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Jyoti K, Soni K, Chandra R. Pharmaceutical industrial wastewater exhibiting the co-occurrence of biofilm-forming genes in the multidrug-resistant bacterial community poses a novel environmental threat. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2024; 273:107019. [PMID: 39002428 DOI: 10.1016/j.aquatox.2024.107019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024]
Abstract
The interaction of the environment with the effluent of wastewater treatment plants, having antibiotics, multidrug-resistant (MDR) bacteria, and biofilm-forming genes (BFGs), has vast environmental risks. Antibiotic pollution bottlenecks environmental bacteria and has the potential to significantly lower the biodiversity of environmental bacteria, causing an alteration in ecological equilibrium. It can induce selective pressure for antibiotic resistance (AR) and can transform the non-resistant environmental bacteria into a resistant form through HGT. This study investigated the occurrence of MDR bacteria, showing phenotypic and genotypic characteristics of biofilm. The bacteria were isolated from the pharmaceutical wastewater treatment plants (WWTPs) of Dehradun and Haridwar (India), located in the pharmaceutical areas. The findings of this study demonstrate the coexistence of BFGs and MDR clinical bacteria in the vicinity of pharmaceutical industrial wastewater treatment plants. A total of 47 bacteria were isolated from both WWTPs and tested for antibiotic resistance to 13 different antibiotics; 16 isolates (34.04 %) tested positive for MDR. 5 (31.25 %) of these 16 MDR isolates were producing biofilm and identified as Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Burkholderia cepacia. The targeted BFGs in this study were ompA, bap and pslA. The most common co-occurring gene was ompA (80 %), with pslA (40 %) being the least common. A. baumannii contains all three targeted genes, whereas B. cepacia only has bap. Except for B. cepacia, all the biofilm-forming MDR isolates show AR to all the tested antibiotics and prove that the biofilm enhances the AR potential. The samples of both wastewater treatment plants also showed the occurrence of tetracycline, ampicillin, erythromycin and chloramphenicol, along with high levels of BOD, COD, PO4-3, NO3-, heavy metals and organic pollutants. The co-occurrence of MDR and biofilm-forming tendency in the clinical strain of bacteria and its environmental dissemination may have an array of hazardous impacts on human and environmental health.
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Affiliation(s)
- Km Jyoti
- Department of Environmental Microbiology, School of Earth and Environmental Sciences, Babasaheb Bhimrao Ambedkar University (A Central University), Lucknow, Uttar Pradesh 226025, India
| | - Kuldeep Soni
- Department of Environmental Microbiology, School of Earth and Environmental Sciences, Babasaheb Bhimrao Ambedkar University (A Central University), Lucknow, Uttar Pradesh 226025, India
| | - Ram Chandra
- Department of Environmental Microbiology, School of Earth and Environmental Sciences, Babasaheb Bhimrao Ambedkar University (A Central University), Lucknow, Uttar Pradesh 226025, India.
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Junaid M, Thirapanmethee K, Khuntayaporn P, Chomnawang MT. CRISPR-Based Gene Editing in Acinetobacter baumannii to Combat Antimicrobial Resistance. Pharmaceuticals (Basel) 2023; 16:920. [PMID: 37513832 PMCID: PMC10384873 DOI: 10.3390/ph16070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Antimicrobial resistance (AMR) poses a significant threat to the health, social, environment, and economic sectors on a global scale and requires serious attention to addressing this issue. Acinetobacter baumannii was given top priority among infectious bacteria because of its extensive resistance to nearly all antibiotic classes and treatment options. Carbapenem-resistant A. baumannii is classified as one of the critical-priority pathogens on the World Health Organization (WHO) priority list of antibiotic-resistant bacteria for effective drug development. Although available genetic manipulation approaches are successful in A. baumannii laboratory strains, they are limited when employed on newly acquired clinical strains since such strains have higher levels of AMR than those used to select them for genetic manipulation. Recently, the CRISPR-Cas (Clustered regularly interspaced short palindromic repeats/CRISPR-associated protein) system has emerged as one of the most effective, efficient, and precise methods of genome editing and offers target-specific gene editing of AMR genes in a specific bacterial strain. CRISPR-based genome editing has been successfully applied in various bacterial strains to combat AMR; however, this strategy has not yet been extensively explored in A. baumannii. This review provides detailed insight into the progress, current scenario, and future potential of CRISPR-Cas usage for AMR-related gene manipulation in A. baumannii.
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Affiliation(s)
- Muhammad Junaid
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Antimicrobial Resistance Interdisciplinary Group (AmRIG), Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
| | - Krit Thirapanmethee
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Antimicrobial Resistance Interdisciplinary Group (AmRIG), Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
| | - Piyatip Khuntayaporn
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Antimicrobial Resistance Interdisciplinary Group (AmRIG), Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
| | - Mullika Traidej Chomnawang
- Department of Microbiology, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Antimicrobial Resistance Interdisciplinary Group (AmRIG), Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
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3
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Silva SMDA, Ramos BA, Sá RAQCDE, Silva MVDA, Correia MTS, Oliveira MBMDE. Investigation of factors related to biofilm formation in Providencia stuartii. AN ACAD BRAS CIENC 2022; 94:e20210765. [PMID: 36074405 DOI: 10.1590/0001-3765202220210765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/18/2021] [Indexed: 11/22/2022] Open
Abstract
Providencia stuartii is one of the Enterobacteriaceae species of medical importance commonly associated with urinary infections, which can also cause other ones, including uncommon ones, such as liver abscess and septic vasculitis. This bacterium stands out in the expression of intrinsic and acquired resistance to antimicrobials. Besides, it uses mechanisms such as biofilm for its persistence in biotic and abiotic environments. This study investigated the cellular hydrophobicity profile of clinical isolates of P. stuartii. It also analyzed genes related to the fimbrial adhesin in this species comparing with other reports described for other bacteria from Enterobacteriaceae family. The investigated isolates to form biofilm and had a practically hydrophilic cell surface profile. However, fimH and mrkD genes were not found in P. stuartii, unlike observed in other species of Enterobacteriaceae. These results show that P. stuartii has specificities regarding its potential for biofilm formation, which makes it difficult to destabilize the infectious process and increases the permanence of this pathogen in hospital units.
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Affiliation(s)
- Sivoneide M DA Silva
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Bárbara A Ramos
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Rafael A Q C DE Sá
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Márcia V DA Silva
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Maria T S Correia
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Maria B M DE Oliveira
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
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Sherif MM, Elkhatib WF, Khalaf WS, Elleboudy NS, Abdelaziz NA. Multidrug Resistant Acinetobacter baumannii Biofilms: Evaluation of Phenotypic-Genotypic Association and Susceptibility to Cinnamic and Gallic Acids. Front Microbiol 2021; 12:716627. [PMID: 34650528 PMCID: PMC8508616 DOI: 10.3389/fmicb.2021.716627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
Acinetobacter baumannii armed with multidrug resistance (MDR) and biofilm-forming ability is increasingly recognized as an alarming pathogen. A deeper comprehension of the correlation between these two armories is required in circumventing its infections. This study examined the biofilm-forming ability of the isolates by crystal violet staining and the antibiotic susceptibility by broth microdilution method. The genetic basis of the MDR and biofilm-forming phenotypes was screened by polymerase chain reaction. The antimicrobial activities of cinnamic and gallic acids against planktonic cells and biofilms of A. baumannii were investigated, and the findings were confirmed with scanning electron microscopy (SEM). Among 90 A. baumannii isolates, 69 (76.6%) were MDR, and all were biofilm formers; they were classified into weak (12.2%), moderate (53.3%), and strong (34.5%) biofilm formers. Our results underlined a significant association between MDR and enhanced biofilm formation. Genotypically, the presence of blaVIM and blaOXA–23 genes along with biofilm-related genes (ompA, bap, and csuE) was statistically associated with the biofilm-forming abilities. Impressively, both gallic and cinnamic acids could significantly reduce the MDR A. baumannii biofilms with variable degrees dependent on the phenotype–genotype characteristics of the tested isolates. The current findings may possess future therapeutic impact through augmenting antimicrobial arsenal against life-threatening infections with MDR A. baumannii biofilms.
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Affiliation(s)
- Mahmoud M Sherif
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, 6th of October City, Egypt
| | - Walid F Elkhatib
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.,Department of Microbiology and Immunology, Faculty of Pharmacy, Galala University, Al Galala, Egypt
| | - Wafaa S Khalaf
- Department of Microbiology and Immunology, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Nooran S Elleboudy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Neveen A Abdelaziz
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, 6th of October City, Egypt
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Silva AMCMDA, Costa Júnior SD, Lima JLC, Farias Filho JLBDE, Cavalcanti IMF, Maciel MAV. Investigation of the association of virulence genes and biofilm production with infection and bacterial colonization processes in multidrug-resistant Acinetobacter spp. AN ACAD BRAS CIENC 2021; 93:e20210245. [PMID: 34550209 DOI: 10.1590/0001-3765202120210245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the phenotypic and molecular patterns of biofilm formation in infection and colonization isolates of Acinetobacter spp. from patients who were admitted in a public hospital of Recife-PE-Brazil in 2018-2019. For the biofilm phenotypic analysis, Acinetobacter spp. isolates were evaluated by the crystal violet staining method; the search of virulence genes (bap, ompA, epsA, csuE and bfmS) was performed by PCR; and the ERIC-PCR was performed for molecular typing. Amongst the 38 Acinetobacter spp. isolates, 20 were isolated from infections and 18 from colonization. The resistance profile pointed that 86.85% (33/38) of the isolates were multidrug-resistant, being three infection isolates, and two colonization isolates resistant to polymyxin B. All the isolates were able to produce biofilm and they had at least one of the investigated virulence genes on their molecular profile, but the bap gene was found in 100% of them. No clones were detected by ERIC-PCR. There was no correlation between biofilm formation and the resistance profile of the bacteria, neither to the molecular profile of the virulence genes. Thus, the ability of Acinetobacter spp. to form biofilm is probably related to the high frequency of virulence genes.
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Affiliation(s)
- Adriana Maria C M DA Silva
- Federal University of Pernambuco, Medical Science Center, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Sérgio D Costa Júnior
- Federal University of Pernambuco, Medical Science Center, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Jailton L C Lima
- Federal University of Pernambuco, Medical Science Center, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - José Luciano B DE Farias Filho
- Federal University of Pernambuco, Medical Science Center, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Isabella M F Cavalcanti
- Federal University of Pernambuco, Laboratory of Immunopathology Keizo Asami (LIKA), Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Maria Amélia V Maciel
- Federal University of Pernambuco, Medical Science Center, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
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Emergence of rmtD1 gene in clinical isolates of Pseudomonas aeruginosa carrying bla KPC and/or bla VIM-2 genes in Brazil. Braz J Microbiol 2021; 52:1959-1965. [PMID: 34420185 DOI: 10.1007/s42770-021-00576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/10/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The aim of the present study is to describe clinical aminoglycoside- or carbapenem-resistant Pseudomonas aeruginosa isolates collected between 2018 and 2019 in a hospital in Recife City, Northeastern Brazil. It was done based on phenotypic and molecular markers of antimicrobial resistance, as well as on the clonal diversity of the investigated isolates. METHODS Thirty-four carbapenem- and/or aminoglycoside-resistant P. aeruginosa isolates were collected in a hospital in Recife City-PE, Brazil. Their antimicrobial susceptibility profile was identified based on the automated BD Phoenix ™ system. In addition, broth microdilution was performed to determine the MICs of tobramycin and polymyxin B. Eventually, isolates were subjected to PCR and sequencing in order to detect the carbapenemase enzyme (blaKPC, blaNDM, blaVIM, blaSPM-1, and blaIMP) and 16S rRNA methylase (armA, rmtB, rmtD, rmtF, and rmtG) genes; ERIC-PCR was conducted for clonal profile determination purposes. RESULTS Thirty-four of the 64 isolates evaluated in the present study were selected for complementary molecular phenotypic tests, based on sample inclusion criteria. The blaKPC and blaVIM-2 genes were identified in 32.4% (11/34) and 38.2% (13/34) of tested isolates, respectively. The rmtD1 gene was detected in 32.4% (11/34) of analyzed isolates. Eight isolates carried both the blaKPC and rmtD1 genes, whereas blaVIM-2 and rmtD1 genes co-occurrence was detected in three strains; one isolate had all blaKPC, blaVIM-2, and rmtD1 genes. ERIC-PCR molecular typing has evidenced cross-transmission of three pathogenic clones among patients in the hospital. CONCLUSIONS The present study is a pioneer in describing isolates harboring both blaVIM-2 and rmtD1 genes. Moreover, it emphasizes the need of conducting local molecular epidemiology studies at different time intervals in order to monitor measures adopted to prevent nosocomial infections in different hospital units.
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Rather MA, Gupta K, Bardhan P, Borah M, Sarkar A, Eldiehy KSH, Bhuyan S, Mandal M. Microbial biofilm: A matter of grave concern for human health and food industry. J Basic Microbiol 2021; 61:380-395. [PMID: 33615511 DOI: 10.1002/jobm.202000678] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/27/2021] [Accepted: 02/06/2021] [Indexed: 12/15/2022]
Abstract
Pathogenic microorganisms have adapted different strategies during the course of time to invade host defense mechanisms and overcome the effect of potent antibiotics. The formation of biofilm on both biotic and abiotic surfaces by microorganisms is one such strategy to resist and survive even in presence of antibiotics and other adverse environmental conditions. Biofilm is a safe home of microorganisms embedded within self-produced extracellular polymeric substances comprising of polysaccharides, extracellular proteins, nucleic acid, and water. It is because of this adaptation strategy that pathogenic microorganisms are taking a heavy toll on the health and life of organisms. In this review, we discuss the colonization of pathogenic microorganisms on tissues and medically implanted devices in human beings. We also focus on food spoilage, disease outbreaks, biofilm-associated deaths, burden on economy, and other major concerns of biofilm-forming pathogenic microorganisms in food industries like dairy, poultry, ready-to-eat food, meat, and aquaculture.
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Affiliation(s)
- Muzamil A Rather
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Kuldeep Gupta
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Pritam Bardhan
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Munmi Borah
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Anupama Sarkar
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Khalifa S H Eldiehy
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India.,Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut, Egypt
| | - Shuvam Bhuyan
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Manabendra Mandal
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
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Santos MDV, Barros MPS, Silveira-Filho VDM, Mendes-Marques CL, Lima AVA, Silva MVD, Leal-Balbino TC, Silva MDPCD, Paiva PMG, Oliveira MBMD. Genetic and Biochemical Diversity of Clinical Acinetobacter baumannii and Pseudomonas aeruginosa Isolates in a Public Hospital in Brazil. Microb Drug Resist 2020; 27:509-517. [PMID: 32882147 DOI: 10.1089/mdr.2020.0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Life-threatening bacterial infections are a major concern in health care services worldwide. This retrospective study aimed to demonstrate genetic and biochemical diversity in isolates of Acinetobacter baumannii and Pseudomonas aeruginosa from a public hospital in Brazil. A total of 63 isolates collected from different sites of infection and hospital sectors were characterized, and their susceptibility profile to antibiotics was assessed for 18 drugs belonging to 8 antimicrobial categories using the automated BACTEC system. Genetic diversity was assessed using the multiple locus variable number tandem repeat analysis. Among the isolates of A. baumannii, 83% were classified as extensively drug resistant (XDR), and 17 genotypic profiles were identified. About 67% of P. aeruginosa isolates were susceptible to antimicrobials and were distributed into 37 genotypic profiles, revealing genetic heterogeneity. This study has demonstrated the multicolonization of investigated pathogens and the high frequency (95.8%) of multidrug-resistant and XDR, as well as high genetic diversity, among the isolates supporting the continuous need to monitor these species in the hospital environment.
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Affiliation(s)
| | | | | | | | | | - Marcia Vanusa da Silva
- Department of Biochemistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Synergistic Effect between Usnic Acid and Polymyxin B against Resistant Clinical Isolates of Pseudomonas aeruginosa. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:9852145. [PMID: 32849907 PMCID: PMC7441413 DOI: 10.1155/2020/9852145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
The present study aimed to characterize the susceptibility profile of Pseudomonas aeruginosa and Acinetobacter spp. clinical isolates to polymyxin B in a public hospital in Recife-PE, Brazil, between the years of 2018 and 2019, as well as to search for the presence of the mcr-1 gene and evaluate the interaction between polymyxin B and usnic acid against these isolates. The strains were identified using the BD Phoenix™ automated system and the agar-spot test was used to determine the susceptibility profile to polymyxin B. The minimum inhibitory concentrations (MICs) of usnic acid and polymyxin B were determined through the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI). Subsequently, Polymerase Chain Reaction (PCR) was performed to detect the mcr-1 gene in the isolates. The interaction between usnic acid and polymyxin B was evaluated by the Checkerboard assay. Among 34 isolates of P. aeruginosa, 26.5% (9/34) were positive for the polymyxin B agar-spot test, and 11.8% (4/34) presented an intermediate susceptibility (MIC = 4 μg/mL), while 14.7% (5/34) presented antimicrobial resistance with MIC values ranging from 8 to 32 μg/mL. Among 38 isolates of Acinetobacter spp., 13.2% (5/38) were positive for the polymyxin B agar-spot test and all of them were resistant to polymyxin B with a MIC value > 32 μg/mL. The mcr-1 gene was not detected in the clinical isolates. Regarding usnic acid, it presented a moderate antibacterial activity against two P. aeruginosa isolates (MIC = 250 μg/mL) and no activity was detected against the others. A synergistic effect between usnic acid and polymyxin B was observed against three clinical isolates of P. aeruginosa which were resistant to polymyxin B (FICI ≤ 0.5). Therefore, it was possible to observe that usnic acid is a promising candidate to be used in combination with polymyxin B against infections caused by resistant P. aeruginosa.
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Ereshefsky BJ, Alrahmany D, El Nekidy WS, Pontiggia L, Ghazi IM. Optimal vancomycin dose in the treatment of Clostridium difficile infection, antimicrobial stewardship initiative. J Chemother 2020; 33:165-173. [PMID: 32715951 DOI: 10.1080/1120009x.2020.1790166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
C. difficile infections (CDI) are increasingly recognized as a leading cause of infectious diarrhea, with increasing morbidity and mortality. Treatment primarily centers around oral vancomycin treatment. A wide range of dosing regimens exist in clinical practice, with little evidence to help distinguish the therapeutic benefit between them. This is a retrospective cohort study conducted at an academic medical center that enrolled adult patients admitted with CDI. The primary outcome was a composite of complete or partial cure at the end of treatment and was assessed using a test of equivalency with a 20% equivalency limit. Subjects were divided into low dose (125 mg) or high dose (250 mg or 500 mg) of oral vancomycin dosed every 6 hours. Overall, 78 patients were included who received low dose vancomycin and 33 who received high dose. Generally, the two groups were similar, except the low dose group had significantly more leukocytosis and less ICU admission or hypotension compared to the high dose group. Equivalency between the two treatment groups was demonstrated (Absolute Risk Difference -0.022, 90% confidence interval: -0.13 to 0.18, p = 0.03). A stepwise logistic regression identified gender, baseline albumin, and ICU admission as significant predictors of the chance for complete or partial cure. No differences between groups for the secondary outcomes of 90-day readmission/recurrence, 30-day all-cause mortality, or time to resolution of diarrhea were demonstrated. Low dose oral vancomycin was demonstrated to result in equivalent outcomes compared to high dose vancomycin for the treatment of CDI.
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Affiliation(s)
- Benjamin J Ereshefsky
- Department of Pharmacy Services, Kaweah Delta Health Care District, Visalia, California, USA
| | - Diaa Alrahmany
- Department of Pharmacy Services, Sohar Hospital, Sohar, Oman
| | - Wasim S El Nekidy
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Laura Pontiggia
- Misher College of Arts and Sciences, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Islam M Ghazi
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
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Antibiotic Resistance Profiles, Molecular Mechanisms and Innovative Treatment Strategies of Acinetobacter baumannii. Microorganisms 2020; 8:microorganisms8060935. [PMID: 32575913 PMCID: PMC7355832 DOI: 10.3390/microorganisms8060935] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022] Open
Abstract
Antibiotic resistance is one of the biggest challenges for the clinical sector and industry, environment and societal development. One of the most important pathogens responsible for severe nosocomial infections is Acinetobacter baumannii, a Gram-negative bacterium from the Moraxellaceae family, due to its various resistance mechanisms, such as the β-lactamases production, efflux pumps, decreased membrane permeability and altered target site of the antibiotic. The enormous adaptive capacity of A. baumannii and the acquisition and transfer of antibiotic resistance determinants contribute to the ineffectiveness of most current therapeutic strategies, including last-line or combined antibiotic therapy. In this review, we will present an update of the antibiotic resistance profiles and underlying mechanisms in A. baumannii and the current progress in developing innovative strategies for combating multidrug-resistant A. baumannii (MDRAB) infections.
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