1
|
Kim J, Bae M. Taurolidine irrigation reduces relapse and recurrence of hemodialysis access infection. Ann Vasc Surg 2024:S0890-5096(24)00653-8. [PMID: 39424185 DOI: 10.1016/j.avsg.2024.09.058] [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: 07/08/2024] [Revised: 09/20/2024] [Accepted: 09/23/2024] [Indexed: 10/21/2024]
Abstract
OBJECTIVES Infection of hemodialysis access is a clinically important concern and can lead to increased morbidity and mortality among patients on hemodialysis. In this study, we aimed to determine whether using taurolidine as an irrigating antiseptic after drainage of pus or removal of infected tissue and graft during surgery decreases the relapse and recurrence of infection. METHODS Between January 2016 and December 2023, 48 episodes in 38 patients hospitalized and treated for hemodialysis access infections were examined. Relapse, recurrence, and mortality of infection were analyzed in patients who received additional taurolidine irrigation versus those who did not. After drainage alone or after total or partial graft removal, all patients received massive irrigation with normal saline. The episodes of infection were examined consecutively during follow-up. RESULTS The majority (97.9%) of hemodialysis access infections were arteriovenous grafts (AVGs) or interposed grafts from native veins. In AVGs, infections occurred primarily after a median of 523 days from the first needling. All prosthetic materials that were the infection foci were removed in 58.3% of the cases, with partial resection and bypass or drainage performed in the remaining cases. The most common pathogen was Staphylococcus aureus (45.8%). After surgical intervention, relapse was observed in 12.5% of the cases and recurrence in 20.8% of the cases. The relapse occurrence was significantly reduced by taurolidine irrigation (odds ratio [OR]: 0.16, 95% confidence interval [CI]: 0.02-0.98, p = 0.05) and the total resection of prosthetic material (OR: 0.07, 95% CI: 0.01-0.70, p = 0.02). Recurrence was significantly decreased by taurolidine irrigation (OR: 0.10, 95% CI: 0.02-0.56, p = 0.01) and increased dramatically in cases with relapse history (OR: 8.50, 95% CI: 1.69-42.76, p < 0.01). Finally, male sex (hazard ratio: 7.01, 95% CI: 1.19-41.40, p = 0.03) and AVG (hazard ratio: 4.49, 95% CI: 1.01-20.01, p = 0.05) were significantly associated with increased overall mortality in infected hemodialysis access. CONCLUSIONS Additional taurolidine irrigation after surgical resection significantly reduced the relapse and recurrence of infection in hemodialysis access. Taurolidine appears to be a safe and useful antiseptic for the control of hemodialysis access infection.
Collapse
Affiliation(s)
- Jongwon Kim
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan 49241, Republic of Korea
| | - Miju Bae
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan 49241, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea.
| |
Collapse
|
2
|
Chen ER, Wozniak RAF. Reimagining the Past: A Future for Antibiotic Drug Discovery in Ophthalmology. Cornea 2024; 43:1-5. [PMID: 37702607 DOI: 10.1097/ico.0000000000003391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 09/14/2023]
Abstract
ABSTRACT Antibiotic resistance has emerged as a critical threat for the treatment of bacterial ocular infections. To address the critical need for novel therapeutics, antibiotic drug repurposing holds significant promise. As such, examples of existing FDA-approved drugs currently under development for new applications, novel combinations, and improved delivery systems are discussed.
Collapse
Affiliation(s)
- Eric R Chen
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
| | | |
Collapse
|
3
|
Ikemoto K, Kobayashi S, Haranosono Y, Kozai S, Wada T, Tokushige H, Kawamura A. Contribution of anti-inflammatory and anti-virulence effects of azithromycin in the treatment of experimental Staphylococcus aureus keratitis. BMC Ophthalmol 2020; 20:89. [PMID: 32143675 PMCID: PMC7060554 DOI: 10.1186/s12886-020-01358-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/27/2020] [Indexed: 12/01/2022] Open
Abstract
Background We aimed to demonstrate the contribution of anti-inflammatory and anti-virulence effects of azithromycin (AZM) in ocular surface infection treatment. Methods Staphylococcus aureus was injected into the corneal stroma of rabbits to induce keratitis. AZM at concentrations of 0.01, 0.1, and 1% was instilled into the eye twice daily. The eyes were examined using a slit lamp and scored. The viable bacteria in the cornea were counted at 48 h post infection. To evaluate the anti-inflammatory efficacy of AZM, S. aureus culture supernatant-induced anterior ocular inflammation in rabbit was examined using a slit lamp and scored. To evaluate the inhibitory effect of AZM on bacterial toxin production, S. aureus was cultured with AZM and hemolytic reaction in the culture supernatant was determined. Results In the bacterial keratitis model, AZM dose-dependently inhibited the increase in the clinical score. The viable bacterial count in the cornea treated with 1% AZM significantly decreased compared with that of the vehicle, whereas bacterial count in 0.01 and 0.1% AZM-treated corneas was similar to that of the vehicle. In the anterior ocular inflammation model, 0.1 and 1% AZM inhibited the increase in the clinical score. AZM inhibited hemolytic reaction at concentrations that did not inhibit bacterial growth. Conclusions The results demonstrated that AZM has not only anti-bacterial, but also anti-inflammatory effects, and inhibits bacterial toxin production leading to ocular surface damage in bacterial infection. Thus, the therapeutic effect of AZM against ocular infections is expected to be higher than that which could be assumed if it only had anti-bacterial activity.
Collapse
Affiliation(s)
- Kana Ikemoto
- Senju Pharmaceutical Co., Ltd., 6-4-3 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan.
| | - Shinya Kobayashi
- Senju Pharmaceutical Co., Ltd., 6-4-3 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Yu Haranosono
- Senju Pharmaceutical Co., Ltd., 6-4-3 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Seiko Kozai
- Senju Pharmaceutical Co., Ltd., 6-4-3 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Tomoyuki Wada
- Senju Pharmaceutical Co., Ltd., 6-4-3 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Hideki Tokushige
- Senju Pharmaceutical Co., Ltd., 6-4-3 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| | - Akio Kawamura
- Senju Pharmaceutical Co., Ltd., 6-4-3 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan
| |
Collapse
|
4
|
Zhang Z, Abdel-Razek O, Wang G. A Mouse Model for Ocular Surface Staphylococcus aureus Infection. ACTA ACUST UNITED AC 2017; 7:55-63. [PMID: 28252202 DOI: 10.1002/cpmo.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Creation of an appropriate animal model that accurately reflects the disease and host immune response to bacterial infection in humans is a major challenge in ocular-surface infection research. For decades, mice have been the ideal small animal model for ocular-surface infection research because of the availability and relatively low cost of various genetic backgrounds, targeted defects, and immunologic reagents. By employing different combinations of mouse and bacterial strains, murine infection models can be used to explore a complete picture of bacterial infection and innate immunity of the ocular surface. A murine model of Staphylococcus aureus infection under normal ocular circumstances is presented here as a convenient and tractable model system in which to study mammalian host responses to pathogens. © 2017 by John Wiley & Sons, Inc.
Collapse
Affiliation(s)
- Zhiyong Zhang
- Department of Surgery, The State University of New York Upstate Medical University, Syracuse, New York.,Department of Ophthalmology, Zhejiang Medical College Affiliated Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Osama Abdel-Razek
- Department of Surgery, The State University of New York Upstate Medical University, Syracuse, New York
| | - Guirong Wang
- Department of Surgery, The State University of New York Upstate Medical University, Syracuse, New York
| |
Collapse
|
5
|
Pinnock A, Shivshetty N, Roy S, Rimmer S, Douglas I, MacNeil S, Garg P. Ex vivo rabbit and human corneas as models for bacterial and fungal keratitis. Graefes Arch Clin Exp Ophthalmol 2016; 255:333-342. [PMID: 27844206 PMCID: PMC5285415 DOI: 10.1007/s00417-016-3546-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/23/2016] [Accepted: 10/31/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In the study of microbial keratitis, in vivo animal models often require a large number of animals, and in vitro monolayer cell culture does not maintain the three-dimensional structure of the tissues or cell-to-cell communication of in vivo models. Here, we propose reproducible ex vivo models of single- and dual-infection keratitis as an alternative to in vivo and in vitro models. METHODS Excised rabbit and human corneoscleral rims maintained in organ culture were infected using 108 cells of Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans or Fusarium solani. The infection was introduced by wounding with a scalpel and exposing corneas to the microbial suspension or by intrastromal injection. Post-inoculation, corneas were maintained for 24 and 48 h at 37 °C. After incubation, corneas were either homogenised to determine colony-forming units (CFU)/cornea or processed for histological examination using routine staining methods. Single- and mixed-species infections were compared. RESULTS We observed a significant increase in CFU after 48 h compared to 24 h with S. aureus and P. aeruginosa. However, no such increase was observed in corneas infected with C. albicans or F. solani. The injection method yielded an approximately two- to 100-fold increase (p < 0.05) in the majority of organisms from infected corneas. Histology of the scalpel-wounded and injection models indicated extensive infiltration of P. aeruginosa throughout the entire cornea, with less infiltration observed for S. aureus, C. albicans and F. solani. The models also supported dual infections. CONCLUSIONS Both scalpel wounding and injection methods are suitable for inducing infection of ex vivo rabbit and human cornea models. These simple and reproducible models will be useful as an alternative to in vitro and in vivo models for investigating the detection and treatment of microbial keratitis, particularly when this might be due to two infective organisms.
Collapse
Affiliation(s)
| | | | - Sanhita Roy
- LV Prasad Eye Institute, Banjara Hills, Hyderabad, 500034, India
| | | | - Ian Douglas
- University of Sheffield, Sheffield, S10 2TA, UK
| | - Sheila MacNeil
- University of Sheffield, Sheffield, S10 2TA, UK.
- The Kroto Research Institute, North Campus, University of Sheffield, Broad Lane, Sheffield, S3 7HQ, UK.
| | - Prashant Garg
- LV Prasad Eye Institute, Banjara Hills, Hyderabad, 500034, India
| |
Collapse
|
6
|
Animal models of bacterial keratitis. J Biomed Biotechnol 2011; 2011:680642. [PMID: 21274270 PMCID: PMC3022227 DOI: 10.1155/2011/680642] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 11/29/2010] [Accepted: 12/09/2010] [Indexed: 11/20/2022] Open
Abstract
Bacterial keratitis is a disease of the cornea characterized by pain, redness, inflammation, and opacity. Common causes of this disease are Pseudomonas aeruginosa and Staphylococcus aureus. Animal models of keratitis have been used to elucidate both the bacterial factors and the host inflammatory response involved in the disease. Reviewed herein are animal models of bacterial keratitis and some of the key findings in the last several decades.
Collapse
|
7
|
|
8
|
Danion A, Arsenault I, Vermette P. Antibacterial activity of contact lenses bearing surface-immobilized layers of intact liposomes loaded with levofloxacin. J Pharm Sci 2007; 96:2350-63. [PMID: 17541976 DOI: 10.1002/jps.20871] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In vitro methods to evaluate antibacterial activity were used with contact lenses bearing levofloxacin-loaded liposomes developed for the prevention and treatment of bacterial ocular infections such as keratitis. Levofloxacin was incorporated into liposomes before these intact liposomes were immobilized onto the surfaces of soft contact lenses using a multilayer immobilization strategy. The release of levofloxacin from contact lenses bearing 2, 5, and 10 layers of liposomes into a saline buffer at 37 degrees C was monitored by fluorescence. The levofloxacin release, as a function of time, was described by a mechanism taking into account two independent first-order kinetic models. The total release of levofloxacin from the contact lenses was completed within 6 days. The release of levofloxacin from contact lenses bearing 10 layers of liposomes and subsequently soaked overnight in a levofloxacin solution was also studied and compare to that of dried contact lenses without any chemical modification rehydrated in a levofloxacin solution. The antibacterial activity of the liposome-coated contact lenses against Staphylococcus aureus was evaluated by measuring (i) the diameters of the inhibition zone on an agar plate and (ii) the optical density using a broth assay. The liposome-coated lenses showed an antibacterial activity both on agar and in broth following 24 h. When initial bacteria inocula were equal or below 10(6) CFU/mL, all the bacteria were inhibited within 2 h. When using initial bacteria inocula of 10(8) CFU/mL, an initial burst release provided by soaking the liposomal lenses was required for the first hours to inhibit bacteria growth.
Collapse
Affiliation(s)
- Anne Danion
- Laboratoire de Bioingénierie et de Biophysique de l'Université de Sherbrooke, Department of Chemical Engineering, Université de Sherbrooke, 2500, blvd de l'Université, Sherbrooke, Québec, Canada, J1K 2R1
| | | | | |
Collapse
|
9
|
Oguz H. Cytotoxic effects of the fluoroquinolone ofloxacin on stromal keratocytes. Cornea 2007; 26:241; author reply 241. [PMID: 17251826 DOI: 10.1097/01.ico.0000244872.00503.4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|