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MATSUMOTO Y, YAMASAKI S, HAYAMA K, IINO R, NOJI H, YAMAGUCHI A, NISHINO K. Changes in the expression of mexB, mexY, and oprD in clinical Pseudomonas aeruginosa isolates. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2024; 100:57-67. [PMID: 38199247 PMCID: PMC10864171 DOI: 10.2183/pjab.100.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/12/2023] [Indexed: 01/12/2024]
Abstract
Changes in expression levels of drug efflux pump genes, mexB and mexY, and porin gene oprD in Pseudomonas aeruginosa were investigated in this study. Fifty-five multidrug-resistant P. aeruginosa (MDRP) strains were compared with 26 drug-sensitive strains and 21 strains resistant to a single antibiotic. The effect of the efflux inhibitor Phe-Arg-β-naphthylamide on drug susceptibility was determined, and gene expression was quantified using real-time quantitative real-time reverse transcription polymerase chain reaction. In addition, the levels of metallo-β-lactamase (MBL) and 6'-N-aminoglycoside acetyltransferase [AAC(6')-Iae] were investigated. Efflux pump inhibitor treatment increased the sensitivity to ciprofloxacin, aztreonam, and imipenem in 71%, 73%, and 29% of MDRPs, respectively. MBL and AAC(6')-Iae were detected in 38 (69%) and 34 (62%) MDRP strains, respectively. Meanwhile, 76% of MDRP strains exhibited more than 8-fold higher mexY expression than the reference strain PAO1. Furthermore, 69% of MDRP strains expressed oprD at levels less than 0.01-fold of those in PAO1. These findings indicated that efflux pump inhibitors in combination with ciprofloxacin or aztreonam might aid in treating MDRP infections.
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Affiliation(s)
- Yoshimi MATSUMOTO
- SANKEN (The Institute of Scientific and Industrial Research), Osaka University, Ibaraki, Osaka, Japan
| | - Seiji YAMASAKI
- SANKEN (The Institute of Scientific and Industrial Research), Osaka University, Ibaraki, Osaka, Japan
- Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
- Institute for Advanced Co-Creation Studies, Osaka University, Osaka, Japan
| | - Kouhei HAYAMA
- SANKEN (The Institute of Scientific and Industrial Research), Osaka University, Ibaraki, Osaka, Japan
| | - Ryota IINO
- Institute for Molecular Science, National Institutes of Natural Sciences, Okazaki, Aichi, Japan
- Graduate Institute for Advanced Studies, The Graduate University for Advanced Studies (SOKENDAI), Hayama, Kanagawa, Japan
| | - Hiroyuki NOJI
- Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Akihito YAMAGUCHI
- SANKEN (The Institute of Scientific and Industrial Research), Osaka University, Ibaraki, Osaka, Japan
| | - Kunihiko NISHINO
- SANKEN (The Institute of Scientific and Industrial Research), Osaka University, Ibaraki, Osaka, Japan
- Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
- Center for Infectious Disease Education and Research, Osaka University, Suita, Osaka, Japan
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Bayatinejad G, Salehi M, Beigverdi R, Halimi S, Emaneini M, Jabalameli F. In Vitro antibiotic combinations of Colistin, Meropenem, Amikacin, and Amoxicillin/clavulanate against multidrug-resistant Klebsiella pneumonia isolated from patients with ventilator-associated pneumonia. BMC Microbiol 2023; 23:298. [PMID: 37864176 PMCID: PMC10588070 DOI: 10.1186/s12866-023-03039-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Hospital infections such as ventilator-associated pneumonia (VAP) due to multidrug-resistant Klebsiella pneumoniae (MDR-KP) strains have increased worldwide. In addition, biofilm production by these resistant isolates has confronted clinicians with higher treatment failure and infection recurrence. Given the paucity of new agents and limited data on combination therapy for MDR-KPs, the present study sought to evaluate the in vitro activity of several antibiotic combinations against planktonic and biofilm MDR-KPs isolated from patients with VAP. RESULTS All 10 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates demonstrated multidrug resistance against the tested antibiotics. At planktonic mode, combinations of colistin-meropenem and amoxicillin/clavulanate in combination with meropenem, colistin, or amikacin showed synergism against 60-70% isolates. On the other hand, in the biofilm state, colistin-based combinations exhibited synergism against 50-70% isolates and the most effective combination was colistin-amikacin with 70% synergy. CONCLUSIONS The results revealed that combinations of amoxicillin/clavulanate with colistin, meropenem, or amikacin in the planktonic mode and colistin with amoxicillin/clavulanate, meropenem, or amikacin in the biofilm mode could effectively inhibit CRKP isolates, and thus could be further explored for the treatment of CRKPs.
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Affiliation(s)
- Ghazal Bayatinejad
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Beigverdi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahnaz Halimi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Emaneini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Jabalameli
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran.
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Suzuki R, Yumoto R, Shirai H, Tanaka T. Anti-Helicobacter pylori activity of swertianolin, isolated from swertia herb. J Nat Med 2023; 77:1005-1008. [PMID: 37382767 DOI: 10.1007/s11418-023-01718-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/01/2023] [Indexed: 06/30/2023]
Abstract
Helicobacter pylori is a Gram-negative, spiral-shaped, motile bacterium present in human stomachs that causes gastric ulcers. A preliminary screening revealed that a methanolic extract of swertia herb demonstrated anti-H. pylori activity. Swertia herb (Swertia japonica Makino, Gentianaceae) is a well-known Japanese traditional medicine to treat gastrointestinal diseases. In this study, we explored the active compounds in methanolic extract of swertia herb. The dried extract was dissolved in water and partitioned with n-hexane, ethyl acetate, and n-butanol, successively. The part soluble in ethyl acetate showed effective anti-H. pylori activity, and two compounds, swertianolin (1) and isoorientin (2), were isolated. The IC50 values of 1, 2, and amoxicillin (AMPC) which is used as positive control were 6.1, 177.0, and 0.044 μM, respectively. The minimum bactericidal concentration (MBC) values of 1 and AMPC were 91.7 and 0.21 μM, respectively. The MBC of 2 could not be determined (> 892.9 μM). Furthermore, synergy was observed when compound 1 was used in combination with AMCP. Therefore, 1 could be considered as one of the active compounds of swertia herb. To our knowledge, the anti-H. pylori activities of methanolic extract of swertia herb and its isolated compound have never been reported.
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Affiliation(s)
- Ryuichiro Suzuki
- Department of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan.
| | - Riku Yumoto
- Department of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan
| | - Hiromu Shirai
- Department of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan
| | - Toru Tanaka
- Department of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan.
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Seki M, Karaushi H, Arai N, Hayashi T, Mitsutake K. COVID-19 and Listeria Meningitis Treated by Ampicillin, Sulfamethoxazole/Trimethoprim and Meropenem. Infect Drug Resist 2023; 16:4289-4295. [PMID: 37424669 PMCID: PMC10328099 DOI: 10.2147/idr.s414879] [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: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023] Open
Abstract
Background Secondary bacterial infection was initially rare in SARS-CoV-2 infectious disease (COVID-19) patients, but COVID-19-associated bacterial infectious diseases have recently been increasing. Furthermore, it might be difficult to distinguish COVID-19 from bacterial meningitis by the symptoms, and one might be uncertain about antibiotic therapy for Listeria meningitis infection-typically caused by eating contaminated food-in elderly persons and pregnant women. Case Report A 96-year-old woman who had been living alone was found to have SARS-CoV-2 infection in February 2023. She was admitted to our hospital with high fever and disturbance of consciousness and was started on treatment with remdesivir. Two days later, her consciousness was still disturbed, and she was found to have a stiff neck. In addition, increased white blood cell counts and C-reactive protein suggested bacterial infection. Therefore, a lumbar puncture was done, and Listeria monocytogenes was ultimately isolated from blood cultures and its genetic material was detected in cerebrospinal fluid. She had previously eaten refrigerated food and cheese products. Intravenous ampicillin 1.0 g 6×/day was started, but one week later, loss of consciousness continued, and the cerebrospinal findings were not improved, although nasal swab became negative for SARS-CoV-2. Intravenous sulfamethoxazole/trimethoprim (ST) 80/400 mg 3×/day was added, and her consciousness and fever improved by one week later. A drug rash appeared after ST was started, and she was switched to meropenem. Her condition finally improved. Conclusion COVID-19-associated secondary listeria infection was found in an elderly woman. She was treated with not only ampicillin, but also ST and meropenem. Meningitis caused by Listeria monocytogenes should be considered as a secondary complication and carefully treated with antibiotics during the period of the COVID-19 pandemic.
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Affiliation(s)
- Masafumi Seki
- Division of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
| | - Haruka Karaushi
- Division of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
| | - Noriko Arai
- Division of Neurology, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
| | - Takeshi Hayashi
- Division of Neurology, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
| | - Kotaro Mitsutake
- Division of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
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Umemura T, Hagihara M, Mori T, Mikamo H. In Vitro Efficacy of Antibiotic Combinations with Carbapenems and Other Agents against Anaerobic Bacteria. Antibiotics (Basel) 2022; 11:antibiotics11030292. [PMID: 35326756 PMCID: PMC8944673 DOI: 10.3390/antibiotics11030292] [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: 01/16/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
We investigated the in vitro efficacy of combinations of carbapenems with clindamycin (CLDM) and minocycline (MINO) against Bacteroides fragilis and Peptostreptococcus species. We selected the carbapenems imipenem, meropenem, panipenem, doripenem, and biapenem. To evaluate the antibiotic efficacy of these combination regimens, the fractional inhibitory concentration index (FICI) was calculated against clinical isolates. Consequently, combination regimens of each carbapenem with CLDM or MINO showed synergistic or additive effects against 83.3−100.0% and no antagonistic effects against P. anaerobius isolates. However, against the B. fragilis group (B. fragilis, B. thetaiotaomicron, and Parabacteroides distasonis), although the combination with other carbapenems and CLDM or MINO did not show remarkable synergistic effects, the combination regimen of IPM with CLDM or MINO indicated mainly additive antibiotic efficacies (FICIs: >0.5 to ≤1.0) to B. fragilis groups. Then, antagonistic effects were admitted in only 5.6% of B. fragilis groups. The effectiveness of antibiotic combination therapy against pathogenic anaerobes has remained unclear. Then, our results can provide new insights to explore the effective combination regimens against multidrug-resistant anaerobic bacteria as empirical and definitive therapies, while this study used only carbapenem susceptible isolates. Hence, further studies are needed to use highly antibiotic-resistant anaerobic isolates to carbapenems.
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Affiliation(s)
- Takumi Umemura
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (T.U.); (M.H.); (T.M.)
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (T.U.); (M.H.); (T.M.)
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Nagakute 480-1195, Japan
| | - Takeshi Mori
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (T.U.); (M.H.); (T.M.)
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute 480-1195, Japan; (T.U.); (M.H.); (T.M.)
- Correspondence: ; Tel./Fax: +81-561-61-1842
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Sato M, Honda A, Maki H, Toyama K, Yamaguchi R, Ikeda M, Moriya K, Kurokawa M. Successful treatment of pneumonia caused by multidrug-resistant Pseudomonas aeruginosa after allogeneic hematopoietic stem cell transplantation with colistin and amikacin inhalation therapy. J Infect Chemother 2021; 28:91-94. [PMID: 34518095 DOI: 10.1016/j.jiac.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022]
Abstract
Pseudomonas aeruginosa is a Gram-negative bacillus that often causes severe infections during immunosuppression in patients with hematologic malignancies. P. aeruginosa can easily acquire drug resistance, and often develops into multidrug-resistant P. aeruginosa (MDRP). Although many antibiotics are used in combination to treat MDRP infections, colistin and amikacin are less likely to be transferred to the lungs, and inhalation therapy may be used. Herein, we report a Case of pneumonia caused by MDRP after allogeneic hematopoietic stem cell transplantation (HSCT) treated with inhaled colistin and amikacin. This 61-year-old female patient was diagnosed with myelodysplastic syndromes and underwent allogeneic HSCT from an 8/8 HLA-matched unrelated donor after reduced-intensity conditioning. On the day of the stem cell infusion, the patient's sputum culture was found to be positive for MDRP. The patient subsequently developed bacteremia, pneumonia, and lung abscess caused by MDRP, and we administered multidrug antibiotic therapy including colistin and amikacin inhalation therapy. The patient's blood cultures were subsequently turned negative, and the lung abscess disappeared. To our knowledge, this is the first case of MDRP pneumonia after HSCT in which colistin and amikacin inhalation therapy was effective.
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Affiliation(s)
- Michiaki Sato
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Honda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Maki
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Toyama
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Yamaguchi
- Department of Pharmacy, The University of Tokyo Hospital, Japan
| | - Mahoko Ikeda
- Department of Infection Control and Prevention, Faculty of Medicine, The University of Tokyo, Japan
| | - Kyoji Moriya
- Department of Infection Control and Prevention, Faculty of Medicine, The University of Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan.
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In vitro efficacy of combinations of eight antimicrobial agents against Mycobacteroides abscessus complex. Int J Infect Dis 2020; 97:270-277. [PMID: 32526389 DOI: 10.1016/j.ijid.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES A standard treatment regimen against Mycobacteroides abscessus complex (MABC) infections has not yet been established, making MABC difficult to treat successfully. In this study, we sought to develop an active ingredient for the clinical treatment of MABC infections. METHODS We screened 102 MABC strains isolated from clinical specimens using DNA sequence analysis with the housekeeping genes hsp65 and rpoB. Drug susceptibility testing was performed against two subspecies-Mycobacteroides abscessus subsp. abscessus (M. abscessus) and Mycobacteroides abscessus subsp. massiliense (M. massiliense)-using eight antimicrobial agents (clarithromycin, amikacin, doxycycline, imipenem, linezolid, moxifloxacin, faropenem, and rifampicin). The combined efficacy of the antimicrobial agents was investigated using a checkerboard method. RESULTS We identified 51 isolates as M. abscessus, 46 as M. massiliense, and five as others. Most of the M. abscessus isolates (83.0 %) exhibited inducible resistance to clarithromycin via the expression of the erm(41) gene. Combinations of imipenem with linezolid, moxifloxacin, and rifampicin exhibited additive effects against 81.0 %, 40.7 %, and 26.9 % of M. abscessus, respectively, and against 54.5 %, 69.2 %, and 30.8 % of M. massiliense, respectively. CONCLUSIONS These results demonstrated the potential efficacy of a regimen containing imipenem against M. abscessus and M. massiliense infections.
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In vitro effect of an antimicrobial combination therapy without colistin and tigecycline for CPE and non-CPE. J Infect Chemother 2020; 26:322-330. [PMID: 31924522 DOI: 10.1016/j.jiac.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/01/2019] [Accepted: 12/03/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This study aimed to investigate the in vitro effects of a combination of antimicrobials other than colistin (CL) and tigecycline (TGC) on carbapenem-resistant Enterobacteriaceae (CRE). METHODS We used 72 CRE strains including 65 carbapenemase-producing Enterobacteriaceae (CPE) that produce IMP-1, IMP-6, NDM, KPC, and OXA-48-like carbapenemases; and 7 carbapenemase-nonproducing Enterobacteriaceae (non-CPE) strains. These strains were assessed using antimicrobial susceptibility testing, breakpoint checkerboard (BC) plate method, and kill curve experiment to determine the effect of the combination therapy. RESULTS NDM, KPC, and OXA-48-like carbapenemase-producers showed higher MICs of carbapenem and aminoglycosides, and lower MICs of minocycline, compared to non-CPE and IMP-1/-6-producers. The results of the BC plate method suggested that the suitability of combinations of antimicrobials differ depending on the type of carbapenemases. Killing curve experiments demonstrated bactericidal or bacteriostatic action of the combination of antimicrobials even in sub-MIC concentrations of drugs. Our results suggest that the most effective antimicrobial combinations for each carbapenemase-producers are as follows; IMP-1 (tobramycin + tazobactam/piperacillin), IMP-6 (gentamicin + meropenem), NDM (minocycline + biapenem), KPC (arbekacin + doripenem) and OXA-48-like (minocycline + imipenem). CONCLUSION These results suggest that the combination of antimicrobials other than CL and TGC may be another candidate for the treatments of CPE infections, even though we have to choose effective antimicrobial combinations depending on the type of carbapenemase.
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El-Shorbagi AN, Chaudhary S. Monobactams: A Unique Natural Scaffold of Four-Membered Ring Skeleton, Recent Development to Clinically Overcome Infections by Multidrug- Resistant Microbes. LETT DRUG DES DISCOV 2019. [DOI: 10.2174/1570180816666190516113202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:
Monobactam antibiotics have been testified to demonstrate significant antibacterial
activity especially the treatment of infections by superbug microbes. Recently, research has
been focused on the structural modifications, and new generation of this privileged natural scaffold.
Objective:
Efforts have been made to discover the structure-antibacterial relationship of monbactams
in order to avoid the aimless work involving the ongoing generated analogues. This review aims to
summarize the current knowledge and development of monobactams as a broad-spectrum antibacterial
scaffolds. The recent structural modifications that expand the activity, especially in the infections
by resistant-strains, combinational therapies and dosing, as well as the possibility of crosshypersensitivity/
reactivity/tolerability with penicillins and cephalosporins will also be summarized
and inferred. Different approaches will be covered with emphasis on chemical methods and Structure-
Activity Relationship (SAR), in addition to the proposed mechanisms of action. Clinical investigation
of monobactams tackling various aspects will not be missed in this review.
Conclusion:
The conclusion includes the novels approaches, that could be followed to design new
research projects and reduce the pitfalls in the future development of monobactams.
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Affiliation(s)
- Abdel Nasser El-Shorbagi
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Sachin Chaudhary
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
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Avery LM, Nicolau DP. Feasibility of routine synergy testing using antibiotic gradient diffusion strips in the clinical laboratory. J Antimicrob Chemother 2018; 73:2264-2265. [DOI: 10.1093/jac/dky165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lindsay M Avery
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
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Inamasu J, Ishikawa K, Oheda M, Nakae S, Hirose Y, Yoshida S. Intrathecal administration of colistin for meningitis due to New Delhi metallo-β-lactamase 1(NDM-1)-producing Klebsiella pneumoniae. J Infect Chemother 2015; 22:184-6. [PMID: 26683242 DOI: 10.1016/j.jiac.2015.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/08/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
Infection by bacteria carrying New Delhi metallo-β-lactamase 1 (NDM-1) is becoming a global health problem. We report a case of meningitis caused by NDM-1-producing Klebsiella pneumoniae, for which intrathecal administration of colistin was curative. A previously healthy 38-year-old Japanese man, who lived in Hyderabad, India, suddenly collapsed and was brought to a local hospital. He was diagnosed with subarachnoid hemorrhage and underwent emergency surgery which included partial skull removal. Approximately 1 month after surgery, he was repatriated to Japan and was admitted to our institution with information that he had been treated for multi-drug resistant Acinetobacter infection with colistin. A week after admission, he developed aspiration pneumonia due to NDM-1-producing K. pneumoniae, which was successfully treated by intravenous (IV) administration of colistin. Subsequently, he underwent a surgical procedure to repair his skull defect. He developed high-grade fever and altered mental status on postoperative day 2. NDM-1-producing K. pneumoniae was identified in the cerebrospinal fluid, establishing the diagnosis of meningitis. Although IV colistin was only partially effective, intrathecal colistin (10 mg daily by lumbar puncture for 14 days) successfully eradicated the meningitis. Because of economic globalization, NDM-1-producing bacteria may be brought to Japan by those who are repatriated after sustaining critical illnesses and being treated in foreign countries. This report may provide useful information on the treatment of central nervous system infection by NDM-1-producing bacteria.
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Affiliation(s)
- Joji Inamasu
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
| | - Kiyohito Ishikawa
- Division of Infection Control and Prevention, Fujita Health University Hospital, Toyoake, Japan
| | - Motoki Oheda
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Shunsuke Nakae
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Shunji Yoshida
- Department of Rheumatology and Infectious Diseases, Fujita Health University Hospital, Toyoake, Japan
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Combination Therapy against Polymicrobial Infection, Including by NDM-1-Producing Enterobacteriaceae Resistant to Colistin. Antimicrob Agents Chemother 2015; 59:5092-3. [PMID: 26033729 DOI: 10.1128/aac.00746-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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New options of antibiotic combination therapy for multidrug-resistant Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 2014; 34:83-87. [PMID: 25070493 DOI: 10.1007/s10096-014-2192-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/22/2014] [Indexed: 10/24/2022]
Abstract
Several antibiotic combinations have demonstrated increased activity against multidrug-resistant Pseudomonas aeruginosa (MDRP) in vitro compared with a single antibiotic. The aim of this study was to investigate the activity against MDRP of some aminoglycosides in combination with monobactam, piperacillin (PIPC), and carbapenem. Clinical isolates of MDRP were collected between November 2010 and October 2012 from patients in Tokyo Medical University Hospital, Tokyo (1,015 beds). Our new method was designed to evaluate three concentrations around the breakpoint of each drug using the Checkerboard method. The aminoglycosides tested were amikacin (AMK), tobramycin (TOB), and arbekacin (ABK). Ciprofloxacin, PIPC, and biapenem (BIPM), which have been reported to demonstrate combination effects, were also tested. Sixty-six MDRP strains were identified from the 2,417 P. aeruginosa strains. Of the 66, 27 tested positive for metallo-β-lactamase (MBL). Aztreonam (AZT) with AMK or ABK was the most effective against MDRP. PIPC with AMK or ABK were somewhat effective. AZT with AMK or ABK were more effective against MBL-positive strains than MBL-negative strains. However, PIPC with AMK or ABK were more effective against MBL-negative strains than MBL-positive strains. Combination activities showed differences between MBL-positive and MBL-negative strains.
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Nakamura I, Yamaguchi T, Tsukimori A, Sato A, Fukushima S, Mizuno Y, Matsumoto T. Effectiveness of antibiotic combination therapy as evaluated by the Break-point Checkerboard Plate method for multidrug-resistant Pseudomonas aeruginosa in clinical use. J Infect Chemother 2014; 20:266-9. [PMID: 24486172 DOI: 10.1016/j.jiac.2013.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 12/20/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Abstract
Multidrug-resistant Pseudomonas aeruginosa (MDRP) strains are defined as having resistance to the following 3 groups of antibiotics: carbapenems, aminoglycosides, and fluoroquinolones. Antibiotic combinations have demonstrated increased activity in vitro compared with a single agent. As an in vitro method of determining the combination activity of antibiotics, the Break-point Checkerboard Plate (BC-plate) can be used routinely in clinical microbiology laboratories. We evaluated the effectiveness of the BC-plate for MDRP infections in clinical settings. We retrospectively selected cases of MDRP infection treated with combination therapy of antibiotics in Tokyo Medical University Hospital (1015 beds), Tokyo, Japan, from November 2010 to October 2012. A total of 28 MDRP strains were clinically isolated from 28 patients during the study period. This study design is a case series of MDRP infection. Six infections among the 28 patients were treated based on the results of the BC-plate assay, and the 6 strains tested positive for MBL. One patient had pneumonia, 3 had urinary tract infections, 1 had vertebral osteomyelitis, and 1 had nasal abscess. The combination of aztreonam with amikacin demonstrated the most frequently recognized in vitro effect (5 patients). Next, aztreonam with ciprofloxacin and piperacillin with amikacin revealed equivalent in vitro effects (3 patients, respectively). The clinical cure rate was 83.3% (5/6 patients). Antibiotic combination therapy based on the results of the BC-plate assay might indicate the effective therapy against MDRP infection in clinical settings.
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Affiliation(s)
- Itaru Nakamura
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Japan
| | - Tetsuo Yamaguchi
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Japan; Department of Microbiology, Tokyo Medical University, Japan.
| | - Ayaka Tsukimori
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Japan
| | - Akihiro Sato
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Japan
| | - Shinji Fukushima
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Japan
| | - Yasutaka Mizuno
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Japan
| | - Tetsuya Matsumoto
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Japan; Department of Microbiology, Tokyo Medical University, Japan
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15
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Systematic review and meta-analysis of in vitro synergy of polymyxins and carbapenems. Antimicrob Agents Chemother 2013; 57:5104-11. [PMID: 23917322 DOI: 10.1128/aac.01230-13] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Our objective was to examine the evidence of in vitro synergy of polymyxin-carbapenem combination therapy against Gram-negative bacteria (GNB). A systematic review and meta-analysis were performed. All studies examining in vitro interactions of antibiotic combinations consisting of any carbapenem with colistin or polymyxin B against any GNB were used. A broad search was conducted with no language, date, or publication status restrictions. Synergy rates, defined as a fractional inhibitory concentration index of ≤0.5 or a >2-log reduction in CFU, were pooled separately for time-kill, checkerboard, and Etest methods in a mixed-effect meta-analysis of rates. We examined whether the synergy rate depended on the testing method, type of antibiotic, bacteria, and resistance to carbapenems. Pooled rates with 95% confidence intervals (CI) are shown. Thirty-nine published studies and 15 conference proceeding were included, reporting on 246 different tests on 1,054 bacterial isolates. In time-kill studies, combination therapy showed synergy rates of 77% (95% CI, 64 to 87%) for Acinetobacter baumannii, 44% (95% CI, 30 to 59%) for Klebsiella pneumoniae, and 50% (95% CI, 30 to 69%) for Pseudomonas aeruginosa, with low antagonism rates for all. Doripenem showed high synergy rates for all three bacteria. For A. baumannii, meropenem was more synergistic than imipenem, whereas for P. aeruginosa the opposite was true. Checkerboard and Etest studies generally reported lower synergy rates than time-kill studies. The use of combination therapy led to less resistance development in vitro. The combination of a carbapenem with a polymyxin against GNB, especially A. baumannii, is supported in vitro by high synergy rates, with low antagonism and less resistance development. These findings should be examined in clinical studies.
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16
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Kataoka H, Ida T, Ishii Y, Tateda K, Oguri T, Yoshida A, Okuzumi K, Oishi T, Tsukahara M, Mori SI, Yoneyama A, Araoka H, Mitsuda T, Sumitomo M, Moriya K, Goto M, Nakamori Y, Shibayama A, Ohmagari N, Sato T, Yamaguchi K. Analysis of the influence of drug resistance factors on the efficacy of combinations of antibiotics for multidrug-resistant Pseudomonas aeruginosa isolated from hospitals located in the suburbs of Kanto area, Japan. J Glob Antimicrob Resist 2013; 1:91-96. [PMID: 27873584 DOI: 10.1016/j.jgar.2013.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/04/2013] [Accepted: 03/07/2013] [Indexed: 11/17/2022] Open
Abstract
Infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa are very difficult to treat. The aim of this study was to develop more effective treatments by investigating in vitro the effects of combinations of antibiotics against 47 MDR P. aeruginosa isolates harbouring various resistance factors. The isolates included 41 (87%) metallo-β-lactamase (MBL)-positive strains, 37 (79%) strains with mutations in OprD and 46 (98%) strains carrying the genes encoding aminoglycoside-modifying enzymes (AMEs). The quinolone resistance-determining region was mutated in all of the strains. These strains were classified into 16 groups according to amplified fragment length polymorphism and resistance factors. The effects of combinations of antibiotics on 16 representative strains were determined using a 'Break-point Checkerboard Plate' assay. Combinations of amikacin+aztreonam (coverage rate, 81.3%) and arbekacin+aztreonam (93.8%) inhibited growth. In contrast, combinations of ciprofloxacin+meropenem (6.3%) and ciprofloxacin+ceftazidime (12.5%) were much less effective. Aztreonam and arbekacin (or amikacin) are not substrates for MBLs and AMEs, respectively. We conclude that the combined effects of these drugs were possibly because of resistance factors.
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Affiliation(s)
- Hiroshi Kataoka
- Pharmaceutical Research Center, Meiji Seika Pharma Co., Ltd., Tokyo 104 8002, Japan
| | - Takashi Ida
- Pharmaceutical Research Center, Meiji Seika Pharma Co., Ltd., Tokyo 104 8002, Japan
| | - Yoshikazu Ishii
- Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143 8540, Japan.
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143 8540, Japan
| | | | | | | | - Tsuyoshi Oishi
- Tokyo Medical University Ibaraki Medical Center, Ibaraki 300 0395, Japan
| | - Miyuki Tsukahara
- Tokyo Medical University Ibaraki Medical Center, Ibaraki 300 0395, Japan
| | | | - Akiko Yoneyama
- Department of Infectious Diseases, Toranomon Hospital, Tokyo 105 8470, Japan
| | - Hideki Araoka
- Department of Infectious Diseases, Toranomon Hospital, Tokyo 105 8470, Japan
| | | | | | - Kyoji Moriya
- Graduate School of Medicine, The University of Tokyo, Tokyo 113 8655, Japan
| | - Mieko Goto
- Graduate School of Medicine, The University of Tokyo, Tokyo 113 8655, Japan
| | - Yoshitaka Nakamori
- Department of Respiratory Diseases, Misyuku Hospital, Tokyo 153 051, Japan
| | - Akiyoshi Shibayama
- Department of Respiratory Diseases, Misyuku Hospital, Tokyo 153 051, Japan
| | | | - Tomoaki Sato
- Shizuoka Cancer Center, Shizuoka 411 8777, Japan
| | - Keizo Yamaguchi
- Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143 8540, Japan
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17
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Itonaga H, Taguchi J, Fukushima T, Tsushima H, Sato S, Ando K, Sawayama Y, Matsuo E, Yamasaki R, Onimaru Y, Imanishi D, Imaizumi Y, Yoshida S, Hata T, Moriuchi Y, Honda S, Miyazaki Y. Distinct clinical features of infectious complications in adult T cell leukemia/lymphoma patients after allogeneic hematopoietic stem cell transplantation: a retrospective analysis in the Nagasaki transplant group. Biol Blood Marrow Transplant 2013; 19:607-15. [PMID: 23333533 DOI: 10.1016/j.bbmt.2013.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/15/2013] [Indexed: 11/16/2022]
Abstract
Although allogeneic hematopoietic stem cell transplantation (allo-SCT) is performed as a curative option in adult T cell leukemia-lymphoma (ATL) patients, its high transplantation-related mortality raises a serious issue. The clinical features of infectious complications after transplantation are not well known. To analyze the impact of infections after allo-SCT for ATL, we retrospectively compared infectious complications in 210 patients at 3 institutions in Nagasaki prefecture between 1997 and 2009. There were 91 patients with acute myeloid leukemia (AML), 51 with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL), and 68 with ATL. No patient received ganciclovir or foscarvir as prophylaxis, and most patients received antifungal prophylaxis with fluconazole or itraconazole. The cumulative incidence of cytomegalovirus (CMV) infection at 3 years was 69.2% in ATL patients versus 54.4% in AML patients (P = .0255). Cumulative infection-related mortality was significantly higher in ATL patients than in the 2 other groups (ATL versus AML, P = .0496; ATL versus ALL/LBL, P = .0075), and most death-causing pathogens were bacteria and fungus. The appearance of CMV infection was negatively associated with infectious mortality in ATL patients, but the P value for this association was near the borderline of significance (P = .0569). In multivariate analysis, transplantation using unrelated bone marrow and episodes of CMV infection were associated with worse overall survival in ATL patients, but were not in either AML or ALL/LBL patients. Collectively, the impact of infectious complications after transplantation in ATL patients was different from that in AML and ALL/LBL patients, suggesting that a more intensive strategy for infection control in ATL patients is required to reduce infectious mortality.
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Affiliation(s)
- Hidehiro Itonaga
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
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18
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Yaita K, Sameshima I, Takeyama H, Matsuyama S, Nagahara C, Hashiguchi R, Moronaga Y, Tottori N, Komatsu M, Oshiro Y, Yamaguchi Y. Liver abscess caused by multidrug-resistant Pseudomonas aeruginosa treated with colistin; a case report and review of the literature. Intern Med 2013; 52:1407-12. [PMID: 23774557 DOI: 10.2169/internalmedicine.52.9296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man had undergone left-lobe liver resection and a choledochojejunostomy six years previously, and thereafter he suffered from a postoperative relapse of cholangitis. He was admitted to our hospital due to liver abscesses and bacteremia caused by multidrug-resistant Pseudomonas aeruginosa. Empirical treatment with piperacillin/tazobactam was started, and the patient initially recovered. However, he developed a second case of sepsis caused by piperacillin/tazobactam-resistant P. aeruginosa bacteremia originating from a new liver abscess. We changed the piperacillin/tazobactam to colistin and flomoxef and continued the two antibiotics for one month. During the antibiotic therapy, the patient successfully underwent bile duct stent placement.
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Affiliation(s)
- Kenichiro Yaita
- Division of Infectious Diseases, Kenwakai Otemachi Hospital, Japan.
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19
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Yoshida M. [Infectious diseases: progress in diagnosis and treatment. Topics: II. Measures to prevent the outbreaks. 4. Emergence and control of a new multidrug resistant bacteria]. ACTA ACUST UNITED AC 2012; 101:3134-42. [PMID: 23342585 DOI: 10.2169/naika.101.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Masaki Yoshida
- Department of Infectious Disease and Infection Control, The Jikei University School of Medicine, Japan
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20
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Tateda K. [109th Scientific Meeting of the Japanese Society of Internal Medicine: symposium: 3. Infectious diseases--recent trend and future issues; 2) Multiple antibiotic resistant Gram-negative bacterial infections]. ACTA ACUST UNITED AC 2012. [PMID: 23205440 DOI: 10.2169/naika.101.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kazuhiro Tateda
- Department of Microbiology, Toho University School of Medicine, Japan
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21
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Araoka H, Baba M, Takagi S, Matsuno N, Ishiwata K, Nakano N, Tsuji M, Yamamoto H, Seo S, Asano-Mori Y, Uchida N, Masuoka K, Wake A, Taniguchi S, Yoneyama A. Monobactam and aminoglycoside combination therapy against metallo-beta-lactamase-producing multidrug-resistant Pseudomonas aeruginosa screened using a 'break-point checkerboard plate'. ACTA ACUST UNITED AC 2010; 42:231-3. [PMID: 20001223 DOI: 10.3109/00365540903443157] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Metallo-beta-lactamase-producing multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa) is a cause of life-threatening infections. With parenteral colistin not available in Japan, we treated MDR P. aeruginosa sepsis with monobactam and aminoglycoside combination therapy, with screening using a 'break-point checkerboard plate'.
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Affiliation(s)
- Hideki Araoka
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
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22
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Yamamoto Y, Izumikawa K, Hara A, Fujita H, Amenomori M, Sakamoto N, Seki M, Kakeya H, Yanagihara K, Takasaki K, Miyazaki T, Tsuchiya T, Yamasaki N, Tagawa T, Nagayasu T, Kohno S. Importance of controlling drug-resistant Pseudomonas aeruginosa infection: experience from lung transplantation in a cystic fibrosis case. Intern Med 2010; 49:2353-8. [PMID: 21048374 DOI: 10.2169/internalmedicine.49.3932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cystic fibrosis (CF) is rare in Japan. We encountered a CF case with drug-resistant Pseudomonas aeruginosa infection and successfully performed lung transplant from living related donors. A combination of beta-lactams and aminoglycosides for drug-resistant P. aeruginosa infection was administered before lung transplantation. Intravenous colistin was also used immediately before and after transplant surgery. Gram staining of respiratory specimens was performed every day after surgery and it was useful in monitoring infection status. Strict monitoring of infections by the Gram staining and culture of respiratory specimens is considered to be effective in preventing lower respiratory infection in lung transplantation.
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Affiliation(s)
- Yoshihiro Yamamoto
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki.
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23
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Milne KEN, Gould IM. Combination testing of multidrug-resistant cystic fibrosis isolates of Pseudomonas aeruginosa: use of a new parameter, the susceptible breakpoint index. J Antimicrob Chemother 2009; 65:82-90. [DOI: 10.1093/jac/dkp384] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Araoka H, Baba M, Yoneyama A. [Checkerboard-plate screening synergistic aztreonam and aminoglicoside combination effects against multidrug-resistant Pseudomonas aeruginosa]. KANSENSHOGAKU ZASSHI. THE JOURNAL OF THE JAPANESE ASSOCIATION FOR INFECTIOUS DISEASES 2009; 83:133-135. [PMID: 19364041 DOI: 10.11150/kansenshogakuzasshi.83.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Hideki Araoka
- Department of Infectious Disease, Toranomon hospital
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25
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Kawazoe H, Takiguchi Y, Inoue T, Yamaguchi K, Tanaka H, Kaji M, Tsuji S, Ninomiya M, Fukuoka N, Ohnishi H, Ishida T, Houchi H. [Infection treatment caused by multiple-drug-resistant Pseudomonas aeruginosa in a patient undergoing allogeneic hematopoietic stem cell transplantation]. YAKUGAKU ZASSHI 2008; 128:657-61. [PMID: 18379184 DOI: 10.1248/yakushi.128.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Infections caused by multiple-drug-resistant Pseudomonas aeruginosa (MDRP) are a clinically significant problem. We reported here the effective use of combination therapy in a patient with infection caused by MDRP according to an interventional treatment strategy suggested by a pharmacist. The patient was a 70-year-old male who underwent allogeneic hematopoietic stem cell transplantation. On day 45 after transplant, MDRP was newly isolated from urine, but the diagnosis at that time was colonization. On day 61, the patient developed a fever (> or =38.0 degrees C). In addition, laboratory data showed that C-reactive protein (CRP) was also increased. At the medical team conference, the pharmacist proposed the following treatment strategy for this infection. Aztreonam and amikacin were intravenously administered at doses of 2 g/day and 800 mg/day, respectively. The subsequent clinical course was well controlled, but the infection recurred and was aggravated. Aztreonam and ciprofloxacin were then intravenously administered at doses of 4 g/day and 600 mg/day, respectively, resulting in the alleviation of fever in the patient as well as a decrease in CRP and disappearance of MDRP isolates from urine on day 67; that is, MDRP infection was consequently well controlled. In conclusion, the combination therapy between aztreonam and amikacin, or ciprofloxacin may be clinically useful for severe infections of MDRP in compromised hosts.
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Affiliation(s)
- Hitoshi Kawazoe
- Department of Pharmacy, Kagawa University Hospital, Faculty of Medicine, Kagawa University, Kagawa, Japan.
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26
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An outbreak and isolation of drug-resistant Pseudomonas aeruginosa at Niigata University Hospital, Japan. J Infect Chemother 2008; 14:325-9. [DOI: 10.1007/s10156-008-0620-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 05/13/2008] [Indexed: 11/27/2022]
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27
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Mitsuda T. [Problems in antimicrobial susceptibility tests and progress in diagnostic technique]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2006; 95:2168-75. [PMID: 17168387 DOI: 10.2169/naika.95.2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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