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Rolain H, Schwartz Z, Jubrail R, Downes K, Hong L, FakhriRavari A, Rhodes NJ, Scheetz MH. Meta-analysis on safety of standard vs prolonged infusion of beta-lactams. Int J Antimicrob Agents 2024:107309. [PMID: 39168416 DOI: 10.1016/j.ijantimicag.2024.107309] [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: 04/18/2024] [Revised: 07/11/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Efficacy for prolonged infusion beta-lactam dosing schemes has been previously described, but there has been less focus on the safety of standard vs prolonged infusion protocols of beta-lactams. This study explored differences in adverse drug reactions (ADRs) reported for beta-lactams between each of these infusion protocols. METHODS A systematic review of MEDLINE literature databases via PubMed was conducted and references were compiled. Articles were compiled and assessed with specific inclusion/exclusion criteria. We included randomized and nonrandomized, prospective, and retrospective cohort studies that reported adverse effects due to either standard (30-60 mins) or prolonged (≥3 hours) infusions of beta-lactam infusions. Total ADRs between strategies were analyzed by infusion methodology. The most consistently reported ADRs were subject to meta-analysis across studies. RESULTS 12 studies met inclusion/exclusion criteria with data for 4163 patients. There was insufficient data to systematically analyze neurotoxicity or cytopenias. Seven studies reported on nephrotoxicity outcomes with no significant difference in event rates between standard (n=434/2258,19.2%) vs prolonged infusion (n=266/1271, 20.9%) of beta-lactams (OR=1.08, 95%CI [0.91, 1.29]). Six studies observed diarrhea in a total of 759 patients with no significant difference in patients of standard (n=18/399, 4.5%) vs prolonged (n=19/360, 5.3%) infusion of beta-lactams (OR=1.14, 95%CI [0.59,2.20]). CONCLUSION Prolonged and standard infusion schemes for beta-lactams demonstrated similar adverse event rates. Future research should focus on improved standardization of adverse effect definitions and a priori aim to study neurotoxicity and cytopenias. Consistent recording of ADRs and standardized definitions of these reactions will be paramount to further study of this subject.
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Affiliation(s)
- Hunter Rolain
- Midwestern University- Downers Grove Campus, Chicago College of Osteopathic Medicine, Downers Grove, IL, USA
| | - Zachary Schwartz
- Midwestern University- Downers Grove Campus, Chicago College of Osteopathic Medicine, Downers Grove, IL, USA
| | - Raymond Jubrail
- Midwestern University- Downers Grove Campus, Department of Pharmacy Practice, Downers Grove, IL, USA
| | - Kevin Downes
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Hong
- Loma Linda University School of Pharmacy, Department of Pharmacy Practice, Loma Linda, CA, USA
| | - Alireza FakhriRavari
- Loma Linda University School of Pharmacy, Department of Pharmacy Practice, Loma Linda, CA, USA
| | - Nathaniel J Rhodes
- Midwestern University- Downers Grove Campus, Department of Pharmacy Practice, Downers Grove, IL, USA; Midwestern University- Downers Grove Campus, Pharmacometrics Center of Excellence, Downers Grove, IL, USA; Northwestern Memorial Hospital, Department of Pharmacy, Chicago, IL, USA
| | - Marc H Scheetz
- Midwestern University- Downers Grove Campus, Department of Pharmacy Practice, Downers Grove, IL, USA; Midwestern University- Downers Grove Campus, Pharmacometrics Center of Excellence, Downers Grove, IL, USA; Northwestern Memorial Hospital, Department of Pharmacy, Chicago, IL, USA.
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2
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Akyol D, Çankayalı İ, Ersel M, Demirağ K, Uyar M, Can Ö, Özçete E, Karbek-Akarca F, Yağdı T, Engin Ç, Özgiray E, Yurtseven T, Yağmur B, Nalbantgil S, Ekren P, Bozkurt D, Şirin H, Çilli F, Sezer ED, Taşbakan M, Yamazhan T, Pullukçu H, Sipahi H, Arda B, Ulusoy S, Sipahi OR. Impact of the empirical therapy timing on the clinical progress of septic shock patients. Diagn Microbiol Infect Dis 2024; 108:116149. [PMID: 38142580 DOI: 10.1016/j.diagmicrobio.2023.116149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/11/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023]
Abstract
AIM To evaluate the effect of timing of antimicrobial therapy on clinical progress of patients with septic shock. MATERIALS AND METHOD We included 204 adult patients diagnosed with septic shock according to Sepsis-3 criteria between March 2016 and April 2021. One-month survival was evaluated using univariate and logistic regression analysis. RESULTS Antibiotic treatment was initiated within 1 h of the vasopressors in 26.4 % of patients. One-month mortality did not differ significantly between patients with and without empirical therapy coverage on etiological agents. Univariate factors that significantly affected one-month survival were starting antibiotics at the first hour, the unit where the case was diagnosed with septic shock, SOFA scores, qSOFA scores, and lactate level. In multivariate analysis, diagnosis of septic shock in the Emergency Service, SOFA score ≥11, qSOFA score of three and lactate level ≥4 were significantly associated with one-month mortality. CONCLUSION Training programs should be designed to increase the awareness of septic shock diagnosis and treatment in the Emergency Service and other hospital units. Additionally, electronic patient files should have warning systems for earlier diagnosis and consultation.
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Affiliation(s)
- Deniz Akyol
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
| | - İlkin Çankayalı
- Ege University Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Murat Ersel
- Ege University Faculty of Medicine, Department of Emergency Department, Izmir, Turkey
| | - Kubilay Demirağ
- Ege University Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Mehmet Uyar
- Ege University Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Özge Can
- Ege University Faculty of Medicine, Department of Emergency Department, Izmir, Turkey
| | - Enver Özçete
- Ege University Faculty of Medicine, Department of Emergency Department, Izmir, Turkey
| | - Funda Karbek-Akarca
- Ege University Faculty of Medicine, Department of Emergency Department, Izmir, Turkey
| | - Tahir Yağdı
- Ege University Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - Çağatay Engin
- Ege University Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - Erkin Özgiray
- Ege University Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Taşkın Yurtseven
- Ege University Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Burcu Yağmur
- Ege University Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Sanem Nalbantgil
- Ege University Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Pervin Ekren
- Ege University Faculty of Medicine, Department of Pulmonology, Izmir, Turkey
| | - Devrim Bozkurt
- Ege University Faculty of Medicine, Department of Internal Medicine, Izmir, Turkey
| | - Hadiye Şirin
- Ege University Faculty of Medicine, Department of Neurology, Izmir, Turkey
| | - Feriha Çilli
- Ege University Faculty of Medicine, Department of Medical Microbiology İzmir, Turkey
| | - Ebru Demirel Sezer
- Ege University Faculty of Medicine, Department of Medical Biochemistry, Izmir, Turkey
| | - Meltem Taşbakan
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Tansu Yamazhan
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Hüsnü Pullukçu
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Hilal Sipahi
- Bornova Public Health Directorate, Izmir, Turkey
| | - Bilgin Arda
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Sercan Ulusoy
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Oğuz Reşat Sipahi
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey; King Hamad University Hospital, Bahrain Oncology Center, Infectious Diseases and Clinical Microbiology, Bahrain
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3
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Aldardeer NF, Alshreef MM, Alharbi EA, Aljabri AK, Aljawadi MH, Almangour TA, Alobaili S, Alarifi MI, Alomari A, Alhammad AM. Early Versus Late Antipseudomonal β-Lactam Antibiotic Dose Adjustment in Critically Ill Sepsis Patients With Acute Kidney Injury: A Prospective Observational Cohort Study. Open Forum Infect Dis 2024; 11:ofae059. [PMID: 38434610 PMCID: PMC10906704 DOI: 10.1093/ofid/ofae059] [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: 10/24/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024] Open
Abstract
Background Acute kidney injury (AKI) is a common complication of sepsis, contributing to an increased mortality rate. However, some studies have demonstrated that renal function improves in sepsis patients with AKI within 48 hours, raising questions about the necessity for early antibiotic adjustment. This study evaluates the association between the timing of antipseudomonal β-lactam dose adjustment and the outcomes of critically ill sepsis patients with AKI. Methods A prospective, multicenter observational study of critically ill patients aged ≥18 years admitted to the intensive care unit with sepsis and AKI and started on antipseudomonal β-lactam therapy. After the initial dose, eligible patients were grouped as early β-lactam antibiotic (E-BLA) or late β-lactam antibiotic (L-BLA) dose adjustments based on the administration of subsequent renally adjusted doses within 24 hours and after 24 hours of sepsis recognition, respectively. The main outcome of interest was in-hospital mortality. Results Among 1185 patients screened, 224 (mean age, 62.7 ± 16.8 years; 62% were male) met inclusion criteria. Eighty-four and 140 patients were included in the E-BLA and L-BLA groups, respectively. Approximately half of the cohort presented with AKI stage II, and piperacillin-tazobactam was prescribed as initial empirical therapy in more than 50% of the cohort. In the multivariable Cox proportional hazards model, L-BLA was associated with a significant reduction in in-hospital mortality compared to E-BLA (hazard ratio, 0.588 [95% confidence interval, .355-.974]). Conclusions In sepsis patients with AKI, L-BLA was associated with in-hospital mortality benefits.
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Affiliation(s)
- Namareq F Aldardeer
- Department of Pharmacy Services, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Maram M Alshreef
- Department of Pharmacy Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Emad A Alharbi
- Department of Pharmacy Services, King Fahad Hospital, Madinah, Saudi Arabia
| | - Ahmad K Aljabri
- Department of Pharmacy Services, King Fahad Hospital, Madinah, Saudi Arabia
| | - Mohammad H Aljawadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Thamer A Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alobaili
- Department of Medicine, Nephrology Unit, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed I Alarifi
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad Alomari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah M Alhammad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Corporate Department of Pharmacy Services, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Soto CL, Hsu AJ, Lee JH, Dzintars K, Choudhury R, Jenkins TC, McCreary EK, Quartuccio KS, Stohs EJ, Zimmerman M, Tamma PD. Identifying Effective Durations of Antibiotic Therapy for the Treatment of Carbapenem-resistant Enterobacterales Bloodstream Infections: A Multicenter Observational Study. Clin Infect Dis 2024; 78:27-30. [PMID: 37584360 DOI: 10.1093/cid/ciad476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/13/2023] [Accepted: 08/11/2023] [Indexed: 08/17/2023] Open
Abstract
In a propensity-score-weighted cohort of 183 adults with carbapenem-resistant Enterobacterales bacteremia at 24 US hospitals, patients receiving short courses of active therapy (7-10 days, median 9 days) experienced similar odds of recurrent bacteremia or death within 30 days as those receiving prolonged courses of active therapy (14-21 days, median 14 days).
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Affiliation(s)
- Caitlin L Soto
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alice J Hsu
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jae Hyoung Lee
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kathryn Dzintars
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rebecca Choudhury
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | | | - Erin K McCreary
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Katelyn S Quartuccio
- Department of Pharmacy, University of Rochester Medical Center, Rochester, New York, USA
| | - Erica J Stohs
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Matty Zimmerman
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
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5
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Cook A, Atkinson A, Kronenberg A, Agyeman PKA, Schlapbach LJ, Berger C, Bielicki JA. Estimating antibiotic coverage from linked microbiological and clinical data from the Swiss Paediatric Sepsis Study to support empiric antibiotic regimen selection. Front Pediatr 2023; 11:1124165. [PMID: 37252038 PMCID: PMC10213904 DOI: 10.3389/fped.2023.1124165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/20/2023] [Indexed: 05/31/2023] Open
Abstract
In light of rising antibiotic resistance, better methods for selection of empiric antibiotic treatment based on clinical and microbiological data are needed. Most guidelines target specific clinical infections, and variably adjust empiric antibiotic selection by certain patient characteristics. Coverage estimates reflect the probability that an antibiotic regimen will be active against the causative pathogen once confirmed and can provide an objective basis for empiric regimen selection. Coverage can be estimated for specific infections using a weighted incidence syndromic combination antibiograms (WISCAs) framework. However, no comprehensive data combining clinical and microbiological data for specific clinical syndromes are available in Switzerland. We therefore describe estimating coverage from semi-deterministically linked routine microbiological and cohort data of hospitalised children with sepsis. Coverage estimates were generated for each hospital and separately pooling data across ten contributing hospitals for five pre-defined patient risk groups. Data from 1,082 patients collected during the Swiss Paediatric Sepsis Study (SPSS) 2011-2015 were included. Preterm neonates were the most commonly represented group, and half of infants and children had a comorbidity. 67% of neonatal sepsis cases were hospital-acquired late-onset whereas in children 76% of infections were community-acquired. Escherichia coli, Coagulase-negative staphylococci (CoNS) and Staphylococcus aureus were the most common pathogens. At all hospitals, ceftazidime plus amikacin regimen had the lowest coverage, and coverage of amoxicillin plus gentamicin and meropenem were generally comparable. Coverage was improved when vancomycin was included in the regimen, reflecting uncertainty about the empirically targeted pathogen spectrum. Children with community-acquired infections had high coverage overall. It is feasible to estimate coverage of common empiric antibiotic regimens from linked data. Pooling data by patient risk groups with similar expected pathogen and susceptibility profiles may improve coverage estimate precision, supporting better differentiation of coverage between regimens. Identification of data sources, selection of regimens and consideration of pathogens to target for improved empiric coverage is important.
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Affiliation(s)
- Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London, United Kingdom
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Andrew Atkinson
- Pediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luregn J. Schlapbach
- Department of Intensive Care and Neonatology, Children's Research Center, University children's Hospital Zürich, Zürich, Switzerland
| | | | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Julia Anna Bielicki
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London, United Kingdom
- Pediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland
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6
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Hareza D, Simner PJ, Bergman Y, Jacobs E, Cosgrove SE, Tamma PD. The Frequency of Extended-Spectrum β-Lactamase Genes Harbored by Enterobacterales Isolates at High Risk for Clinically Significant Chromosomal ampC Expression. Open Forum Infect Dis 2023; 10:ofad175. [PMID: 37065982 PMCID: PMC10096897 DOI: 10.1093/ofid/ofad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Dariusz Hareza
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia J Simner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yehudit Bergman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily Jacobs
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Tamma PD, Cosgrove SE. Which trial do we need? Early oral antibiotic therapy for the treatment of gram-negative bloodstream infections. Clin Microbiol Infect 2023:S1198-743X(23)00082-4. [PMID: 36805881 DOI: 10.1016/j.cmi.2023.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Chang JL, Pearson JC, Rhee C. Early Empirical Use of Broad-Spectrum Antibiotics in Sepsis. Curr Infect Dis Rep 2022. [DOI: 10.1007/s11908-022-00777-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Antimicrobial Treatment Options for Difficult-to-Treat Resistant Gram-Negative Bacteria Causing Cystitis, Pyelonephritis, and Prostatitis: A Narrative Review. Drugs 2022; 82:407-438. [PMID: 35286622 PMCID: PMC9057390 DOI: 10.1007/s40265-022-01676-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 02/06/2023]
Abstract
Urinary tract infections, including cystitis, acute pyelonephritis, and prostatitis, are among the most common diagnoses prompting antibiotic prescribing. The rise in antimicrobial resistance over the past decades has led to the increasing challenge of urinary tract infections because of multidrug-resistant and "difficult-to-treat resistance" among Gram-negative bacteria. Recent advances in pharmacotherapy and medical microbiology are modernizing how these urinary tract infections are treated. Advances in pharmacotherapy have included not only the development and approval of novel antibiotics, such as ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, ceftolozane/tazobactam, cefiderocol, plazomicin, and glycylcyclines, but also the re-examination of the potential role of legacy antibiotics, including older aminoglycosides and tetracyclines. Recent advances in medical microbiology allow phenotypic and molecular mechanism of resistance testing, and thus antibiotic prescribing can be tailored to the mechanism of resistance in the infecting pathogen. Here, we provide a narrative review on the clinical and pre-clinical studies of drugs that can be used for difficult-to-treat resistant Gram-negative bacteria, with a particular focus on data relevant to the urinary tract. We also offer a pragmatic framework for antibiotic selection when encountering urinary tract infections due to difficult-to-treat resistant Gram-negative bacteria based on the organism and its mechanism of resistance.
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10
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Ledger EVK, Sabnis A, Edwards AM. Polymyxin and lipopeptide antibiotics: membrane-targeting drugs of last resort. MICROBIOLOGY (READING, ENGLAND) 2022; 168:001136. [PMID: 35118938 PMCID: PMC8941995 DOI: 10.1099/mic.0.001136] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/06/2022] [Indexed: 12/15/2022]
Abstract
The polymyxin and lipopeptide classes of antibiotics are membrane-targeting drugs of last resort used to treat infections caused by multi-drug-resistant pathogens. Despite similar structures, these two antibiotic classes have distinct modes of action and clinical uses. The polymyxins target lipopolysaccharide in the membranes of most Gram-negative species and are often used to treat infections caused by carbapenem-resistant species such as Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. By contrast, the lipopeptide daptomycin requires membrane phosphatidylglycerol for activity and is only used to treat infections caused by drug-resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. However, despite having distinct targets, both antibiotic classes cause membrane disruption, are potently bactericidal in vitro and share similarities in resistance mechanisms. Furthermore, there are concerns about the efficacy of these antibiotics, and there is increasing interest in using both polymyxins and daptomycin in combination therapies to improve patient outcomes. In this review article, we will explore what is known about these distinct but structurally similar classes of antibiotics, discuss recent advances in the field and highlight remaining gaps in our knowledge.
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Affiliation(s)
- Elizabeth V. K. Ledger
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, Armstrong Rd, London, SW7 2AZ, UK
| | - Akshay Sabnis
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, Armstrong Rd, London, SW7 2AZ, UK
| | - Andrew M. Edwards
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, Armstrong Rd, London, SW7 2AZ, UK
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