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Elmassry MM, Colmer-Hamood JA, Kopel J, San Francisco MJ, Hamood AN. Anti- Pseudomonas aeruginosa Vaccines and Therapies: An Assessment of Clinical Trials. Microorganisms 2023; 11:916. [PMID: 37110338 PMCID: PMC10144840 DOI: 10.3390/microorganisms11040916] [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: 02/14/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that causes high morbidity and mortality in cystic fibrosis (CF) and immunocompromised patients, including patients with ventilator-associated pneumonia (VAP), severely burned patients, and patients with surgical wounds. Due to the intrinsic and extrinsic antibiotic resistance mechanisms, the ability to produce several cell-associated and extracellular virulence factors, and the capacity to adapt to several environmental conditions, eradicating P. aeruginosa within infected patients is difficult. Pseudomonas aeruginosa is one of the six multi-drug-resistant pathogens (ESKAPE) considered by the World Health Organization (WHO) as an entire group for which the development of novel antibiotics is urgently needed. In the United States (US) and within the last several years, P. aeruginosa caused 27% of deaths and approximately USD 767 million annually in health-care costs. Several P. aeruginosa therapies, including new antimicrobial agents, derivatives of existing antibiotics, novel antimicrobial agents such as bacteriophages and their chelators, potential vaccines targeting specific virulence factors, and immunotherapies have been developed. Within the last 2-3 decades, the efficacy of these different treatments was tested in clinical and preclinical trials. Despite these trials, no P. aeruginosa treatment is currently approved or available. In this review, we examined several of these clinicals, specifically those designed to combat P. aeruginosa infections in CF patients, patients with P. aeruginosa VAP, and P. aeruginosa-infected burn patients.
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Affiliation(s)
- Moamen M. Elmassry
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Jane A. Colmer-Hamood
- Department of Medical Education, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Michael J. San Francisco
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
- Honors College, Texas Tech University, Lubbock, TX 79409, USA
| | - Abdul N. Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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Martak D, Gbaguidi-Haore H, Meunier A, Valot B, Conzelmann N, Eib M, Autenrieth IB, Slekovec C, Tacconelli E, Bertrand X, Peter S, Hocquet D, Guther J. High prevalence of Pseudomonas aeruginosa carriage in residents of French and German long-term care facilities. Clin Microbiol Infect 2022; 28:1353-1358. [PMID: 35597505 DOI: 10.1016/j.cmi.2022.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine prevalence, incidence, and factors associated with Pseudomonas aeruginosa (PA) intestinal carriage in residents of long-term care facilities (LTCFs) and to understand the population structure of this pathogen in LTCFs from two European countries. METHODS We assessed the prevalence of PA intestinal carriage and the incidence of acquisition by collecting fecal samples from 403 residents of 20 LTCFs. We collected 289 environmental samples from sinks and drinking water. Factors associated with carriage and acquisition of intestinal PA were identified. All PA isolates had their antibiotic phenotypic resistance profile determined and their genome sequenced, from which we assessed the population structure of the collection and identified resistance determinants. RESULTS We found a high proportion of residents with PA intestinal carriage (51.6%) over the entire study period. Over the follow-up period, 28.6% of the residents acquired intestinal PA. Older age (Odds ratio [OR] = 1.29, 95% confidence interval [CI]: 1.09-1.52; p = 0.002), urinary incontinence (OR = 2.56, 95% CI: 1.37-4.88; p = 0.003), and male gender (OR = 2.55), 95% CI: 1.05-6.18; p = 0.039) were associated with higher probability of carriage. Wheelchair usage (OR = 4.56, 95% CI: 1.38-15.05; p = 0.013) and a body mass index >25 (OR = 3.71, 95% CI: 1.17-11.82; p = 0.026) were associated with higher risk of PA acquisition. Population structure of our isolates was mainly non-clonal with 112 different STs among the 241 isolates. Most represented STs were high risk clones ST253 (n=26), ST17 (n=11), ST244 (n=11), ST309 (n=10), and ST395 (n=10). Most PA isolates (86.3%) were susceptible to antibiotics, with no acquired genes conferring resistance to antipseudomonal agents. CONCLUSIONS We found an unexpected high prevalence of PA intestinal carriage in LTCF residents mainly associated with individual-level factors. Our study revealed a polyclonal PA population structure suggesting that individual acquisition is more frequent than resident-to-resident transmission.
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Affiliation(s)
- Daniel Martak
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France.
| | - Houssein Gbaguidi-Haore
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Alexandre Meunier
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Benoit Valot
- UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Nadine Conzelmann
- Infectious Diseases, Dept. of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Michael Eib
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - Ingo B Autenrieth
- University Hospital Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Céline Slekovec
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Xavier Bertrand
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Silke Peter
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - Didier Hocquet
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Universitaire, Besançon, France
| | - Julia Guther
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
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Baiou A, Elbuzidi AA, Bakdach D, Zaqout A, Alarbi KM, Bintaher AA, Ali MMB, Elarabi AM, Ali GAM, Daghfal J, Almaslamani MA, Ibrahim ASS, Alkhal A, Omrani AS. Clinical characteristics and risk factors for the isolation of multi-drug-resistant Gram-negative bacteria from critically ill patients with COVID-19. J Hosp Infect 2021; 110:165-171. [PMID: 33561503 PMCID: PMC7866848 DOI: 10.1016/j.jhin.2021.01.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
Background We investigated the clinical characteristics and risk factors for the isolation of multi-drug-resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients. Methods We retrospectively matched (1:2) critical COVID-19 patients with one or more MDR GNB from any clinical specimen (cases), with those with no MDR GNB isolates (controls). Results Seventy-eight cases were identified (4.5 per 1000 intensive care unit (ICU) days, 95% confidence interval (CI) 3.6–5.7). Of 98 MDR GNB isolates, the most frequent species were Stenotrophomonas maltophilia (24, 24.5%), and Klebsiella pneumoniae (23, 23.5%). Two (8.7%) K. pneumoniae, and six (85.7%) Pseudomonas aeruginosa isolates were carbapenem resistant. A total of 24 (24.5%) isolates were not considered to be associated with active infection. Those with active infection received appropriate antimicrobial agents within a median of one day. The case group had significantly longer median central venous line days, mechanical ventilation days, and hospital length of stay (P<0.001 for each). All-cause mortality at 28 days was not significantly different between the two groups (P=0.19). Mechanical ventilation days (adjusted odds ratio 1.062, 95% CI 1.012–1.114; P=0.015), but not receipt of corticosteroids or tocilizumab, was independently associated with the isolation of MDR GNB. There was no association between MDR GNB and 28-day all-cause mortality (adjusted odds ratio 2.426, 95% CI 0.833–7.069; P= 0.104). Conclusion In critically ill COVID-19 patients, prevention of MDR GNB colonization and infections requires minimizing the use of invasive devices, and to remove them as soon as their presence is no longer necessary.
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Affiliation(s)
- A Baiou
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - A A Elbuzidi
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - D Bakdach
- Division of Critical Care, Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - A Zaqout
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - K M Alarbi
- Division of Internal Medicine, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - A A Bintaher
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - M M B Ali
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - A M Elarabi
- Division of Pulmonary Medicine, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - G A M Ali
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - J Daghfal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - M A Almaslamani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - A S S Ibrahim
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - A Alkhal
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - A S Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
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