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Seo C, Corrado M, Lim R, Thornton CS. Guideline-Concordant Therapy for Community-Acquired Pneumonia in the Hospitalized Population: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2024; 11:ofae336. [PMID: 38966853 PMCID: PMC11222985 DOI: 10.1093/ofid/ofae336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/12/2024] [Indexed: 07/06/2024] Open
Abstract
Background A commonly used guideline for community-acquired pneumonia (CAP) is the joint American Thoracic Society and Infectious Diseases Society of America practice guideline. We aimed to investigate the effect of guideline-concordant therapy in the treatment of CAP. Methods We systematically searched MEDLINE, Embase, CENTRAL, Web of Science, and Scopus from 2007 to December 2023. We screened citations, extracted data, and assessed risk of bias in duplicate. Primary outcomes were mortality rates, intensive care unit (ICU) admission, and length of stay. Secondary outcomes were guideline adherence, readmission, clinical cure rate, and adverse complications. We performed random-effect meta-analysis to estimate the overall effect size and assessed heterogeneity using the I2 statistics. Results We included 17 observational studies and 82 240 patients, of which 10 studies were comparative and pooled in meta-analysis. Overall guideline adherence rate was 65.2%. Guideline-concordant therapy was associated with a statistically significant reduction in 30-day mortality rate (crude odds ratio [OR], 0.49 [95% confidence interval .34-.70; I2 = 60%]; adjusted OR, 0.49 [.37-.65; I2 = 52%]) and in-hospital mortality rate (crude OR, 0.63 [.43-.92]; I2 = 61%). Due to significant heterogeneity, we could not assess the effect of guideline-concordant therapy on length of stay, ICU admission, readmission, clinical cure rate, and adverse complications. Conclusions In hospitalized patients with CAP, guideline-concordant therapy was associated with a significant reduction in mortality rate compared with nonconcordant therapy; however, there was limited evidence to support guideline-concordant therapy for other clinical outcomes. Future studies are needed to assess the clinical efficacy and safety of current guideline recommendations.
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Affiliation(s)
- Chanhee Seo
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mario Corrado
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Lim
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christina S Thornton
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
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2
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Pan D, Nielsen E, Chung S, Niederman MS. Management of pneumonia in the critically ill. Minerva Med 2023; 114:667-682. [PMID: 36700925 DOI: 10.23736/s0026-4806.22.08467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pneumonias continue to be major public health issues and are commonly encountered in the intensive care setting. The most common types of pneumonia leading to critical illness include severe community acquired pneumonia, hospital acquired pneumonia, and ventilator associated pneumonia. Early evaluation, diagnosis, and escalation to appropriate levels of care are imperative to improving survival. Treatment remains challenging with the need to balance antibiotic stewardship and minimizing patient harm. As evidenced in the most recent society guidelines, the identification of risk factors for severe disease and the causative pathogens are crucial in guiding the most appropriate therapy.
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Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Erik Nielsen
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samuel Chung
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA -
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3
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Potts CC, Rodriguez-Rivera LD, Retchless AC, Buono SA, Chen AT, Marjuki H, Blain AE, Wang X. Antimicrobial Susceptibility Survey of Invasive Haemophilus influenzae in the United States in 2016. Microbiol Spectr 2022; 10:e0257921. [PMID: 35536039 PMCID: PMC9241922 DOI: 10.1128/spectrum.02579-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/19/2022] [Indexed: 11/20/2022] Open
Abstract
Antibiotics are important for the treatment and prevention of invasive Haemophilus influenzae disease. Reduced susceptibility to clinically relevant drugs, except ampicillin, has been uncommon in the United States. Susceptibility of 700 invasive H. influenzae isolates, collected through population-based surveillance during 2016, was assessed for 15 antibiotics using broth microdilution, according to the CLSI guidelines; a subset of 104 isolates were also assessed for rifampin susceptibility using Etest. Genomes were sequenced to identify genes and mutations known to be associated with reduced susceptibility to clinically relevant drugs. A total of 508 (72.6%) had reduced susceptibility to at least one antibiotic and more than half of the isolates exhibited reduced susceptibility to only one (33.6%) or two (21.6%) antibiotic classes. All tested isolates were susceptible to rifampin, a chemoprophylaxis agent, and <1% (n = 3) of isolates had reduced susceptibility to third generation cephalosporins, which are recommended for invasive disease treatment. In contrast, ampicillin resistance was more common (28.1%) and predominantly associated with the detection of a β-lactamase gene; 26.2% of isolates in the collection contained either a TEM-1 or ROB-1 β-lactamase gene, including 88.8% of ampicillin-resistant isolates. β-lactamase negative ampicillin-resistant (BLNAR) isolates were less common and associated with ftsI mutations; resistance to amoxicillin-clavulanate was detected in <2% (n = 13) of isolates. The proportion of reduced susceptibility observed was higher among nontypeable H. influenzae and serotype e than other serotypes. US invasive H. influenzae isolates remain predominantly susceptible to clinically relevant antibiotics except ampicillin, and BLNAR isolates remain uncommon. IMPORTANCE Antibiotics play an important role for the treatment and prevention of invasive Haemophilus influenzae disease. Antimicrobial resistance survey of invasive H. influenzae isolates collected in 2016 showed that the US H. influenzae population remained susceptible to clinically relevant antibiotics, except for ampicillin. Detection of approximately a quarter ampicillin-resistant and β-lactamase containing strains demonstrates that resistance mechanisms can be acquired and sustained within the H. influenzae population, highlighting the continued importance of antimicrobial resistance surveillance for H. influenzae to monitor susceptibility trends and mechanisms of resistance.
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Affiliation(s)
- Caelin C. Potts
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lorraine D. Rodriguez-Rivera
- Weems Design Studio, Inc., Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- IHRC, Inc., Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam C. Retchless
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sean A. Buono
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexander T. Chen
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Henju Marjuki
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy E. Blain
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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4
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Morán-Díaz JR, Jiménez-Vázquez HA, Gómez-Pliego R, Arellano-Mendoza MG, Quintana-Zavala D, Guevara-Salazar JA. Correlation study of antibacterial activity and spectrum of Penicillins through a structure-activity relationship analysis. Med Chem Res 2019. [DOI: 10.1007/s00044-019-02391-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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5
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Hare KM, Seib KL, Chang AB, Harris TM, Spargo JC, Smith-Vaughan HC. Antimicrobial susceptibility and impact of macrolide antibiotics on Moraxella catarrhalis in the upper and lower airways of children with chronic endobronchial suppuration. J Med Microbiol 2019; 68:1140-1147. [PMID: 31274402 DOI: 10.1099/jmm.0.001033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Moraxella catarrhalis is an important but insufficiently studied respiratory pathogen. AIM To determine antibiotic susceptibility and impact of recent antibiotics on M. catarrhalis from children with chronic endobronchial suppuration. METHODOLOGY We cultured nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids collected from children who were prospectively enrolled in studies of chronic cough and had flexible bronchoscopy performed. Recent β-lactam or macrolide antibiotic use was recorded. M. catarrhalis isolates stored at -80 °C were re-cultured and susceptibility determined to a range of antibiotics including the macrolide antibiotic erythromycin. RESULTS Data from concurrently collected NP and BAL specimens were available from 547 children (median age 2.4 years) enrolled from 2007 to 2016. M. catarrhalis NP carriage was detected in 149 (27 %) children and lower airway infection (≥104 c.f.u. ml-1 BAL) in 67 (12 %) children. In total, 91 % of 222 M. catarrhalis isolates were β-lactamase producers, and non-susceptibility was high to benzylpenicillin (98 %), cefaclor (39 %) and cotrimoxazole (38 %). Overall, >97 % isolates were susceptible to cefuroxime, chloramphenicol, erythromycin and tetracycline; three isolates were erythromycin-resistant (MIC >0.5 mg l-1). Recent macrolide antibiotics (n=152 children, 28 %) were associated with significantly reduced M. catarrhalis carriage and lower airway infection episodes compared to children who did not receive macrolides; odds ratios 0.19 (95 % CI 0.10-0.35) and 0.15 (0.04-0.41), respectively. CONCLUSION Despite the frequent use of macrolides, few macrolide-resistant isolates were detected. This suggests a fitness cost associated with macrolide resistance in M. catarrhalis. Macrolide antibiotics remain an effective choice for treating M. catarrhalis lower airway infection in children with chronic endobronchial suppuration.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland 4101, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland 4001, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Tegan M Harris
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Jessie C Spargo
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
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Maierean SM, Marinescu DC, Croitoru DO, Verma AA. Infectious endocarditis and vertebral osteomyelitis caused by Moraxella catarrhalis. BMJ Case Rep 2019; 12:12/5/e228776. [PMID: 31129639 DOI: 10.1136/bcr-2018-228776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Moraxella catarrhalis frequently colonises the oropharynges of healthy individuals. Disease is usually limited to the oropharynx, upper airways and lower airways in patients with predisposing conditions. The pathogen rarely causes more invasive disease. We present the case of a 65-year-old woman with Crohn's disease on azathioprine, who was diagnosed with native valve M. catarrhalis endocarditis and vertebral osteomyelitis several weeks after an upper respiratory tract infection. She presented to hospital with 5 weeks of worsening malaise, nausea, relapsing fevers, weight loss, acute-on-chronic exacerbation of lower back pain and diffuse myalgia. Transoesophageal echocardiogram showed a 12 mm vegetation on her mitral valve, contrast-enhanced MRI was consistent with L4 osteomyelitis and blood cultures were persistently positive for M. catarrhalis She was initially treated with ceftriaxone 2 g intravenously daily, and although her symptoms initially resolved, she experienced a relapse of osteomyelitis with L3 extension a few weeks after treatment discontinuation.
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Affiliation(s)
- Serban M Maierean
- Department of Medicine, Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Timisoara, Timis, Romania
| | | | - David O Croitoru
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Amol A Verma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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7
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Cleland G, Leung C, Wan Sai Cheong J, Francis J, Heney C, Nourse C. Paediatric invasive Haemophilus influenzae in Queensland, Australia, 2002-2011: Young Indigenous children remain at highest risk. J Paediatr Child Health 2018; 54:36-41. [PMID: 28871608 DOI: 10.1111/jpc.13662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 05/26/2017] [Accepted: 06/20/2017] [Indexed: 11/27/2022]
Abstract
AIM Haemophilus influenzae continues to cause invasive disease in children despite widespread Hib immunisation. The significance of non-B serotypes continues to be investigated, with evidence of increased invasive non-typeable H. influenzae (NTHi) world-wide. The aim of this study was to examine the current epidemiological and clinical features of invasive H. influenzae disease in children in Queensland, Australia. METHODS A retrospective review was performed of all cases of invasive H. influenzae disease in children <18 years of age in Queensland between January 2002 and December 2011. Cases were identified from pathology records and data requested from treating hospitals. RESULTS Laboratory data were obtained for 144 cases and clinical/demographic data for 123 cases. The majority (72%) of cases were children <5 years of age. Annual incidence rate for all children <5 years was 7.4/100 000, and for Aboriginal and Torres Strait Islander children <5 years was 10.2/100 000. Serotype was reported for 132 isolates, 69 NTHi and 63 encapsulated strains. The most common clinical diagnoses were pneumonia, meningitis and bacteraemia without clinical focus. Of the patients, 5 patients died, and 12 had significant morbidity at hospital discharge. CONCLUSIONS While rates of invasive H. influenzae disease have decreased dramatically following the introduction of Hib vaccination, H. influenzae remains a cause of significant morbidity and mortality, and Aboriginal and Torres Strait Islander children remain particularly vulnerable.
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Affiliation(s)
- Gavin Cleland
- Department of Paediatrics, Western Australian Country Health Service, Kimberley Region, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Clare Leung
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Wan Sai Cheong
- University of Queensland, Brisbane, Queensland, Australia.,Pathology Queensland, Brisbane, Queensland, Australia
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, Australia.,Northern Territory Medical Program, Flinders University, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Claire Heney
- Pathology Queensland, Brisbane, Queensland, Australia
| | - Clare Nourse
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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8
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Lee WY. Antibiotic Prescribing for Patients with Upper Respiratory Tract Infections by Emergency Physicians in a Singapore Tertiary Hospital. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Despite the paucity of supporting evidence, the use of antibiotics in the management of upper respiratory tract infections (URTI) remains a persistent and worrying trend worldwide. This survey study set out to examine the antibiotic prescribing profile of emergency physicians for patients diagnosed with URTI at a local tertiary hospital. Methods Patients seeking treatment for URTI at the emergency department in the year 2001 were identified by their ICD-9 code. The electronic medical records of a random sample of these patients were reviewed. Patients with the following documented findings were excluded: (a) a duration of more than 7 days between disease onset and date of consultation, (b) prior antibiotic usage or medical consultation, (c) presentation of purulent sputum and/or purulent nasal discharge, and (d) existing medical conditions requiring antibiotic treatment/prophylaxis. Chi-square and multivariate analyses were performed to assess the association of patient-related factors with antibiotic prescribing. Results Of a random sample of 488 cases of URTI, inappropriate antibiotic prescribing was observed in 24% of cases (95% CI 20%, 28%). Significant associations were observed between antibiotic prescribing and month of consultation, patients' temperature and symptom of rhinorrhoea. Conclusion A substantial proportion of emergency department patients with URTI received antibiotics despite the lack of evidence supporting the drugs' effectiveness. Appropriate interventions to promote evidence-based prescribing amongst emergency physicians are required to reduce the extent of inappropriate antibiotic prescribing as well as to ensure the longevity of antibiotic effectiveness.
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9
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Kocsis B, Szabo D. New treatment options for lower respiratory tract infections. Expert Opin Pharmacother 2017; 18:1345-1355. [DOI: 10.1080/14656566.2017.1363179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bela Kocsis
- Institute of Medical Microbiology, Semmelweis University , Budapest, Hungary
| | - Dora Szabo
- Institute of Medical Microbiology, Semmelweis University , Budapest, Hungary
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10
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Nagy YI, Hussein MMM, Ragab YM, Attia AS. Isogenic mutations in the Moraxella catarrhalis CydDC system display pleiotropic phenotypes and reveal the role of a palindrome sequence in its transcriptional regulation. Microbiol Res 2017. [PMID: 28647125 DOI: 10.1016/j.micres.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Moraxella catarrhalis is becoming an important human respiratory tract pathogen affecting significant proportions from the population. However, still little is known about its physiology and molecular regulation. To this end, the CydDC, which is a heterodimeric ATP binding cassette transporter that has been shown to contribute to the maintenance of the redox homeostasis across the periplasm in other Gram-negative bacteria, is studied here. Amino acids multiple sequence alignments indicated that M. catarrhalis CydC is different from the CydC proteins of the bacterial species in which this system has been previously studied. These findings prompted further interest in studying this system in M. catarrhalis. Isogenic mutant in the CydDC system showed suppression in growth rate, hypersensitivity to oxidative and reductive stress and increased accumulation of intracellular cysteine levels. In addition, the growth of cydC- mutant exhibited hypersensitivity to exogenous cysteine; however, it did not display a significant difference from its wild-type counterpart in the murine pulmonary clearance model. Moreover, a palindrome was detected 94bp upstream of the cydD ORF suggesting it might act as a potential regulatory element. Real-time reverse transcription-PCR analysis showed that deletion/change in the palindrome resulted into alterations in the transcription levels of cydC. A better understanding of such system and its regulation helps in developing better ways to combat M. catarrhalis infections.
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Affiliation(s)
- Yosra I Nagy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Manal M M Hussein
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Yasser M Ragab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Ahmed S Attia
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt.
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Otero F, Tamayo M, Santiso R, Gosálvez J, Bou G, Fernández JL. Rapid Assessment of Resistance to Antibiotic Inhibitors of Protein Synthesis in the Gram-Positive Pathogens,Enterococcus faecalisandStreptococcus pneumoniae, Based on Evaluation of the Lytic Response. Microb Drug Resist 2017; 23:267-271. [DOI: 10.1089/mdr.2016.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Fátima Otero
- Unidad de Genética, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
- Laboratorio de Genética, Centro Oncológico de Galicia, A Coruña, Spain
| | - María Tamayo
- Unidad de Genética, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
- Laboratorio de Genética, Centro Oncológico de Galicia, A Coruña, Spain
| | - Rebeca Santiso
- Unidad de Genética, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
- Laboratorio de Genética, Centro Oncológico de Galicia, A Coruña, Spain
| | - Jaime Gosálvez
- Unidad de Genética, Facultad de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Germán Bou
- Servicio de Microbiología, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - José Luis Fernández
- Unidad de Genética, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
- Laboratorio de Genética, Centro Oncológico de Galicia, A Coruña, Spain
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12
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Candel FJ, Peñuelas M. Delafloxacin: design, development and potential place in therapy. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:881-891. [PMID: 28356714 PMCID: PMC5367733 DOI: 10.2147/dddt.s106071] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Delafloxacin (DLX) is a new fluoroquinolone pending approval, which has shown a good in vitro and in vivo activity against major pathogens associated with skin and soft tissue infections and community-acquired respiratory tract infections. DLX also shows good activity against a broad spectrum of microorganisms, including those resistant to other fluoroquinolones, as methicillin-resistant Staphylococcus aureus. Its pharmacokinetic properties and excellent activity in acidic environments make DLX an alternative in the treatment of these and other infections. In this manuscript, a detailed analysis of this new fluoroquinolone is performed, from its chemical structure to its in vivo activity in recently published clinical trials. Its possible place in the current antimicrobial outlook and in other infectious models is also discussed.
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Affiliation(s)
- Francisco Javier Candel
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Marina Peñuelas
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
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13
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Hauser C, Kronenberg A, Allemann A, Mühlemann K, Hilty M. Serotype/serogroup-specific antibiotic non-susceptibility of invasive and non-invasive Streptococcus pneumoniae, Switzerland, 2004 to 2014. ACTA ACUST UNITED AC 2017; 21:30239. [PMID: 27254535 DOI: 10.2807/1560-7917.es.2016.21.21.30239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/07/2016] [Indexed: 11/20/2022]
Abstract
Concurrent analysis of antibiotic resistance of colonising and invasive Streptococcus pneumoniae gives a more accurate picture than looking at either of them separately. Therefore, we analysed 2,129 non-invasive and 10,996 invasive pneumococcal isolates from Switzerland from 2004 to 2014, which spans the time before and after the introduction of the heptavalent (PCV7) and 13-valent (PCV13) conjugated pneumococcal polysaccharide vaccines. Serotype/serogroup information was linked with all antibiotic resistance profiles. During the study period, the proportion of non-susceptible non-invasive and invasive isolates significantly decreased for penicillin, ceftriaxone, erythromycin and trimethoprim/sulfamethoxazole (TMP-SMX). This was most apparent in non-invasive isolates from study subjects younger than five years (penicillin (p = 0.006), erythromycin (p = 0.01) and TMP-SMX (p = 0.002)). Resistant serotypes/serogroups included in PCV7 and/or PCV13 decreased and were replaced by non-PCV13 serotypes (6C and 15B/C). Serotype/serogroup-specific antibiotic resistance rates were comparable between invasive and non-invasive isolates. Adjusted odds ratios of serotype/serogroup-specific penicillin resistance were significantly higher in the west of Switzerland for serotype 6B (1.8; 95% confidence interval (CI): 1.4-4.8), 9V (3.4; 95% CI: 2.0-5.7), 14 (5.3; 95% CI: 3.8-7.5), 19A (2.2; 95% CI: 1.6-3.1) and 19F (3.1; 95% CI: 2.1-4.6), probably due to variations in the antibiotic consumption.
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Affiliation(s)
- Christoph Hauser
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
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14
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Liu G, Ermert D, Johansson ME, Singh B, Su YC, Paulsson M, Riesbeck K, Blom AM. PRELP Enhances Host Innate Immunity against the Respiratory Tract Pathogen Moraxella catarrhalis. THE JOURNAL OF IMMUNOLOGY 2017; 198:2330-2340. [PMID: 28148731 DOI: 10.4049/jimmunol.1601319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/09/2017] [Indexed: 01/25/2023]
Abstract
Respiratory tract infections are one of the leading causes of mortality worldwide urging better understanding of interactions between pathogens causing these infections and the host. Here we report that an extracellular matrix component proline/arginine-rich end leucine-rich repeat protein (PRELP) is a novel antibacterial component of innate immunity. We detected the presence of PRELP in human bronchoalveolar lavage fluid and showed that PRELP can be found in alveolar fluid, resident macrophages/monocytes, myofibroblasts, and the adventitia of blood vessels in lung tissue. PRELP specifically binds respiratory tract pathogens Moraxella catarrhalis, Haemophilus influenzae, and Streptococcus pneumoniae, but not other bacterial pathogens tested. We focused our study on M. catarrhalis and found that PRELP binds the majority of clinical isolates of M. catarrhalis (n = 49) through interaction with the ubiquitous surface protein A2/A2H. M. catarrhalis usually resists complement-mediated serum killing by recruiting to its surface a complement inhibitor C4b-binding protein, which is also a ligand for PRELP. We found that PRELP competitively inhibits binding of C4b-binding protein to bacteria, which enhances membrane attack complex formation on M. catarrhalis and thus leads to increased serum sensitivity. Furthermore, PRELP enhances phagocytic killing of serum-opsonized M. catarrhalis by human neutrophils in vitro. Moreover, PRELP reduces Moraxella adherence to and invasion of human lung epithelial A549 cells. Taken together, PRELP enhances host innate immunity against M. catarrhalis through increasing complement-mediated attack, improving phagocytic killing activity of neutrophils, and preventing bacterial adherence to lung epithelial cells.
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Affiliation(s)
- Guanghui Liu
- Division of Medical Protein Chemistry, Department of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden
| | - David Ermert
- Division of Medical Protein Chemistry, Department of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden
| | - Martin E Johansson
- Division of Pathology, Department of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden; and
| | - Birendra Singh
- Division of Clinical Microbiology, Department of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden
| | - Yu-Ching Su
- Division of Clinical Microbiology, Department of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden
| | - Magnus Paulsson
- Division of Clinical Microbiology, Department of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden
| | - Kristian Riesbeck
- Division of Clinical Microbiology, Department of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden
| | - Anna M Blom
- Division of Medical Protein Chemistry, Department of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden;
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15
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Otitis, Sinusitis and Related Conditions. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Estimating the morbidity and mortality associated with infections due to multidrug-resistant bacteria (MDRB), France, 2012. Antimicrob Resist Infect Control 2016; 5:56. [PMID: 27999665 PMCID: PMC5154061 DOI: 10.1186/s13756-016-0154-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/24/2016] [Indexed: 11/30/2022] Open
Abstract
Background A study based on 2007 data estimated that 386,000 infections due to multidrug-resistant bacteria (MDRB) occurred in Europe that year and 25,000 patients died from these infections. Our objective was to estimate the morbidity and mortality associated with these infections in France. Methods The MDRB considered were methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci, third-generation cephalosporin-resistant (3GC-R) Escherichia coli and Klebsiella pneumoniae, carbapenem-resistant Klebsiella pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa (CR P. aeruginosa). The number of invasive infections (infections with bacteria isolated from blood or cerebrospinal fluid) due to MDRB, as reported by France to EARS-Net in 2012, was corrected for the coverage of our surveillance network and extrapolated to other body sites using ratios from the French healthcare-associated infections point prevalence survey and the literature. Mortality associated with MDRB infection was estimated using proportions from the literature. Methods and parameters were reviewed by a panel of experts. Results We estimate that 158,000 (127,000 to 245,000) infections due to MDRB occurred in 2012 in France (incidence: 1.48 to 2.85 per 1000 hospital days), including 16,000 invasive infections. MRSA, 3GC-R E. coli and K. pneumoniae were responsible for 120,000 (90,000 to 172,000) infections, i.e., 75% of the total. An estimated 12,500 (11,500 to 17,500) deaths were associated with these infections, including 2,700 associated with invasive infections. MRSA, 3GC-R E. coli and CR P. aeruginosa accounted for 88% of these deaths. Conclusion These first estimates confirm that MRSA, 3GC-R Escherichia coli and Klebsiella pneumoniae account for the largest portion of the morbidity and mortality of infections due to MDRB in France. These results are not directly comparable with the European study because the methodology used differs in many respects. The differences identified between our study and previous studies underline the need to define a standardised protocol for international assessments of the morbidity and mortality of antibiotic resistance. Estimating morbidity and mortality will facilitate communication and awareness in order to reinforce adherence and support of healthcare professionals and policy-makers to MDRB prevention programs. Electronic supplementary material The online version of this article (doi:10.1186/s13756-016-0154-z) contains supplementary material, which is available to authorized users.
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Lee ML, Cho CY, Hsu CL, Chen CJ, Chang LY, Lee YS, Soong WJ, Jeng MJ, Wu KG. Recent trends in antibiotic prescriptions for acute respiratory tract infections in pediatric ambulatory care in Taiwan, 2000–2009: A nationwide population-based study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:554-60. [DOI: 10.1016/j.jmii.2014.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/11/2014] [Accepted: 08/23/2014] [Indexed: 11/29/2022]
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Earl JP, de Vries SPW, Ahmed A, Powell E, Schultz MP, Hermans PWM, Hill DJ, Zhou Z, Constantinidou CI, Hu FZ, Bootsma HJ, Ehrlich GD. Comparative Genomic Analyses of the Moraxella catarrhalis Serosensitive and Seroresistant Lineages Demonstrate Their Independent Evolution. Genome Biol Evol 2016; 8:955-74. [PMID: 26912404 PMCID: PMC4860680 DOI: 10.1093/gbe/evw039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 02/07/2023] Open
Abstract
The bacterial speciesMoraxella catarrhalishas been hypothesized as being composed of two distinct lineages (referred to as the seroresistant [SR] and serosensitive [SS]) with separate evolutionary histories based on several molecular typing methods, whereas 16S ribotyping has suggested an additional split within the SS lineage. Previously, we characterized whole-genome sequences of 12 SR-lineage isolates, which revealed a relatively small supragenome when compared with other opportunistic nasopharyngeal pathogens, suggestive of a relatively short evolutionary history. Here, we performed whole-genome sequencing on 18 strains from both ribotypes of the SS lineage, an additional SR strain, as well as four previously identified highly divergent strains based on multilocus sequence typing analyses. All 35 strains were subjected to a battery of comparative genomic analyses which clearly show that there are three lineages-the SR, SS, and the divergent. The SR and SS lineages are closely related, but distinct from each other based on three different methods of comparison: Allelic differences observed among core genes; possession of lineage-specific sets of core and distributed genes; and by an alignment of concatenated core sequences irrespective of gene annotation. All these methods show that the SS lineage has much longer interstrain branches than the SR lineage indicating that this lineage has likely been evolving either longer or faster than the SR lineage. There is evidence of extensive horizontal gene transfer (HGT) within both of these lineages, and to a lesser degree between them. In particular, we identified very high rates of HGT between these two lineages for ß-lactamase genes. The four divergent strains aresui generis, being much more distantly related to both the SR and SS groups than these other two groups are to each other. Based on average nucleotide identities, gene content, GC content, and genome size, this group could be considered as a separate taxonomic group. The SR and SS lineages, although distinct, clearly form a single species based on multiple criteria including a large common core genome, average nucleotide identity values, GC content, and genome size. Although neither of these lineages arose from within the other based on phylogenetic analyses, the question of how and when these lineages split and then subsequently reunited in the human nasopharynx is explored.
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Affiliation(s)
- Joshua P Earl
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA Center for Genomic Sciences and Center for Advanced Microbial Processing, Institute of Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA
| | - Stefan P W de Vries
- Present address: Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Azad Ahmed
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA
| | - Evan Powell
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA
| | - Matthew P Schultz
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA
| | - Peter W M Hermans
- Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Darryl J Hill
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Zhemin Zhou
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Fen Z Hu
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA Center for Genomic Sciences and Center for Advanced Microbial Processing, Institute of Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA Department of Otolaryngology Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Hester J Bootsma
- Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Garth D Ehrlich
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA Center for Genomic Sciences and Center for Advanced Microbial Processing, Institute of Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA Department of Otolaryngology Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA
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Lâm TT, Claus H, Elias J, Frosch M, Vogel U. Ampicillin resistance of invasive Haemophilus influenzae isolates in Germany 2009-2012. Int J Med Microbiol 2015; 305:748-55. [PMID: 26321008 DOI: 10.1016/j.ijmm.2015.08.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In this retrospective study covering a four-year observation period (2009-2012) the prevalence of aminopenicillin resistance of invasive Haemophilus influenzae (Hi) in Germany was analyzed. The main resistance mechanism against aminopenicillins is conferred by β-lactamase production, which can be inhibited by clavulanate or sulbactam. Apart from that, β-lactamase negative ampicillin resistance (BLNAR) has been reported due to mutations in the penicillin-binding protein PBP3. The prevalence of BLNAR varies considerably in different countries. Representative data from Germany have not been reported. We analyzed 704 culture positive cases with bacteraemia or detection of Hi in cerebrospinal fluid; 82 isolates (11.6%) were phenotypically resistant to ampicillin. Among these isolates, 65 (79.3%) showed β-lactamase production, and 17 isolates (20.7%) were phenotypic BLNAR Hi. The proportion of ampicillin resistant isolates remained stable over the observation period. Analysis of the PBP3 sequences of 133 isolates with different susceptibility phenotypes including susceptible, BLNAR, and β-lactamase positive isolates, revealed a high genetic diversity. Previously described PBP3 mutations were associated to elevated MIC values, albeit not exclusively, since few highly susceptible strains were found to be positive for the mutations. Furthermore, since ampicillin susceptible strains with elevated MIC values frequently harboured these mutations, prediction of the resistance phenotype using ftsI sequencing appears to be impossible.
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Affiliation(s)
- Thiên-Trí Lâm
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany.
| | - Heike Claus
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany
| | - Johannes Elias
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany
| | - Matthias Frosch
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany
| | - Ulrich Vogel
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany
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Karcic E, Aljicevic M, Bektas S, Karcic B. Antimicrobial Susceptibility/Resistance of Streptococcus Pneumoniae. Mater Sociomed 2015; 27:180-4. [PMID: 26236165 PMCID: PMC4499292 DOI: 10.5455/msm.2015.27.180-184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 06/05/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pneumococcal infections are a major cause of morbidity and mortality worldwide, whose treatment is threatened with an increase in the number of strains resistant to antibiotic therapy. GOAL The main goal of this research was to investigate the presence of antimicrobial susceptibility/resistance of S. pneumoniae. MATERIAL AND METHODS Taken are swabs of the nose and nasopharynx, eye and ear. In vitro tests that were made in order to study the antimicrobial resistance of pneumococci are: disk diffusion method and E-test. RESULTS The resistance to inhibitors of cell wall synthesis was recorded at 39.17%, protein synthesis inhibitors 19.67%, folate antagonists 47.78% and quinolone in 1.11%. S. pneumoniae has shown drug resistance to erythromycin in 45%, clindamycin in 45%, chloramphenicol-0.56%, rifampicin-6.11%, tetracycline-4.67%, penicillin-G in 4.44%, oxacillin in 73.89%, ciprofloxacin in 1.11% and trimethoprim-sulfamethoxazole in 5.34% of cases. CONCLUSION The highest resistance pneumococcus showed to erythromycin, clindamycin and trimethoprim-sulfamethoxazole and these should be avoided in the treatment. The least resistance pneumococcus showed to tetracycline, rifampicin, chloramphenicol, penicillin-G and ciprofloxacin.
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Affiliation(s)
- Emina Karcic
- Department of Pediatrics, Cantonal hospital, Zenica, Bosnia and Herzegovina
| | - Mufida Aljicevic
- Institute of Microbiology, Medical Faculty, University of Sarajevo, Bosnia and Herzegovina
| | - Sabaheta Bektas
- Department of Microbiology, Institute for Public Health of Canton Sarajevo, Bosnia and Herzegovina
| | - Bekir Karcic
- Departmenr of Radiology, General hospital “Dr. Abdulah Nakaš”, Sarajevo, Bosnia and Herzegovina
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Tay HL, Kaiko GE, Plank M, Li J, Maltby S, Essilfie AT, Jarnicki A, Yang M, Mattes J, Hansbro PM, Foster PS. Antagonism of miR-328 increases the antimicrobial function of macrophages and neutrophils and rapid clearance of non-typeable Haemophilus influenzae (NTHi) from infected lung. PLoS Pathog 2015; 11:e1004549. [PMID: 25894560 PMCID: PMC4404141 DOI: 10.1371/journal.ppat.1004549] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 11/01/2014] [Indexed: 11/23/2022] Open
Abstract
Pathogenic bacterial infections of the lung are life threatening and underpin chronic lung diseases. Current treatments are often ineffective potentially due to increasing antibiotic resistance and impairment of innate immunity by disease processes and steroid therapy. Manipulation miRNA directly regulating anti-microbial machinery of the innate immune system may boost host defence responses. Here we demonstrate that miR-328 is a key element of the host response to pulmonary infection with non-typeable haemophilus influenzae and pharmacological inhibition in mouse and human macrophages augments phagocytosis, the production of reactive oxygen species, and microbicidal activity. Moreover, inhibition of miR-328 in respiratory models of infection, steroid-induced immunosuppression, and smoke-induced emphysema enhances bacterial clearance. Thus, miRNA pathways can be targeted in the lung to enhance host defence against a clinically relevant microbial infection and offer a potential new anti-microbial approach for the treatment of respiratory diseases. MicroRNAs regulate pathogen recognition pathways by modulating translation. In the immune system, miRNAs have been identified as important regulators of gene expression programs, which regulate differentiation, growth and function of innate and adaptive immune cells. Using miRNA microarray, we demonstrated that lung miRNAs were differentially expressed following non-typeable Haemophilus Influenzae (NTHi) infection in mice. To study the role of a specific miRNA in macrophages, we used antagomir (chemically modified single-stranded RNA analogues, complementary to the target miRNA) to block miRNA function. Interestingly, inhibition of microRNA-328 in mouse and human macrophages increases microbicidal activity by amplifying phagocytosis and production of reactive oxygen species. Inhibition of mR-328 in the lung enhanced bacterial clearance in mouse models of immunosuppression and emphysema. Our study provides proof of principle that miRNA pathways can be targeted in the lung and offer a potential new anti-microbial approach for the treatment of respiratory infection.
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Affiliation(s)
- Hock L. Tay
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Gerard E. Kaiko
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Maximilian Plank
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - JingJing Li
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Steven Maltby
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Ama-Tawiah Essilfie
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Andrew Jarnicki
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | | | - Joerg Mattes
- Priority Research Centre for Asthma and Respiratory Disease, Discipline of Paediatrics and Child Health, School of Medicine and Public Health, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Philip M. Hansbro
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Paul S. Foster
- Priority Research Centre for Asthma and Respiratory Disease, Department of Microbiology and Immunology, School of Pharmacy and Biomedical Sciences, Faculty of Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
- * E-mail:
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Bassetti M, Della Siega P, Pecori D, Scarparo C, Righi E. Delafloxacin for the treatment of respiratory and skin infections. Expert Opin Investig Drugs 2015; 24:433-42. [PMID: 25604710 DOI: 10.1517/13543784.2015.1005205] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION There has been a striking increase in the emergence of multidrug-resistant pathogens in recent times. Delafloxacin is a novel, broad-spectrum fluoroquinolone with antimicrobial activity against resistant Gram-positive, Gram-negative and anaerobic organisms. It has the potential to treat a variety of infections including complicated skin and skin structure infections and respiratory tract infections. AREAS COVERED In this review, the authors report the microbiological spectrum of activity of delafloxacin as well as its pharmacokinetic characteristics. They also report the results of recent studies investigating its safety and efficacy. EXPERT OPINION The profile of delafloxacin offers several advantages. Delafloxacin presents a broad spectrum of activity against pathogens involved in respiratory infections and complicated skin and skin structure infections (SSSIs), including methicillin-resistant Staphylococcus aureus. It has also shown activity against Gram-negative pathogens, such as quinolone-susceptible and -resistant strains of Escherichia coli and Klebsiella pneumoniae and quinolone-susceptible Pseudomonas aeruginosa. The availability of an oral formulation supports its use in sequential therapy. The efficacy and tolerability of delafloxacin have been demonstrated in Phase II clinical trials in comparison with moxifloxacin for respiratory infections and linezolid and vancomycin in SSSIs. Compared with other quinolones such as moxifloxacin, delafloxacin showed comparable efficacy and a lower rate of adverse effects. The results of new Phase III studies are awaited to confirm delafloxacin's future applications in the treatment of SSSIs.
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Affiliation(s)
- Matteo Bassetti
- Santa Maria Misericordia University Hospital, Infectious Diseases Division , Piazzale S. Maria della Misericordia, n. 15, 33100, Udine , Italy + 86 21 38804518; extn. 8319 ; + 39 0432 559360 ;
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Mobegi FM, van Hijum SAFT, Burghout P, Bootsma HJ, de Vries SPW, van der Gaast-de Jongh CE, Simonetti E, Langereis JD, Hermans PWM, de Jonge MI, Zomer A. From microbial gene essentiality to novel antimicrobial drug targets. BMC Genomics 2014; 15:958. [PMID: 25373505 PMCID: PMC4233050 DOI: 10.1186/1471-2164-15-958] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/23/2014] [Indexed: 01/12/2023] Open
Abstract
Background Bacterial respiratory tract infections, mainly caused by Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are among the leading causes of global mortality and morbidity. Increased resistance of these pathogens to existing antibiotics necessitates the search for novel targets to develop potent antimicrobials. Result Here, we report a proof of concept study for the reliable identification of potential drug targets in these human respiratory pathogens by combining high-density transposon mutagenesis, high-throughput sequencing, and integrative genomics. Approximately 20% of all genes in these three species were essential for growth and viability, including 128 essential and conserved genes, part of 47 metabolic pathways. By comparing these essential genes to the human genome, and a database of genes from commensal human gut microbiota, we identified and excluded potential drug targets in respiratory tract pathogens that will have off-target effects in the host, or disrupt the natural host microbiota. We propose 249 potential drug targets, 67 of which are targets for 75 FDA-approved antimicrobials and 35 other researched small molecule inhibitors. Two out of four selected novel targets were experimentally validated, proofing the concept. Conclusion Here we have pioneered an attempt in systematically combining the power of high-density transposon mutagenesis, high-throughput sequencing, and integrative genomics to discover potential drug targets at genome-scale. By circumventing the time-consuming and expensive laboratory screens traditionally used to select potential drug targets, our approach provides an attractive alternative that could accelerate the much needed discovery of novel antimicrobials. Electronic supplementary material The online version of this article (doi:10.1186/1471-2164-15-958) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sacha A F T van Hijum
- Radboud Institute for Molecular Life Sciences, Laboratory of Paediatric Infectious Diseases, Radboud University Medical Centre, Nijmegen 6500 HB, The Netherlands.
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Eason MM, Fan X. The role and regulation of catalase in respiratory tract opportunistic bacterial pathogens. Microb Pathog 2014; 74:50-8. [DOI: 10.1016/j.micpath.2014.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 07/03/2014] [Accepted: 07/06/2014] [Indexed: 12/27/2022]
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Yamada K, Saito R. Molecular analysis of low-level fluoroquinolone resistance in clinical isolates of Moraxella catarrhalis. J Med Microbiol 2014; 63:1066-1070. [DOI: 10.1099/jmm.0.073734-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kageto Yamada
- Department of Clinical Laboratory, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, 33-1 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Ryoichi Saito
- Department of Microbiology and Immunology, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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Gaubert A, Kauss T, Marchivie M, Ba BB, Lembege M, Fawaz F, Boiron JM, Lafarge X, Lindegardh N, Fabre JL, White NJ, Olliaro PL, Millet P, Grislain L, Gaudin K. Preliminary pharmaceutical development of antimalarial-antibiotic cotherapy as a pre-referral paediatric treatment of fever in malaria endemic areas. Int J Pharm 2014; 468:55-63. [PMID: 24726300 PMCID: PMC4045394 DOI: 10.1016/j.ijpharm.2014.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/08/2014] [Indexed: 11/19/2022]
Abstract
Artemether (AM) plus azithromycin (AZ) rectal co-formulations were studied to provide pre-referral treatment for children with severe febrile illnesses in malaria-endemic areas. The target profile required that such product should be cheap, easy to administer by non-medically qualified persons, rapidly effective against both malaria and bacterial infections. Analytical and pharmacotechnical development, followed by in vitro and in vivo evaluation, were conducted for various AMAZ coformulations. Of the formulations tested, stability was highest for dry solid forms and bioavailability for hard gelatin capsules; AM release from AMAZ rectodispersible tablet was suboptimal due to a modification of its micro-crystalline structure.
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Affiliation(s)
- Alexandra Gaubert
- Université de Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
| | - Tina Kauss
- Université de Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France.
| | - Mathieu Marchivie
- Université de Bordeaux, FRE 3396 CNRS Pharmacochimie, Bordeaux, France
| | - Boubakar B Ba
- Université de Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
| | - Martine Lembege
- Université de Bordeaux, Laboratory of Organic and Therapeutic Chemistry, Pharmacochimie, Bordeaux, France
| | - Fawaz Fawaz
- Université de Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
| | - Jean-Michel Boiron
- EFS (Etablissement Français du Sang) Aquitaine Limousin, Bordeaux, France
| | - Xavier Lafarge
- EFS (Etablissement Français du Sang) Aquitaine Limousin, Bordeaux, France
| | | | - Jean-Louis Fabre
- OTECI (Office Technique d'Etude et de Coopération Internationale), Paris, France
| | - Nicholas J White
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, UK
| | - Piero L Olliaro
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, UK; UNICEF/UNDP/WB/WHO Special Program for Research & Training in Tropical Diseases (TDR), Geneva, Switzerland
| | - Pascal Millet
- Université de Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
| | | | - Karen Gaudin
- Université de Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
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Arguedas A, Loaiza C, Perez A, Gutierrez A, Herrera ML, Rothermel CD. A pilot study of single-dose azithromycin versus three-day azithromycin or single-dose ceftriaxone for uncomplicated acute otitis media in children. Curr Ther Res Clin Exp 2014; 64:16-29. [PMID: 24944350 DOI: 10.1016/j.curtheres.2003.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2003] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The pharmacokinetic profile of azithromycin supports its use as single-dose therapy for uncomplicated acute otitis media (AOM) in children. OBJECTIVE This study was designed to (1) compare the safety of single-dose oral azithromycin, 3 daily doses of oral azithromycin, and a single dose of intramuscular ceftriaxone for the treatment of uncomplicated AOM in children, and (2) provide preliminary efficacy data to support initiation of a larger, comparative trial of single-dose azithromycin for the treatment of uncomplicated acute otitis media in children. METHODS In this single-center pilot study, children with uncomplicated AOM were randomly assigned to receive single-dose oral azithromycin (30 mg/kg), 3-day oral azithromycin (10 mg/kg once daily), or single-dose intramuscular ceftriaxone (50 mg/kg). Tympanocentesis was performed before administration of the first dose, and clinical response was assessed on days 14-15 and 28-30. RESULTS Between September 1995 and May 1997, 198 children (mean age, 2.5 years) were enrolled. All of the patients were evaluable for the safety and clinical intent-to-treat (ITT) analyses, and 98 were evaluable for the microbiologic ITT analysis. On day 14-15, rates of clinical success (cure or improvement) for the 3 treatment groups were: 62/64 (97%) for single-dose azithromycin, 60/63 (95%) for 3-day azithromycin, and 61/62 (98%) for single-dose ceftriaxone. On day 28-30, the corresponding clinical success rates were 61/65 (94%), 61/66 (92%), and 62/64 (97%). For the 98 microbiologically evaluable patients, clinical success rates at day 14-15 were 28/30 (93%) for single-dose azithromycin, 31/35 (89%) for 3-day azithromycin, and 33/33 (100%) for single-dose ceftriaxone. On day 28-30, the corresponding clinical success rates were 27/30 (90%), 30/35 (86%), and 32/33 (97%). Treatment-related adverse event rates for single-dose azithromycin, 3-day azithromycin, and single-dose ceftriaxone were 10.6%, 9.1%, and 9.1%, respectively. CONCLUSION In this pilot study comparing single-dose azithromycin, 3-day azithromycin, and single-dose ceftriaxone for the treatment of uncomplicated AOM in children, no differences were detected among the 3 regimens.
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Affiliation(s)
| | | | | | | | - Marco Luis Herrera
- Clinical Laboratory, Hospital Nacional de Niños, San José, Costa Rica, and
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Block SL, Arrieta A, Seibel M, McLinn S, Eppes S, Murphy MJ. Single-dose (30 mg/kg) azithromycin compared with 10-day amoxicillin/clavulanate for the treatment of uncomplicated acute otitis media: a double-blind, placebo-controlled, randomized clinical trial. Curr Ther Res Clin Exp 2014; 64:30-42. [PMID: 24944351 DOI: 10.1016/j.curtheres.2003.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2003] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The long half-life of azithromycin allows for single-dose oral therapy for acute otitis media (AOM). OBJECTIVE This study was designed to compare the efficacy and tolerability of single-dose azithromycin with 10-day, twice-daily amoxicillin/clavulanate for the treatment of new-onset, uncomplicated AOM in children. METHODS Children aged 6 months to 12 years with new-onset AOM were randomly assigned to receive either a single 30-mg/kg dose of azithromycin or standard-dose amoxicillin/clavulanate (45 mg/kg administered BID for 10 days) in a double-blind, double-placebo, multicenter clinical trial. The diagnosis of AOM was based on specific clinical signs and symptoms, and was confirmed by pneumatic otoscopy and acoustic reflectometry (level ≥3). Clinical response was assessed on days 12-16 and 28-32. RESULTS Mean (SD) age of children receiving azithromycin (n = 173) or amoxicillin/clavulanate (n = 173) was 2.7 (2.3) years and 3.4 (2.8) years, respectively, with 43% and 36% ≤2 years of age. Most (53.2%) of the children were boys, and most (51.2%) were white. Clinical success rates (intent-to-treat) for azithromycin and amoxicillin/clavulanate, respectively, were 87% and 88% (95% CI, -9.2 to 6.5) on day 12-16 and 75% and 75% (95% CI, -10.2 to 10.5) on day 28-32. The incidences of treatment-related adverse events for azithromycin and amoxicillin/clavulanate were 16.8% and 22.5%, respectively. Corresponding rates of diarrhea were 6.4% and 12.7%, respectively. Vomiting, which was generally mild, occurred in 7 children in each group. One azithromycin patient and 5 amoxicillin/clavulanate patients discontinued treatment because of adverse events. The compliance rate for azithromycin was significantly higher than that for amoxicillin/clavulanate (99% vs 83%; P<0.001). CONCLUSIONS In this trial comparing the efficacy of single-dose azithromycin (30 mg/kg) with twice-daily amoxicillin/clavulanate (45 mg/kg) for the treatment of new-onset, uncomplicated AOM, no differences were detected between the 2 regimens. Single-dose azithromycin was generally well tolerated and provides an alternative to conventional oral regimens for AOM.
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Affiliation(s)
- Stan L Block
- Kentucky Pediatric Research, Bardstown, Kentucky
| | - Antonio Arrieta
- Division of Infectious Disease, Children's Hospital of Orange County, Orange, California
| | - Matthew Seibel
- Arnold Palmer Hospital for Children and Women, Orlando, Florida
| | | | - Stephen Eppes
- Division of Infectious Diseases, Jefferson Medical College and duPont Hospital for Children, Wilmington, Delaware, and
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Clarke ET, Heyderman RS. Current concepts in the treatment of bacterial meningitis beyond the neonatal period. Expert Rev Anti Infect Ther 2014; 4:663-74. [PMID: 17009944 DOI: 10.1586/14787210.4.4.663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The epidemiology and treatment approach to bacterial meningitis has changed dramatically since the advent of antimicrobial therapy. New vaccines against meningeal pathogens have been implemented into national immunization programs successfully around the world. Antibiotic resistance has had a considerable impact on the efficacy of several therapeutic agents. In this review, the authors will discuss the principles of antibiotic chemotherapy, focusing on new agents for the treatment of penicillin-resistant pneumococci and adjunctive treatments to reduce the inflammatory response to bacterial infection of the meninges.
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Affiliation(s)
- Edward T Clarke
- University of Bristol, Department of Cellular & Molecular Medicine, School of Medical Sciences, University Walk, Bristol BS8 1TD, UK
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Xu Y, Chen X, Zhu D, Liu Y, Zhao Z, Jin L, Liu C, Lei P. Synthesis and antibacterial activity of novel modified 5-O-mycaminose 14-membered ketolides. Eur J Med Chem 2013; 69:174-81. [DOI: 10.1016/j.ejmech.2013.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/08/2013] [Accepted: 08/12/2013] [Indexed: 11/25/2022]
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Yook JH, Kim MY, Kim EJ, Yang JH, Ryu HM, Oh KY, Shin JH, Foxman B, Ki M. Risk factors associated with group B streptococcus resistant to clindamycin and erythromycin in pregnant korean women. Infect Chemother 2013; 45:299-307. [PMID: 24396631 PMCID: PMC3848523 DOI: 10.3947/ic.2013.45.3.299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 05/07/2013] [Accepted: 07/11/2013] [Indexed: 11/24/2022] Open
Abstract
Background The prevalence of group B streptococcus (GBS) among pregnant women and neonates in the Republic of Korea has increased. In addition, rates of resistance to antibiotics recommended for pregnant women allergic to penicillin, such as clindamycin and erythromycin, have increased. The aim of this study was to evaluate subject characteristics associated with GBS resistance to clindamycin and erythromycin. Materials and Methods A total of 418 clinical isolates from pregnant women in Korea were screened for antibiotic resistance from January 2006 to December 2011. Sociodemographic information, medical and obstetric history, and details of events during the previous 2 weeks were recorded using a standardized questionnaire. Results The resistance rates were 39.5% for clindamycin and 23.0% for erythromycin. In multiple logistic regression analysis, the subject characteristic significantly associated with resistance to both antibiotics was a history of symptomatic sore throat in the 2 weeks before obtaining the specimen (erythromycin: odds ratio [OR]: 2.13, 95% confidence interval [CI]: 1.10 to 4.13; clindamycin: OR: 2.31, 95% CI: 1.21, 4.42). Premature rupture of membranes (PROM) had an association of borderline significance. Conclusions In the urgent treatment of GBS-colonized pregnant women, the subject's history of previous sore throat and PROM should be considered when choosing appropriate antibiotics.
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Affiliation(s)
- Ji-Hyoung Yook
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Moon Young Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Eun Ju Kim
- Department of Preventive Medicine, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae Hyug Yang
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Hyun-Mee Ryu
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Kwan Young Oh
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jung-Hwan Shin
- Department of Obstetrics and Gynecology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Betsy Foxman
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, USA
| | - Moran Ki
- Department of Preventive Medicine, Eulji University Hospital, Eulji University, Daejeon, Korea
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Ginsburg AS, Tinkham L, Riley K, Kay NA, Klugman KP, Gill CJ. Antibiotic non-susceptibility among Streptococcus pneumoniae and Haemophilus influenzae isolates identified in African cohorts: a meta-analysis of three decades of published studies. Int J Antimicrob Agents 2013; 42:482-91. [PMID: 24139883 DOI: 10.1016/j.ijantimicag.2013.08.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
Abstract
Management of community-acquired pneumonia caused by Streptococcus pneumoniae and Haemophilus influenzae type B (Hib) can be complicated by emerging antimicrobial non-susceptibility. We conducted a meta-analysis to examine the antibiotic susceptibility of community-acquired invasive infections with S. pneumoniae and Hib in Africa from 1978 to 2011. With the notable exceptions of widespread trimethoprim/sulfamethoxazole (SXT) and tetracycline non-susceptibility, the majority of pneumococci remain susceptible to ampicillin/amoxicillin. However, 23.8% of pneumococcal meningitis isolates are non-susceptible to penicillin. Similarly, Hib isolates show non-susceptibility to SXT, tetracycline, erythromycin and chloramphenicol. β-Lactamase production among Hib isolates is increasing, a new observation for Africa, but is mitigated somewhat by Hib vaccination scale-up. In summary, pneumococcal susceptibility to amoxicillin remains high throughout Africa, and amoxicillin can be effectively and safely used as first-line treatment for childhood pneumonia. Data support first-line treatment of bacterial meningitis with ceftriaxone or cefotaxime.
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Geelen TH, Stassen FR, Hoogkamp-Korstanje JAA, Bruggeman CA, Stobberingh EE. Antimicrobial resistance among respiratory Haemophilus influenzae isolates from pulmonology services over a six-year period. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2013; 45:606-611. [PMID: 23746341 DOI: 10.3109/00365548.2013.796088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Respiratory tract infections (RTI) are frequently caused by Haemophilus influenzae. Widespread antibacterial resistance among respiratory microorganisms complicates empirical RTI treatment. Therefore, national data on antibiotic resistance for H. influenzae are important for guiding optimal antibiotic choice. METHODS The antibiotic susceptibility of H. influenzae strains isolated from respiratory specimens of patients admitted to the pulmonology services between 2005 and 2010 was assessed. Isolates were collected annually from 13 hospitals in the Netherlands as part of the national intramural antimicrobial resistance surveillance performed by the Dutch Working Group on Antibiotic Policy (SWAB). Breakpoints for resistance were in accordance with the criteria of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Trend analysis was performed using logistic regression analysis. RESULTS In total, 1606 H. influenzae strains were analyzed. The prevalence of antibiotic resistance to amoxicillin, co-amoxiclav, doxycycline, co-trimoxazole, and clarithromycin was stable over the 6-y period, and there was a trend towards a decrease in the prevalence of beta-lactamase-producing isolates. Regarding prevalences, no significant trends were observed. CONCLUSIONS Our study showed no significant changes in antibiotic resistance for H. influenzae isolated at different hospitals in the Netherlands over a 6-y period. Regular surveillance remains important in controlling the prevalence of resistance, since actual resistance data should be taken into account when the choice of an empiric antibiotic is made.
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Affiliation(s)
- Tanja H Geelen
- Department of Medical Microbiology, Research Institute NUTRIM, Maastricht University Medical Centre, the Netherlands
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Genomic characterization of ciprofloxacin resistance in a laboratory-derived mutant and a clinical isolate of Streptococcus pneumoniae. Antimicrob Agents Chemother 2013; 57:4911-9. [PMID: 23877698 DOI: 10.1128/aac.00418-13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The broad-spectrum fluoroquinolone ciprofloxacin is a bactericidal antibiotic targeting DNA topoisomerase IV and DNA gyrase encoded by the parC and gyrA genes. Resistance to ciprofloxacin in Streptococcus pneumoniae mainly occurs through the acquisition of mutations in the quinolone resistance-determining region (QRDR) of the ParC and GyrA targets. A role in low-level ciprofloxacin resistance has also been attributed to efflux systems. To look into ciprofloxacin resistance at a genome-wide scale and to discover additional mutations implicated in resistance, we performed whole-genome sequencing of an S. pneumoniae isolate selected for resistance to ciprofloxacin in vitro (128 μg/ml) and of a clinical isolate displaying low-level ciprofloxacin resistance (2 μg/ml). Gene disruption and DNA transformation experiments with PCR fragments harboring the mutations identified in the in vitro S. pneumoniae mutant revealed that resistance is mainly due to QRDR mutations in parC and gyrA and to the overexpression of the ABC transporters PatA and PatB. In contrast, no QRDR mutations were identified in the genome of the S. pneumoniae clinical isolate with low-level resistance to ciprofloxacin. Assays performed in the presence of the efflux pump inhibitor reserpine suggested that resistance is likely mediated by efflux. Interestingly, the genome sequence of this clinical isolate also revealed mutations in the coding region of patA and patB that we implicated in resistance. Finally, a mutation in the NAD(P)H-dependent glycerol-3-phosphate dehydrogenase identified in the S. pneumoniae clinical strain was shown to protect against ciprofloxacin-mediated reactive oxygen species.
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Schito GC, Marchese A, Elkharrat D, Farrell DJ. Comparative Activity of Telithromycin Against Macrolide-Resistant Isolates ofStreptococcus pneumoniae:Results of Two Years of the PROTEKT Surveillance Study. J Chemother 2013; 16:13-22. [PMID: 15077994 DOI: 10.1179/joc.2004.16.1.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
UNLABELLED The increase in resistance to macrolides has been linked with increasing use of these agents as empirical therapy for community-acquired respiratory tract infections (CARTIs). As part of the ongoing PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) surveillance program, over 7600 Streptococcus pneumoniae isolates were collected worldwide from 1999-2001 and evaluated for macrolide resistance. Globally, macrolide resistance was 31-33%, with considerable inter-country variation (<10-88%) and particularly high prevalence in the Far East (>71%). In Europe, France had the most resistant isolates (>53%). The highest rates of macrolide resistance were seen in 0-2 year olds. Co-resistance to clindamycin (64%) and all beta-lactams (14-79%) was seen among macrolide-resistant isolates, but >99% of these isolates were susceptible to telithromycin, vancomycin and linezolid. There was considerable variation in the prevalence of erm(B) (56-64%) and mef(A) (30-35%): erm(B) was prevalent in Europe and mef(A) in North America. Globally, 5-7% isolates carried both mechanisms (erm(B)+mef(A)); of these, 47-65% were from South Korea. These double resistance isolates were >90% resistant to the beta-lactams, except amoxicillin-clavulanate. Clindamycin was active against >98% mef(A) but poorly active against erm(B) and erm(B)+mef(A) isolates. Telithromycin, vancomycin and linezolid were highly active (>99.5%) across all three genotypes. CONCLUSIONS In vitro, telithromycin, vancomycin and linezolid are highly active against antibiotic-resistant strains of S. pneumoniae. Telithromycin may be a useful therapeutic alternative to macrolides for the treatment of CARTIs.
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Adriani KS, Brouwer MC, van der Ende A, van de Beek D. Bacterial meningitis in adults after splenectomy and hyposplenic states. Mayo Clin Proc 2013; 88:571-8. [PMID: 23628588 DOI: 10.1016/j.mayocp.2013.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/01/2013] [Accepted: 02/08/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the occurrence, disease course, prognosis, and vaccination status of patients with community-acquired bacterial meningitis with a history of splenectomy or functional hyposplenia. PATIENTS AND METHODS Patients with bacterial meningitis proven by cerebrospinal fluid culture were prospectively included in a nationwide cohort study between March 1, 2006, and September 1, 2011. Splenectomy or diseases associated with functional hyposplenia were scored for all patients. Vaccination status, clinical features, and outcome of patients with a history of splenectomy or functional hyposplenia were analyzed and compared with patients with normal spleen function. RESULTS Twenty-four of 965 patients (2.5%) had an abnormal splenic function: 16 had a history of splenectomy and 8 had functional hyposplenia. All patients had pneumococcal meningitis. Pre-illness vaccination status could be retrieved for 19 of 21 patients (90%), and only 6 patients (32%) were adequately vaccinated against pneumococci. Pneumococcal serotype was known in 21 patients; 52% of pneumococcal isolates had a serotype included in the 23-valent vaccine. Vaccine failure occurred in 3 patients. Splenectomized patients more often presented with signs of septic shock compared with patients with a normal spleen (63% vs 24%; P=.02). Outcome was unfavorable in 14 patients (58%), and 6 patients died (25%). CONCLUSION Splenectomy or functional hyposplenia is an uncommon risk factor for bacterial meningitis but results in a high rate of mortality and unfavorable outcome. Most patients were not adequately vaccinated against Streptococcus pneumoniae.
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Affiliation(s)
- Kirsten S Adriani
- Department of Neurology, Academic Medical Center, Center of Infection and Immunity Amsterdam, Amsterdam, the Netherlands
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Kärpänoja P, Nissinen A, Huovinen P, Sarkkinen H. Antimicrobial susceptibility testing of Streptococcus pneumoniaeand Haemophilus influenzae- Internal quality control as a quality tool on a national level. APMIS 2013; 121:561-8. [DOI: 10.1111/apm.12021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Pauliina Kärpänoja
- Päijät-Häme Social and Health Care Group; Clinical Microbiology; Lahti; Finland
| | - Antti Nissinen
- Department of Clinical Microbiology; Central Hospital of Keski-Suomi; Jyväskylä; Finland
| | | | - Hannu Sarkkinen
- Päijät-Häme Social and Health Care Group; Clinical Microbiology; Lahti; Finland
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Thomas K, Mukkai Kesavan L, Veeraraghavan B, Jasmine S, Jude J, Shubankar M, Kulkarni P, Steinhoff M. Invasive pneumococcal disease associated with high case fatality in India. J Clin Epidemiol 2013. [PMID: 23177893 DOI: 10.1016/j.jclinepi.2012.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To study the seroepidemiology and antimicrobial resistance pattern of invasive pneumococcal disease (IPD) in older subjects who are admitted to hospitals in India. STUDY DESIGN AND SETTING Prospective surveillance of IPD in patients older than 18 years in seven large academic teaching hospitals in India from 1993 to 2008. All subjects who had Streptococcus pneumoniae isolated from normally sterile body fluids or were antigen positive in cerebrospinal fluid, ascitic fluid, and pleural fluid were identified as IPD cases in the study. Serotype/group (STG) and minimum inhibitory concentration for penicillin, chloramphenicol, co-trimoxazole (trimethoprim-sulfamethoxazole), erythromycin, and cefotaxime were determined. RESULTS A total of 1,037 adult subjects with suspected invasive bacterial infection were recruited in the study. S pneumoniae was identified from normally sterile body fluids in 449 (43.3%) subjects. Meningitis (34.3%) and pneumonia (33.9%) were the most common clinical conditions associated with IPD. The case fatality was 25-30% across all age groups. Penicillin resistance was low at 2.7% overall. Resistance to co-trimoxazole was noted to be high and increasing in the study period from 42.9% in 1993 to 85.2% in 2008 (P = 0.001). The most common STG was serotype 1, which accounted for 22.9% of all isolates. The 23-valent pneumococcal polysaccharide vaccine covered 83.3% of the STGs (49/54; 95% confidence interval: 79.7, 96.9) for patients older than 60 years. CONCLUSION IPD continues to be a problem in India and is associated with high case fatality in spite of treatment in the hospital setting. Penicillin resistance is currently low in India. More than 80% of invasive STGs causing disease in the elderly in India are included in the formulation of polysaccharide pneumococcal vaccine.
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Affiliation(s)
- Kurien Thomas
- Department of Medicine, Christian Medical College, Vellore 632004, India.
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Miravitlles M, Zalacain R, Murio C, Ferrer M, Alvarez-Sala JL, Masa JF, Verea H, Ros F, Vidal R. Speed of recovery from acute exacerbations of chronic obstructive pulmonary disease after treatment with antimicrobials : results of a two-year study. Clin Drug Investig 2012; 23:439-50. [PMID: 17535055 DOI: 10.2165/00044011-200323070-00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE We performed a multicentre study under a 2-year observational protocol that included data on time to recovery from acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) in patients receiving moxifloxacin and comparator antimicrobials. PATIENTS AND METHODS Outpatients with moderate or severe COPD were recruited from respiratory clinics throughout Spain. Moxifloxacin was available in year 2, and was to be prescribed to 50% of patients in that period in a non-randomised allocation. Time to recovery was compared in successfully treated AE-COPD; cross-sectionally for all AE-COPD over 2 years, first AE-COPD and all AE-COPD in year 2, and longitudinally in patients receiving comparator antimicrobials for AE-COPD in year 1 and moxifloxacin in year 2. RESULTS 614 AE-COPD were treated in 441 patients over 2 years (mean age 66.7 +/- 8.3 years, 98% males, mean forced expiratory volume in 1 second [FEV(1)] 35.9 +/- 8.8%). Mean time to recovery overall was 4.6 days (SD 3.3) with moxifloxacin 400 mg/day for 5 days, and 5.8 days (SD 4.6) with comparators (p < 0.01), which were most frequently amoxicillin/clavulanic acid 500/125mg/8h, clarithromycin 500mg/12h and cefuroxime axetil 500mg/12h for 7-10 days. Longitudinal analysis showed that 27 patients treated with moxifloxacin in the second year of the study recovered in a mean of 3.7 days (SD 3.1), and the same patients treated with comparator antimicrobials in year one recovered in a mean of 6.8 days (SD 4.6) [p = 0.02]. In contrast, in 66 patients treated with comparator antimicrobials in both years, mean time to recovery was 7.4 days (SD 7.3) in year one and 5.5 days (SD 3.5) in year two (p = 0.24). All subgroup analyses showed a statistically significant reduction of 18-25% in time to recovery with moxifloxacin compared with other antibiotics. CONCLUSIONS Moxifloxacin significantly reduced time to recovery from AE-COPD in patients with moderate to severe disease by approximately 20% (>1 day) compared with other antimicrobials. Faster recovery should result in earlier return to work or normal activities, and to social and economic savings.
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Affiliation(s)
- Marc Miravitlles
- Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica (IDIBAPS), Hospital Clinic i Provincial, Barcelona, Spain
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Koch H, Landen H, Stauch K. Daily-practice treatment of acute exacerbations of chronic bronchitis with moxifloxacin in a large cohort in Germany. Clin Drug Investig 2012; 24:449-55. [PMID: 17523705 DOI: 10.2165/00044011-200424080-00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To monitor the efficacy and safety of moxifloxacin in respiratory tract infections (RTIs) focussing on acute exacerbations of chronic bronchitis (AECB). METHODS Patients with RTIs could be enrolled in this open-label, prospective, non-controlled post-marketing surveillance study from October 2001 until June 2002 unless moxifloxacin was contraindicated. At the initial visit, data were recorded on patient demographics, diagnosis and clinical symptoms. Two follow-up examinations could be performed to determine cure or improvement based on clinical symptoms, and to record adverse events. Clinical symptoms including fever, cough and purulent sputum were assessed individually. Efficacy, tolerability and patient acceptance were assessed globally at the final visit. RESULTS Of 9036 enrolled patients, 4328 had AECB, most of whom were treated with moxifloxacin at a daily dose of 400mg. Mean +/- SD time to clinical improvement was 3.4 +/- 1.5 days, and mean +/- SD time to clinical cure was 6.6 +/- 2.4 days. Cure rates were 39.4% at day 5 and 94.3% at day 10. By day 6, the proportion of patients with severe cough decreased from 85.4% at the initial visit to 6.9%, and those with severe dyspnoea from 22.5% to 1.2%. Purulent sputum was absent within 4 days in the majority of cases. Physicians rated efficacy, tolerability and patient acceptance as 'very good' or 'good' in approximately 95% of patients. There were 59 adverse events in 44 (1.0%) patients, most frequently gastrointestinal and nervous system disorders. CONCLUSIONS This study further confirms that AECB patients treated with moxifloxacin benefit from more rapid symptom relief and that this therapy option is well accepted in general practice.
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Affiliation(s)
- H Koch
- Kreiskrankenhaus Beeskow, Beeskow, Germany
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Prevalence of Ceftriaxon-Sensitive Pneumococci Infection and Use of E- Test for Patients Admitted to Ghaem and Imam Reza Hospitals During a Two-Year Period. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2012. [DOI: 10.5812/archcid.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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43
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Ilić K, Jakovljević E, Skodrić-Trifunović V. Social-economic factors and irrational antibiotic use as reasons for antibiotic resistance of bacteria causing common childhood infections in primary healthcare. Eur J Pediatr 2012; 171:767-77. [PMID: 21987082 DOI: 10.1007/s00431-011-1592-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
Abstract
The most prevalent childhood bacterial infections in primary healthcare are respiratory, gastrointestinal and urogenital infections. The main aim of this paper was to consider factors (socio-economic factors and irrational antibiotic use) that contribute to the development of bacterial resistance, as well as measures that resulted in a reduction of this problem. Computerized search through the Medline of published articles on antibiotic resistance from 1996 to 2011 in English or Serbian was completed in August 2011. Combinations of used terms were antimicrobial/antibacterial/antibiotic and resistance/susceptibility in pediatric/children, and Streptococcus pneumoniae/Streptococci/Haemophilus influenzae/Salmonellae/Escherichia coli/Shigella/Staphylococcus aureus as well as antibiotics/antimicrobials/antibacterials and consumption/utilization/use. In many developing countries, antibiotic dispensing and its use in medicine, cattle breeding and agriculture are inadequately regulated, or existing laws are not being appropriately implemented. In addition, human travel contributes to antimicrobial drug resistance around the world. All of these factors have led to a very high level of bacterial resistance. On the contrary, in countries with a clearly defined and implemented legal framework concerning antibiotic prescribing, dispensing and utilization, the use of antibiotics is under constant surveillance. That resulted in a significantly lower antibacterial resistance. In conclusion, bacterial resistance could be reduced by the implementation of systemic and long-term measures at a country level as well as at all levels of healthcare. In order to reduce bacterial resistance, antibiotic use needs to be precisely regulated, and regulations should be coherent with practice. The international community must have a more active role in solving this global problem.
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Affiliation(s)
- Katarina Ilić
- Department of Pharmacology, School of Pharmacy, University of Belgrade, PO BOX 146, Vojvode Stepe 450, 11221, Belgrade, Republic of Serbia.
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Antimicrobial resistance of Moraxella catarrhalis isolates in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:134-40. [DOI: 10.1016/j.jmii.2011.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 05/12/2011] [Accepted: 07/18/2011] [Indexed: 11/22/2022]
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Liang JH, Li XL, Wang H, An K, Wang YY, Xu YC, Yao GW. Structure-activity relationships of novel alkylides: 3-O-arylalkyl clarithromycin derivatives with improved antibacterial activities. Eur J Med Chem 2012; 49:289-303. [PMID: 22301216 DOI: 10.1016/j.ejmech.2012.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 10/14/2022]
Abstract
A series of novel alkylides, possessing 3-O-arylalkyl group instead of 3-O-cladinose, were designed, synthesized and evaluated for in vitro antibacterial activities. The increased potency clearly ranked by the order of 3-O-(3-aryl-2-propargyl), 3-O-(3-aryl-E-prop-2-enyl), 3-O-(3-aryl-propyl), and 3-O-(3-aryl-Z-prop-1-enyl) groups. Some alkylides, exemplified by 7a, 10a, 21, 22, 26, 27 and 33, showed improved activities against inducible MLS(B) resistance and efflux resistance compared to the second-generation macrolides. Among them, 26 possessed comparable activities against erythromycin-susceptible Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes (MICs of 0.016-0.5 μg/mL). Moreover, 26 displayed dramatically enhanced potency against both efflux resistant and inducibly MLS(B) resistant strains (MICs of 0.125-0.5 μg/mL) resistant to clarithromycin and azithromycin (MICs of 1- >254 μg/mL), independent of methicillin-susceptible and methicillin-resistant phenotypes.
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Affiliation(s)
- Jian-Hua Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China.
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46
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VASOO SHAWN, SINGH KAMALJIT, HSU LIYANG, CHIEW YOKEFONG, CHOW CAROL, LIN RAYMONDT, TAMBYAH PAULA. Increasing antibiotic resistance in Streptococcus pneumoniae colonizing children attending day-care centres in Singapore. Respirology 2011; 16:1241-8. [DOI: 10.1111/j.1440-1843.2011.02036.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Setzer WN. Drugs from the Cloudforest: The Search for New Medicines from Monteverde, Costa Rica. Nat Prod Commun 2011. [DOI: 10.1177/1934578x1100601035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The University of Alabama in Huntsville Natural Products Research Group has been investigating the phytopharmaceutical potential of tropical rainforest higher plants from the Monteverde region of northwestern Costa Rica for the past twenty years. The group has focused primarily on anticancer agents, antimicrobial agents, and antiparasitic agents. This review presents an overview of some of our efforts in natural products drug discovery from Monteverde, Costa Rica.
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Affiliation(s)
- William N. Setzer
- Department of Chemistry, University of Alabama in Huntsville, Huntsville, Alabama 35899, USA
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Ashley EA, Lubell Y, White NJ, Turner P. Antimicrobial susceptibility of bacterial isolates from community acquired infections in Sub-Saharan Africa and Asian low and middle income countries. Trop Med Int Health 2011; 16:1167-79. [PMID: 21707879 PMCID: PMC3469739 DOI: 10.1111/j.1365-3156.2011.02822.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Antimicrobial resistance has arisen across the globe in both nosocomial and community settings as a consequence of widespread antibiotic consumption. Poor availability of laboratory diagnosis means that resistance frequently goes unrecognised and may only be detected as clinical treatment failure. In this review, we provide an overview of the reported susceptibility of common community acquired bacterial pathogens in Sub-Saharan Africa and Asia to the antibiotics that are most widely used in these areas. METHODS We reviewed the literature for reports of the susceptibility of prevalent pathogens in the community in SSA and Asia to a range of commonly prescribed antibiotics. Inclusion criteria required that isolates were collected since 2004 and that they were obtained from either normally sterile sites or urine. The data were aggregated by region and by age group. RESULTS Eighty-three studies were identified since 2004 which reported the antimicrobial susceptibilities of common bacterial pathogens. Different methods were used to assess in-vitro susceptibility in the different studies. The quality of testing (evidenced by resistance profiles) also varied considerably. For Streptococcus pneumoniae and Neisseria meningitidis most drugs maintained relatively high efficacy, apart from co-trimoxazole to which there were high levels of resistance in most of the pathogens surveyed. CONCLUSIONS Compared with the enormous infectious disease burden and widespread use of antibiotics there are relatively few reliable data on antimicrobial susceptibility from tropical Asia and Africa upon which to draw firm conclusions, although it is evident that many commonly used antibiotics face considerable resistance in prevalent bacterial pathogens. This is likely to exacerbate morbidity and mortality. Investment in improved antimicrobial susceptibility testing and surveillance systems is likely to be a highly cost-effective strategy and should be complemented by centralized and readily accessible information resources.
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Affiliation(s)
- Elizabeth A Ashley
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok, Thailand
- Imperial College NHS TrustLondon, UK
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok, Thailand
- Centre for Tropical Medicine, University of OxfordOxford, UK
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok, Thailand
- Centre for Tropical Medicine, University of OxfordOxford, UK
| | - Paul Turner
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkok, Thailand
- Centre for Tropical Medicine, University of OxfordOxford, UK
- Shoklo Malaria Research UnitMae Sot, Thailand
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Antimicrobial susceptibility of invasive and lower respiratory tract isolates of Streptococcus pneumoniae, 1998 to 2007. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 20:e139-44. [PMID: 21119791 DOI: 10.1155/2009/413749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous surveys of antimicrobial resistance in Streptococcus pneumoniae have found differences depending on source of isolate (eg, higher resistance in lower respiratory tract [LRT] versus invasive isolate) and age (higher resistance in children versus adults). Susceptibility profiles in the Calgary Health Region (approximately 1.25 million population) over a 10-year period were studied. Prospective laboratory-based population surveillance for S pneumoniae disease has been conducted since 1998. Patient demographics and susceptibility testing were analyzed. In total, 2382 patient isolates were available for analysis from 1998 to 2007. Of these, 1170 isolates were invasive while 496 were LRT. Patient age distribution was: younger than five years, 14%; five to 17 years, 6%; 18 to 64 years, 56%; and 65 years or older, 24%. Mean patient age was 44.8 years and 60.0% were male. The overall incidence of nonsusceptibility was: penicillin, 8.2%; amoxicillin, 0.3%; cefuroxime, 6.2%; ceftriaxone, 1.7%; erythromycin, 8.8%; trimethoprim-sulfamethoxazole (TMP-SMX), 25.6%; clindamycin, 2.3%; and levofloxacin, 0.2%. Overall resistance rates were stable, except for increasing erythromycin resistance from 5.4% (1998) to a high of 14.2% (2004) (P=0.007). Isolates that were nonsusceptible to penicillin or TMP-SMX were more likely to be multidrug resistant (P<0.001) compared with penicillin- or TMP-SMX-susceptible isolates. Compared with invasive isolates, LRT isolates showed more resistance to penicillin, TMP-SMX, cefuroxime and erythromycin, and were more likely to be multidrug resistant. Isolates from children younger than five years of age are more likely to be multidrug resistant and resistant to erythromycin and cefotaxime. Ongoing surveillance of S pneumoniae isolates is important because resistance rates vary by source and patient age among health care regions.
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Lubell Y, Turner P, Ashley EA, White NJ. Susceptibility of bacterial isolates from community-acquired infections in sub-Saharan Africa and Asia to macrolide antibiotics. Trop Med Int Health 2011; 16:1192-205. [PMID: 21740488 DOI: 10.1111/j.1365-3156.2011.02837.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To review the literature on the susceptibility of common community pathogens in sub-Saharan Africa and Asia to the macrolide antibiotics. METHODS Inclusion criteria required that isolates were collected since 2004 to ensure results were of contemporary relevance. The data were aggregated by region, age group and sterility of site of culture sample. RESULTS A total of 51 studies were identified, which reported the macrolide antimicrobial susceptibilities of common bacterial pathogens isolated since 2004. In general, there was less macrolide resistance in African than in Asian isolates. Most African studies reported high levels of macrolide susceptibility in Streptococcus pneumoniae, whereas most Chinese studies reported high levels of resistance. There was very little information available for Gram-negative organisms. CONCLUSIONS Susceptibility of the pneumococcus to macrolides in SSA remains high in many areas, and good activity of azithromycin has been shown against Salmonellae spp. in Asia. In urban areas where high antibiotic consumption is prevalent, there was evidence of increased resistance to macrolides. However, there is no information on susceptibility from large areas in both continents.
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Affiliation(s)
- Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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