetobacter species, and extended-spectrum beta-lactamase-producing strains of Escherichia coli and Klebsiella pneumoniae. The emergence of these strains has provided a major impetus toward development of the present consensus treatment recommendations of the Asian HAP Working Group. The following review provides summary data regarding the incidence and prevalence of antibiotic-resistant pathogens in 10 Asian countries.
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Eisenstein BI. Use of daptomycin for treatment ofStaphylococcus aureusinfections. Expert Opin Drug Discov 2007; 2:1523-36. [DOI: 10.1517/17460441.2.11.1523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Perdelli F, Dallera M, Cristina ML, Sartini M, Ottria G, Spagnolo AM, Orlando P. A new microbiological problem in intensive care units: environmental contamination by MRSA with reduced susceptibility to glycopeptides. Int J Hyg Environ Health 2007; 211:213-8. [PMID: 17652023 DOI: 10.1016/j.ijheh.2007.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 04/24/2007] [Accepted: 04/24/2007] [Indexed: 11/27/2022]
Abstract
The present study evaluated the percentage of methicillin-resistant Staphylococcus aureus strains with reduced susceptibility to glycopeptides in four intensive care units (ICU) by means of environmental sampling of air and representative surfaces. The total bacterial count was taken and possible S. aureus strains were subsequently isolated. To assess methicillin resistance, an antibiogram was performed on the colonies that were positive to the coagulase test. A standard E-test was then carried out on the colonies that developed, in order to evaluate glycopeptide resistance, and any heterogeneous resistance was confirmed by means of a macromethod E-test. The antibiogram performed on the colonies of S. aureus revealed that 85.7% of all air samples were positive for MRSA, and that 64.3% of all the samples proved to be heterogeneously resistant to glycopeptides. Methicillin resistance was recorded in 41.0% of surface samples, and 32.5% of all samples proved positive for hGISA.
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Pea F, Viale P. Pharmacodynamics of antibiotics to treat multidrug-resistant Gram-positive hospital infections. Expert Rev Anti Infect Ther 2007; 5:255-70. [PMID: 17402840 DOI: 10.1586/14787210.5.2.255] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hospital infection due to multidrug-resistant Gram-positive bacteria may often represent a life-threatening challenge; thus, to appropriately combat them, clinicians should be confident and systematically apply several important pharmacodynamic concepts. The concept of 'correct antibiotic treatment' should include, in addition to an appropriate choice in terms of antimicrobial susceptibility, an appropriate dosage and administration schedule consistent with the pharmacodynamic principles. In the next few years, it is expected that some of the anti-Gram-positive antimicrobial agents that are currently under investigation will be added to the therapeutic armamentarium. However, optimization of the usage of old drugs still remains a clinical priority and a scientific challenge, whose dignity may be considered of similar importance to that of the assessment of the possible therapeutic role of the new compounds.
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Affiliation(s)
- Federico Pea
- University of Udine, Institute of Clinical Pharmacology & Toxicology, Department of Experimental and Clinical Pathology and Medicine, Medical School, P.le S. Maria della Misericordia 3, 33100 Udine, Italy.
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Tattevin P, Arvieux C, Michelet C. What is the place of teicoplanin and linezolid in the treatment of prosthetic joint infections? Clin Microbiol Infect 2006; 12:1241-2. [PMID: 17121636 DOI: 10.1111/j.1469-0691.2006.01560.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thorburn K, Taylor N, Saladi SM, van Saene HKF. Use of surveillance cultures and enteral vancomycin to control methicillin-resistant Staphylococcus aureus in a paediatric intensive care unit. Clin Microbiol Infect 2006; 12:35-42. [PMID: 16460544 DOI: 10.1111/j.1469-0691.2005.01292.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study assessed the effects of throat and gut surveillance, combined with enteral vancomycin, on gut overgrowth, transmission of methicillin-resistant Staphylococcus aureus (MRSA), infections and mortality in patients admitted to a paediatric intensive care unit (PICU). A 4-year prospective observational study was undertaken with 1241 children who required ventilation for >or=4 days. Patients identified as MRSA carriers following surveillance cultures of throat and rectum received enteral vancomycin. Twenty-nine (2.4%) children carried MRSA, 19 on admission and nine during treatment in the PICU; one patient was not able to be evaluated. Overgrowth was present in 22 (75%) of the carriers. Ten (0.8%) children developed 21 MRSA infections (15 exogenous infections in eight children at a median of 8 days (IQR 3-10.5); five primary endogenous infections at a median of 3 days (IQR 1-25) in three children when they were in overgrowth status; one child developed both types of infection). Enteral vancomycin reduced gut overgrowth significantly, completely preventing secondary endogenous infections. Transmission occurred on nine occasions over a period of 4 years. Four patients died, two (5.9%) with MRSA infection, giving a mortality (11.8%) similar to the study population (9.8%). No emergence of vancomycin-resistant enterococci or S. aureus with intermediate susceptibility to vancomycin was detected. A policy based on throat and gut surveillance, combined with enteral vancomycin, for critically-ill children who were MRSA carriers was found to be effective and safe, and challenges the recommended guidelines of nasal swabbing followed by topical mupirocin.
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Affiliation(s)
- K Thorburn
- Paediatric Intensive Care Unit, Royal Liverpool Children's Hospital, Alder Hey, Liverpool L12 2AP, UK.
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Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother 2006; 57:589-608. [PMID: 16507559 DOI: 10.1093/jac/dkl017] [Citation(s) in RCA: 268] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
These evidence-based guidelines have been produced after a literature review of the treatment and prophylaxis of methicillin-resistant Staphylococcus aureus (MRSA) infection. The guidelines were further informed by antibiotic susceptibility data on MRSA from the UK. Recommendations are given for the treatment of common infections caused by MRSA, elimination of MRSA from carriage sites and prophylaxis of surgical site infection. There are several antibiotics currently available that are suitable for use in the management of this problem and potentially useful new agents are continuing to emerge.
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Affiliation(s)
- Curtis G Gemmell
- Department of Bacteriology, Royal Infirmary, Glasgow, Scotland, UK
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Vaudaux P, Gjinovci A, Bento M, Li D, Schrenzel J, Lew DP. Intensive therapy with ceftobiprole medocaril of experimental foreign-body infection by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2005; 49:3789-93. [PMID: 16127054 PMCID: PMC1195398 DOI: 10.1128/aac.49.9.3789-3793.2005] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The therapeutic activity of ceftobiprole medocaril, the water-soluble prodrug of ceftobiprole, was compared to that of vancomycin in a rat tissue cage model of chronic methicillin-resistant Staphylococcus aureus (MRSA) foreign-body infection. The MICs and MBCs of ceftobiprole and vancomycin in Mueller-Hinton broth for strain MRGR3 were 1 and 4 and 1 and 2 microg/ml, respectively. In vitro elimination rates of strain MRGR3 of 4 and 8 microg/ml of ceftobiprole or vancomycin were equivalent. After 2 weeks of infection, mean +/- standard error of the mean viable counts of strain MRGR3 were 6.83 +/- 0.11 log CFU/ml of tissue cage fluid (n = 87). High-dose regimens of ceftobiprole medocaril (equivalent to 150 mg/kg of ceftobiprole) or 50 mg/kg vancomycin produced nearly identical average peak and trough levels of ceftobiprole and vancomycin in tissue cage fluid, which exceeded the MBC of either antibiotic towards strain MRGR3 for > or =75% of each dosing interval. After 7 days of therapy with ceftobiprole medocaril or vancomycin, average counts of MRGR3 decreased significantly (P < 0.02) by 0.68 +/- 0.28 (n = 29) and 0.88 +/- 0.22 (n = 28) log CFU/ml of tissue cage fluid, respectively, compared with cages of untreated animals, but were not significantly different from each other. No resistant mutants were detected on ceftobiprole-supplemented agar following therapy with this cephalosporin. The in vivo activity of ceftobiprole medocaril against chronic MRSA foreign-body infections was equivalent to that of vancomycin and did not lead to the emergence of resistant subpopulations.
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Affiliation(s)
- Pierre Vaudaux
- Service of Infectious Diseases, University Hospitals of Geneva, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland.
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Cunha BA. Methicillin-resistant Staphylococcus aureus: clinical manifestations and antimicrobial therapy. Clin Microbiol Infect 2005; 11 Suppl 4:33-42. [PMID: 15997484 DOI: 10.1111/j.1469-0691.2005.01162.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common skin coloniser and less commonly causes infection. MRSA colonisation should be contained by infection control measures and not treated. MRSA infections cause the same spectrum of infection as MSSA infections, i.e., skin/soft tissue infections, bone/joint infections, central IV line infections, and acute bacterial endocarditis (native valve/prosthetic valve). There is a discrepancy between in-vitro sensitivity and in-vivo effectiveness with MRSA. To treat MRSA infections, clinicians should select an MRSA drug with proven in-vivo effectiveness, i.e., daptomycin. Linezolid, quinupristin/dalfopristin, minocycline, or vancomycin, and not rely on in-vitro susceptibility data. For MRSA, doxycycline cannot be substituted for minocycline. Linezolid and minocycline are available for oral administration and both are also effective in treating MRSA CNS infections. Vancomycin is being used less due to side effects, (increasing MICs/resistance, VISA/VRSA), and increased VRE prevalence. The most potent anti-MRSA drug at the present time is daptomycin. Daptomycin is useful when rapid/effective therapy of MRSA bacteraemia/endocarditis is necessary. Daptomycin is also useful to treat persistent MRSA bacteraemias/MRSA treatment failures with other drugs, i.e., vancomycin. There is no difference in virulence between MSSA and MRSA infections if treatment is started early and with an agent that has in-vivo effectiveness.
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Affiliation(s)
- B A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York and State university of New York, School of Medicine, Stony Brook, New York, USA
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Cui L, Lian JQ, Neoh HM, Reyes E, Hiramatsu K. DNA microarray-based identification of genes associated with glycopeptide resistance in Staphylococcus aureus. Antimicrob Agents Chemother 2005; 49:3404-13. [PMID: 16048954 PMCID: PMC1196288 DOI: 10.1128/aac.49.8.3404-3413.2005] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Six pairs of transcription profiles between glycopeptide-intermediate S. aureus (GISA [or vancomycin-intermediate S. aureus; VISA]) and glycopeptide-susceptible S. aureus (vancomycin-susceptible S. aureus [VSSA], including glycopeptide-susceptible isogenic mutants from VISA) strains were compared using a microarray. Ninety-two open reading frames which were or tended to be increased in transcription in VISA in at least five out of six array combination pairs were evaluated for their effects on glycopeptide susceptibility by introducing these genes one by one into VSSA strain N315 to construct an overexpression library. By screening the library, 17 genes including 8 novel genes were identified as associated with glycopeptide resistance since their experimental overexpression reduced vancomycin and/or teicoplanin susceptibility of N315. The raised MICs of vancomycin and teicoplanin were 1.25 to 3.0 and 1.5 to 6.0 mg/liter, respectively, as compared to 1.0 mg/liter of N315. Three of these genes, namely graF, msrA2, and mgrA, also raised the oxacillin MIC from 8.0 mg/liter for N315 to 64 to approximately 128 mg/liter when they were overexpressed in N315. Their contribution to vancomycin and beta-lactam resistance was further supported by gene knockout and trans-complementation assay. By using a plasmid-based promoter-green fluorescent protein gene (gfp) transcriptional fusion system, graF promoter-activated cells were purified, and subsequent susceptibility tests and Northern blot analysis demonstrated that the cells with up-regulated activity of graF promoter showed reduced susceptibility to vancomycin, teicoplanin, and oxacillin. In addition, cell morphology studies showed that graF and msrA2 overexpression increased cell wall thickness of N315 by factors of 23.91 and 22.27%, respectively, accompanied by glycopeptide MIC increments of 3- to 6-fold, when they were overexpressed in N315. Moreover, extended experiments and analyses indicate that many of the genes identified above are related to the cell wall biosynthetic pathway, including active nutrient transport systems. We propose that the genes which raise glycopeptide resistance in S. aureus function toward altering the cell wall metabolic pathway.
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Affiliation(s)
- Longzhu Cui
- Department of Bacteriology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan.
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Abstract
The emergence of bacterial resistance to commonly used antibiotics is not new. In this review we have tried to cover the ever increasing problems facing the treatment and containment of bacterial skin infections. We have tried to give an overview of the varied mechanisms by which bacteria gain and spread antimicrobial resistance, whilst dealing with the patterns of resistance exhibited by some of the commonly encountered organisms. Where there is evidence, we have formulated an approach on how to tackle antibiotic resistance. Where there is a lack of evidence we have formulated what we perceive to be appropriate guidelines.
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Affiliation(s)
- G Perera
- Department of Dermatology, King's College Hospital, Denmark Hill, Camberwell, London, SE5 9RS, UK.
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Abstract
Foot infection is the most common reason for hospitalization and subsequent lower extremity amputation among persons with diabetes. Foot ulceration caused by diabetic neuropathy, trauma, and peripheral vascular disease can lead to a limbor life-threatening infection. The optimum treatment of these potentially devastating conditions depends on a multidisciplinary approach that addresses the related or underlying disorders and thus ensures proper wound healing and a positive outcome. In addition to antibiotic therapy, severe soft-tissue or bone infections may necessitate surgical treatment, including drainage, débridement, and vascular reconstruction. Initial (empiric) antibiotic therapy should provide coverage against staphylococci and streptococci and should be revised according culture results. Antibiotic therapy is not indicated in clinically noninfected wounds. The duration of antibiotic treatment can range from 1 week for mild infections to 6 weeks or more for residual osteomyelitis and severe deep tissue infections. Aggressive (and sometimes repeated or staged) surgical intervention and appropriate antibiotic therapy can reduce the likelihood of a major amputation and the duration of hospitalization.
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Affiliation(s)
- Thomas Zgonis
- Department of Orthopaedics/Podiatry Division, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
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KPI MARIA, TAKEUCHI FUMIHIKO, OKUMA KEIKO, KURODA MAKOTO, CUI LONGZHU, YAMAMOTO KENJI, HIRAMATSU KEIICHI. Spontaneous mutation accompanying decreased growth rate and cell wall thickening confers vancomycin resistance in the subpopulation of heterogeneously vancomycim-resistaut strain Mu3. ACTA ACUST UNITED AC 2005. [DOI: 10.14789/pjmj.51.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- MARIA KPI
- Department of Microbiology and Infection Control Science, Juntendo University Graduate School of Medicine,
| | - FUMIHIKO TAKEUCHI
- Department of Microbiology and Infection Control Science, Juntendo University Graduate School of Medicine,
| | - KEIKO OKUMA
- Department of Microbiology and Infection Control Science, Juntendo University Graduate School of Medicine,
| | - MAKOTO KURODA
- Department of Microbiology and Infection Control Science, Juntendo University Graduate School of Medicine,
| | - LONGZHU CUI
- Department of Microbiology and Infection Control Science, Juntendo University Graduate School of Medicine,
| | - KENJI YAMAMOTO
- Research Institute, International Medical Center of Japan
| | - KEIICHI HIRAMATSU
- Department of Microbiology and Infection Control Science, Juntendo University Graduate School of Medicine,
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49
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Abstract
Over the last several decades, a number of previously known or newly described species of gram-positive bacteria have emerged as important human pathogens, particularly in industrialized countries. These microbes have demonstrated an impressive ability to produce an array of striking infectious diseases never before seen or only infrequently encountered in the past. Despite aggressive therapeutic intervention, many of these conditions portend significant morbidity and mortality. Diseases caused by members of the Staphylococcus and Streptococcus genera have figured prominently in this regard, with Staphylococcus aureus, S. epidermidis, Streptococcus pyogenes, and other beta-hemolytic streptococci being regarded as the most important species. This review focuses on the clinical and microbiologic aspects of key emerging infections caused by this group of microorganisms.
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Affiliation(s)
- Sameer Elsayed
- Department of Pathology and Laboratory Medicine, University of Calgary, 9, 3535 Research Road NW, Calgary, Alberta T2L 2K8, Canada.
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50
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Vuagnat A, Stern R, Lotthe A, Schuhmacher H, Duong M, Hoffmeyer P, Bernard L. High dose vancomycin for osteomyelitis: continuous vs. intermittent infusion. J Clin Pharm Ther 2004; 29:351-7. [PMID: 15271102 DOI: 10.1111/j.1365-2710.2004.00572.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the efficacy, ease of use and safety of intermittent vancomycin infusion (IVI) and continuous vancomycin infusion (CVI) in high-dose therapy of osteomyelitis. METHODS Forty-four patients with an osteomyelitis requiring vancomycin for more than 4 weeks were prospectively included, 21 receiving IVI and 23, CVI. The target serum concentration of vancomycin was 20-25 mg/L. Pharmacokinetics, adverse effects, and clinical efficacy were recorded. RESULTS The mean daily vancomycin dosing was the same in the two groups, but the serum vancomycin concentrations (trough or plateau) were lower in the IVI group than the CVI group (21.7 +/- 9.3 and 26.0 +/- 6.1 mg/L, respectively; P < 0.0001). The target concentrations were achieved quicker with CVI, and daily dosing was changed more frequently in the IVI group. After reaching the target, variability of vancomycin serum concentration (trough or plateau concentrations) was higher in the IVI group than in CVI group (standard deviation 7.9 mg/L vs. 5.6 mg/L, respectively; P = 0.001). CVI did not show clinical superiority, but adverse drug effects were more frequent in the IVI group as compared with the CVI group, 9 (42.9%) and 2 (8.7%), respectively (P = 0.03). Survival multiple regression using Cox's proportional hazard model showed that IVI (RR = 5.9, P = 0.03) and osteomyelitis of the foot (RR = 5.2, P = 0.01) were the only factors associated with adverse drug reactions leading to treatment termination. CONCLUSIONS CVI is practical and effective, and may be a good alternative for patients requiring prolonged treatment with high vancomycin serum levels.
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Affiliation(s)
- A Vuagnat
- Department of Statistics, St Michel Hospital, Angoulème, France
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