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Hotz JF, Staudacher M, Schefberger K, Spettel K, Schmid K, Kriz R, Schneider L, Hagemann JB, Cyran N, Schmidt K, Starzengruber P, Lötsch F, Leutzendorff A, Daller S, Ramharter M, Burgmann H, Lagler H. Unraveling novel mutation patterns and morphological variations in two dalbavancin-resistant MRSA strains in Austria using whole genome sequencing and transmission electron microscopy. BMC Infect Dis 2024; 24:899. [PMID: 39223565 DOI: 10.1186/s12879-024-09797-w] [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: 03/29/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains resistant to non-beta-lactam antimicrobials poses a significant challenge in treating severe MRSA bloodstream infections. This study explores resistance development and mechanisms in MRSA isolates, especially after the first dalbavancin-resistant MRSA strain in our hospital in 2016. METHODS This study investigated 55 MRSA bloodstream isolates (02/2015-02/2021) from the University Hospital of the Medical University of Vienna, Austria. The MICs of dalbavancin, linezolid, and daptomycin were assessed. Two isolates (16-33 and 19-362) resistant to dalbavancin were analyzed via whole-genome sequencing, with morphology evaluated using transmission electron microscopy (TEM). RESULTS S.aureus BSI strain 19-362 had two novel missense mutations (p.I515M and p.A606D) in the pbp2 gene. Isolate 16-33 had a 534 bp deletion in the DHH domain of GdpP and a SNV in pbp2 (p.G146R). Both strains had mutations in the rpoB gene, but at different positions. TEM revealed significantly thicker cell walls in 16-33 (p < 0.05) compared to 19-362 and dalbavancin-susceptible strains. None of the MRSA isolates showed resistance to linezolid or daptomycin. CONCLUSION In light of increasing vancomycin resistance reports, continuous surveillance is essential to comprehend the molecular mechanisms of resistance in alternative MRSA treatment options. In this work, two novel missense mutations (p.I515M and p.A606D) in the pbp2 gene were newly identified as possible causes of dalbavancin resistance.
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Affiliation(s)
- Julian Frederic Hotz
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria
- Department of Internal Medicine III, Division of Infectious Diseases, University Hospital of Ulm, Ulm, 89081, Germany
- Department of Neurology, Hospital St. John's of God, Vienna, 1020, Austria
| | - Moritz Staudacher
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria
- Department of Angiology, Medical University of Vienna, Vienna, 1090, Austria
| | - Katharina Schefberger
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria
| | - Kathrin Spettel
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, 1090, Austria
| | - Katharina Schmid
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria
| | - Richard Kriz
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria
| | - Lisa Schneider
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria
| | | | - Norbert Cyran
- Faculty of Life Sciences, Research Support Facilities UBB, University of Vienna, Vienna, 1030, Austria
| | - Katy Schmidt
- Faculty of Life Sciences, Research Support Facilities UBB, University of Vienna, Vienna, 1030, Austria
| | - Peter Starzengruber
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, 1090, Austria
| | - Felix Lötsch
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, 1090, Austria
| | - Amelie Leutzendorff
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, 1090, Austria
| | - Simon Daller
- Department of Respiratory and Lung Diseases, Klinik Penzing, Vienna, 1140, Austria
| | - Michael Ramharter
- Center for Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20359, Germany
| | - Heinz Burgmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria
| | - Heimo Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, 1090, Austria.
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Lafon-Desmurs B, Gachet B, Hennart B, Valentin B, Roosen G, Degrendel M, Loiez C, Beltrand E, D'Elia P, Migaud H, Robineau O, Senneville E. Dalbavancin as suppressive therapy for implant-related infections: a case series with therapeutic drug monitoring and review of the literature. Eur J Clin Microbiol Infect Dis 2024; 43:1475-1480. [PMID: 38753112 DOI: 10.1007/s10096-024-04849-0] [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: 12/21/2023] [Accepted: 05/07/2024] [Indexed: 07/20/2024]
Abstract
Implant-related infections may need suppressive antibiotic therapy (SAT). We describe a SAT strategy using dalbavancin with therapeutic drug monitoring (TDM). This is a retrospective bicentric study of patients with implant-related infection who received dalbavancin SAT between January 2021 and September 2023. Fifteen patients were included. Median number of injections was 4 (IQR: 2-7). Median time between two reinjections was 57 days (IQR 28-82). Dalbavancin plasma concentrations were above 4 mg/L for 97.9% of dosages (93/95) and above 8 mg/L for 85% (81/95). These results support the use of dalbavancin SAT for implant-related infections.
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Affiliation(s)
- Barthelemy Lafon-Desmurs
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France.
| | - Benoit Gachet
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
- METRICS ULR 2694, Biostatistics, Lille, France
| | - Benjamin Hennart
- Lille University Hospital, Department of Pharmacology and Toxicology, Lille, France
| | - Benjamin Valentin
- Lille University Hospital, Department of Pharmacology, Lille, France
| | - Gabrielle Roosen
- Centre Hospitalier Gustave Dron, Department of Microbiology, Tourcoing, France
| | - Maxime Degrendel
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
| | - Caroline Loiez
- Lille University Hospital, Department of Microbiology, Lille, France
| | - Eric Beltrand
- Centre Hospitalier Gustave Dron, Department of Orthopedic Surgery, Tourcoing, France
| | - Piervito D'Elia
- Centre Hospitalier Gustave Dron, Départment of Vascular Surgery, Tourcoing, France
| | - Henri Migaud
- Lille University Hospital, Department of Orthopedic Surgery, Lille, France
| | - Olivier Robineau
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
- METRICS ULR 2694, Biostatistics, Lille, France
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, Paris, France
| | - Eric Senneville
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
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McSorley JC, Reyes D, Tonna I, Bateman V. Experience with dalbavancin use in various gram-positive infections within Aberdeen Royal Infirmary OPAT service. Infection 2024; 52:567-576. [PMID: 38165594 PMCID: PMC10954975 DOI: 10.1007/s15010-023-02152-2] [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: 06/29/2023] [Accepted: 11/27/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE Dalbavancin, approved in 2014 for Gram-positive acute bacterial skin and skin structure infections (ABSSSI), has pharmacokinetics enabling treatment with one or two doses. Dalbavancin might be useful in outpatient parenteral antibiotic therapy (OPAT) of deep-seated infections, otherwise requiring inpatient admission. We documented our experience with pragmatic dalbavancin use to assess its effectiveness for varied indications, on- and off-label, as primary or sequential consolidation therapy. METHODS Patients prescribed dalbavancin between 1 December 2021 and 1 October 2022 were screened for demographics of age, sex, Charlson comorbidity index (CCI), allergies, pathogens, doses of dalbavancin, other antibiotics administered and surgery. Where available, infection markers were recorded. The primary outcome was a cure at the end of treatment. Secondary outcomes included any adverse events and for those with treatment failures, response to salvage antibiotics. RESULTS Sixty-seven per cent of patients were cured. Cure rates by indication were 93% for ABSSSI, 100% for bacteraemia, 90% for acute osteomyelitis, 0% for chronic osteomyelitis, 75% for native joint septic arthritis and 33% for prosthetic joint infection. Most bone and joint infections that were not cured did not have source control, and the goal of treatment was suppressive. Successful suppression rates were greater at 48% for chronic osteomyelitis and 66% for prosthetic joint infections. Adverse events occurred in 14 of 102 patients. CONCLUSION This report adds to clinical experience with dalbavancin for off-label indications whilst further validating its role in ABSSSI. Dalbavancin as primary therapy in deep-seated infections merits investigation in formal clinical trials.
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Affiliation(s)
- James C McSorley
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Darshini Reyes
- Department of Pharmacy, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ivan Tonna
- Infection Unit, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK.
| | - Vhairi Bateman
- Infection Unit, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
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Zambrano S, Paras ML, Suzuki J, Pearson JC, Dionne B, Schrager H, Mallada J, Szpak V, Fairbank-Haynes K, Kalter M, Prostko S, Solomon DA. Real-World Dalbavancin Use for Serious Gram-Positive Infections: Comparing Outcomes Between People Who Use and Do Not Use Drugs. Open Forum Infect Dis 2024; 11:ofae186. [PMID: 38651139 PMCID: PMC11034951 DOI: 10.1093/ofid/ofae186] [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: 01/03/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
Background Dalbavancin has been used off-label to treat invasive bacterial infections in vulnerable populations like people who use drugs (PWUD) because of its broad gram-positive coverage and unique pharmacological properties. This retrospective, multisite study examined clinical outcomes at 90 days in PWUD versus non-PWUD after secondary treatment with dalbavancin for bacteremia, endocarditis, osteomyelitis, septic arthritis, and epidural abscesses. Methods Patients at 3 teaching hospitals who received dalbavancin for an invasive infection between March 2016 and May 2022 were included. Characteristics of PWUD and non-PWUD, infection highlights, hospital stay and treatment, and outcomes were compared using χ2 for categorical variables, t test for continuous variables, and nonparametric tests where appropriate. Results There were a total of 176 patients; 78 were PWUD and 98 were non-PWUD. PWUD were more likely to have a patient-directed discharge (26.9% vs 3.1%; P < .001) and be lost to follow-up (20.5% vs 7.14%; P < .01). Assuming loss to follow-up did not achieve clinical cure, 73.1% of PWUD and 74.5% of non-PWUD achieved clinical cure at 90 days (P = .08). Conclusions Dalbavancin was an effective treatment option for invasive gram-positive infections in our patient population. Despite higher rates of patient-directed discharge and loss to follow-up, PWUD had similar rates of clinical cure at 90 days compared to non-PWUD.
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Affiliation(s)
- Sarah Zambrano
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly L Paras
- Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Joji Suzuki
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey C Pearson
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon Dionne
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Harry Schrager
- Newton Wellesley Hospital, Department of Medicine, Boston, Massachusetts, USA
| | - Jason Mallada
- Newton Wellesley Hospital, Department of Medicine, Boston, Massachusetts, USA
| | - Veronica Szpak
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Marlene Kalter
- Newton Wellesley Hospital, Department of Medicine, Boston, Massachusetts, USA
| | - Sara Prostko
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Solomon
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Rebold N, Alosaimy S, Pearson JC, Dionne B, Taqi A, Lagnf A, Lucas K, Biagi M, Lombardo N, Eudy J, Anderson DT, Mahoney MV, Kufel WD, D'Antonio JA, Jones BM, Frens JJ, Baumeister T, Geriak M, Sakoulas G, Farmakiotis D, Delaportas D, Larew J, Veve MP, Rybak MJ. Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study. Infect Dis Ther 2024; 13:565-579. [PMID: 38427289 DOI: 10.1007/s40121-024-00933-2] [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: 11/13/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Long-acting lipoglycopeptides such as dalbavancin may have utility in patients with Gram-positive bloodstream infections (BSI), particularly in those with barriers to discharge or who require prolonged parenteral antibiotic courses. A retrospective cohort study was performed to provide further multicenter real-world evidence on dalbavancin use as a sequential therapy for Gram-positive BSI. METHODS One hundred fifteen patients received dalbavancin with Gram-positive BSI, defined as any positive blood culture or diagnosed with infective endocarditis, from 13 centers geographically spread across the United States between July 2015 and July 2021. RESULTS Patients had a mean (SD) age of 48.5 (17.5) years, the majority were male (54%), with many who injected drugs (40%). The most common infection sources (non-exclusive) were primary BSI (89%), skin and soft tissue infection (SSTI) (25%), infective endocarditis (19%), and bone and joint infection (17%). Staphylococcus aureus accounted for 72% of index cultures, coagulase-negative Staphylococcus accounted for 18%, and Streptococcus species in 16%. Dalbavancin started a median (Q1-Q3) of 10 (6-19) days after index culture collection. The most common regimen administered was dalbavancin 1500 mg as one dose for 50% of cases. The primary outcome of composite clinical failure occurred at 12.2%, with 90-day mortality at 7.0% and 90-day BSI recurrence at 3.5%. CONCLUSIONS Dalbavancin may serve as a useful tool in facilitating hospital discharge in patients with Gram-positive BSI. Randomized controlled trials are anticipated to validate dalbavancin as a surrogate to current treatment standards.
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Affiliation(s)
- Nicholas Rebold
- Wayne State University, Detroit, MI, USA.
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
- Department of Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, 2300 4th St NW, Office 114, Washington, DC, 20059, USA.
| | - Sara Alosaimy
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Jeffrey C Pearson
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Brandon Dionne
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
- School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Ahmad Taqi
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Abdalhamid Lagnf
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
- Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI, USA
| | - Kristen Lucas
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Mark Biagi
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Pharmacy, Swedish American Health System, Rockford, IL, USA
| | - Nicholas Lombardo
- Department of Pharmacy, Swedish American Health System, Rockford, IL, USA
| | - Joshua Eudy
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Daniel T Anderson
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Monica V Mahoney
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Wesley D Kufel
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA
| | - Joseph A D'Antonio
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA
| | - Bruce M Jones
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, GA, USA
| | - Jeremy J Frens
- Department of Pharmacy, Moses H. Cone Memorial Hospital, Cone Health, Greensboro, NC, USA
| | - Tyler Baumeister
- Department of Pharmacy, Moses H. Cone Memorial Hospital, Cone Health, Greensboro, NC, USA
| | - Matthew Geriak
- Sharp Memorial Hospital, Sharp Healthcare, San Diego, CA, USA
| | - George Sakoulas
- Sharp Rees-Stealy Medical Group, San Diego, CA, USA
- University of California San Diego School of Medicine, Division of Host-Microbe Systems and Therapeutics, La Jolla, CA, USA
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Transplant and Oncology Infectious Diseases, Rhode Island Hospital, Providence, RI, USA
| | | | | | - Michael P Veve
- Wayne State University, Detroit, MI, USA
- College of Pharmacy, University of Tennessee, Knoxville, TN, USA
- Department of Pharmacy, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Rybak
- Wayne State University, Detroit, MI, USA.
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
- Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI, USA.
- School of Medicine, Wayne State University, Detroit, MI, USA.
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Cepeda JG, Perona FL, Sanchez IB, Calvo JC, Rico A, Loeches B. Case report: Prosthetic aortic valve endocarditis due to Staphylococcus epidermidis with acquired resistance in the walK gene. Diagn Microbiol Infect Dis 2024; 108:116132. [PMID: 38056190 DOI: 10.1016/j.diagmicrobio.2023.116132] [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: 07/05/2023] [Revised: 10/29/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023]
Abstract
We report the case of a patient with infective endocarditis on a prosthetic aortic valve due to Staphylococcus epidermidis, not a candidate for prosthetic replacement surgery. After three months of supressive treatment with dalbavancin, fever reappears, with growth of S. epidermidis. Susceptibility testing showed new-onset resistance to dalbavancin, with a mutation in walK gene.
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Affiliation(s)
- Javier Gonzalez Cepeda
- Internal Medicine, La Paz University Hospital. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECC), P.° de la Castellana, 261, 28046 Madrid, Spain.
| | - Fernando Lázaro Perona
- Microbiology, La Paz University Hospital. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECC), P.° de la Castellana, 261, 28046 Madrid, Spain
| | - Ivan Bloise Sanchez
- Microbiology, La Paz University Hospital. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECC), P.° de la Castellana, 261, 28046 Madrid, Spain
| | - Juana Cacho Calvo
- Microbiology, La Paz University Hospital. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECC), P.° de la Castellana, 261, 28046 Madrid, Spain
| | - Alicia Rico
- Clinical Microbiology and Infectious Diseases Unit. La Paz University Hospital. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECC), P.° de la Castellana, 261, 28046 Madrid, Spain
| | - Belen Loeches
- Clinical Microbiology and Infectious Diseases Unit. La Paz University Hospital. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECC), P.° de la Castellana, 261, 28046 Madrid, Spain
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Tebano G, Zaghi I, Baldasso F, Calgarini C, Capozzi R, Salvadori C, Cricca M, Cristini F. Antibiotic Resistance to Molecules Commonly Prescribed for the Treatment of Antibiotic-Resistant Gram-Positive Pathogens: What Is Relevant for the Clinician? Pathogens 2024; 13:88. [PMID: 38276161 PMCID: PMC10819222 DOI: 10.3390/pathogens13010088] [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: 12/04/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Antibiotic resistance in Gram-positive pathogens is a relevant concern, particularly in the hospital setting. Several antibiotics are now available to treat these drug-resistant pathogens, such as daptomycin, dalbavancin, linezolid, tedizolid, ceftaroline, ceftobiprole, and fosfomycin. However, antibiotic resistance can also affect these newer molecules. Overall, this is not a frequent phenomenon, but it is a growing concern in some settings and can compromise the effectiveness of these molecules, leaving few therapeutic options. We reviewed the available evidence about the epidemiology of antibiotic resistance to these antibiotics and the main molecular mechanisms of resistance, particularly methicillin-resistant Sthaphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, vancomycin-resistant Enterococcus faecium, and penicillin-resistant Streptococcus pneumoniae. We discussed the interpretation of susceptibility tests when minimum inhibitory concentrations are not available. We focused on the risk of the emergence of resistance during treatment, particularly for daptomycin and fosfomycin, and we discussed the strategies that can be implemented to reduce this phenomenon, which can lead to clinical failure despite appropriate antibiotic treatment. The judicious use of antibiotics, epidemiological surveillance, and infection control measures is essential to preserving the efficacy of these drugs.
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Affiliation(s)
- Gianpiero Tebano
- Infectious Diseases Unit, AUSL Romagna, Ravenna Hospital, 48121 Ravenna, Italy; (I.Z.); (C.C.); (C.S.)
| | - Irene Zaghi
- Infectious Diseases Unit, AUSL Romagna, Ravenna Hospital, 48121 Ravenna, Italy; (I.Z.); (C.C.); (C.S.)
- Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522 Cesena, Italy;
| | - Francesco Baldasso
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, 47121 Forlì and Cesena, Italy; (F.B.); (R.C.); (F.C.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Chiara Calgarini
- Infectious Diseases Unit, AUSL Romagna, Ravenna Hospital, 48121 Ravenna, Italy; (I.Z.); (C.C.); (C.S.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Roberta Capozzi
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, 47121 Forlì and Cesena, Italy; (F.B.); (R.C.); (F.C.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Caterina Salvadori
- Infectious Diseases Unit, AUSL Romagna, Ravenna Hospital, 48121 Ravenna, Italy; (I.Z.); (C.C.); (C.S.)
| | - Monica Cricca
- Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522 Cesena, Italy;
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, 47121 Forlì and Cesena, Italy; (F.B.); (R.C.); (F.C.)
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Minter DJ, Appa A, Chambers HF, Doernberg SB. Contemporary Management of Staphylococcus aureus Bacteremia-Controversies in Clinical Practice. Clin Infect Dis 2023; 77:e57-e68. [PMID: 37950887 DOI: 10.1093/cid/ciad500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Indexed: 11/13/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) carries a high risk for excess morbidity and mortality. Despite its prevalence, significant practice variation continues to permeate clinical management of this syndrome. Since the publication of the 2011 Infectious Diseases Society of America (IDSA) guidelines on management of methicillin-resistant Staphylococcus aureus infections, the field of SAB has evolved with the emergence of newer diagnostic strategies and therapeutic options. In this review, we seek to provide a comprehensive overview of the evaluation and management of SAB, with special focus on areas where the highest level of evidence is lacking to inform best practices.
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Affiliation(s)
- Daniel J Minter
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ayesha Appa
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of HIV, Infectious Diseases, and Global Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Henry F Chambers
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of HIV, Infectious Diseases, and Global Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Senneville E, Cuervo G, Gregoire M, Hidalgo-Tenorio C, Jehl F, Miro JM, Seaton A, Söderquist B, Soriano A, Thalhammer F, Pea F. Expert Opinion on Dose Regimen and Therapeutic Drug Monitoring for Long-Term Use of Dalbavancin: Expert Review Panel. Int J Antimicrob Agents 2023; 62:106960. [PMID: 37633424 DOI: 10.1016/j.ijantimicag.2023.106960] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Dalbavancin is a lipoglycopeptide with a long elimination half-life and is currently licensed for the treatment of acute bacterial skin and skin structure infections in adults. Dalbavancin's potential in treating off-label complex Gram-positive infections is promising and real-world experience in treating such infections is growing. However, clear guidance on extended dosing regimens is lacking. OBJECTIVES This study aimed to provide clear expert opinion based on recent pharmacokinetic literature and expert and real-world experience in infection areas that require > 2 weeks of treatment. METHODS A single face-to-face meeting was held in September 2022 to collate expert opinion and present safety data of dalbavancin use in these clinical indications. A survey was completed by all authors on their individual experience with dalbavancin, which highlighted the heterogeneity in the regimens that were used. RESULTS After review of the survey data and recent literature, this study presents expert panel proposals that accommodate different healthcare settings and resource availability, and centre around the length of treatment duration including up to or exceeding 6 weeks. To achieve adequate dalbavancin concentrations for up to 6 weeks, 3000 mg of dalbavancin should be given over 4 weeks for the agreed complex infections requiring > 2 weeks of treatment. Therapeutic drug monitoring (TDM) is advised for longer treatment durations and in cases of renal failure. Specific dosing recommendations for other special populations require further investigation. CONCLUSIONS These proposals based on expert opinion have been defined to encourage best practice with dalbavancin, to optimise its administration beyond the current approved licenced dose across different healthcare settings.
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Affiliation(s)
- Eric Senneville
- Infectious Diseases department, Gustave Dron Hospital, University of Lille, Tourcoing, France.
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Matthieu Gregoire
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique, Nantes, France; Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, Nantes, France
| | - Carmen Hidalgo-Tenorio
- Infectious Diseases Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitario de Granada (IBS-Granada), Granada, Spain
| | - François Jehl
- Laboratory of Clinical Microbiology, University Hospital of Strasbourg, Strasbourg, France
| | - Jose M Miro
- Department of Infectious Diseases, Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrew Seaton
- Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine, and Health, Örebro University, Örebro, Sweden; Department of Infectious Diseases and Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alex Soriano
- Department of Infectious Diseases, Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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10
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Douglas EJ, Laabei M. Staph wars: the antibiotic pipeline strikes back. MICROBIOLOGY (READING, ENGLAND) 2023; 169:001387. [PMID: 37656158 PMCID: PMC10569064 DOI: 10.1099/mic.0.001387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
Antibiotic chemotherapy is widely regarded as one of the most significant medical advancements in history. However, the continued misuse of antibiotics has contributed to the rapid rise of antimicrobial resistance (AMR) globally. Staphylococcus aureus, a major human pathogen, has become synonymous with multidrug resistance and is a leading antimicrobial-resistant pathogen causing significant morbidity and mortality worldwide. This review focuses on (1) the targets of current anti-staphylococcal antibiotics and the specific mechanisms that confirm resistance; (2) an in-depth analysis of recently licensed antibiotics approved for the treatment of S. aureus infections; and (3) an examination of the pre-clinical pipeline of anti-staphylococcal compounds. In addition, we examine the molecular mechanism of action of novel antimicrobials and derivatives of existing classes of antibiotics, collate data on the emergence of resistance to new compounds and provide an overview of key data from clinical trials evaluating anti-staphylococcal compounds. We present several successful cases in the development of alternative forms of existing antibiotics that have activity against multidrug-resistant S. aureus. Pre-clinical antimicrobials show promise, but more focus and funding are required to develop novel classes of compounds that can curtail the spread of and sustainably control antimicrobial-resistant S. aureus infections.
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Affiliation(s)
| | - Maisem Laabei
- Department of Life Sciences, University of Bath, Bath BA2 7AY, UK
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11
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Mansoor AER, Krekel T, Cabrera NL. Experience with dalbavancin for long-term antimicrobial suppression of left ventricular assist device infections. Transpl Infect Dis 2023; 25:e14068. [PMID: 37159539 DOI: 10.1111/tid.14068] [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: 02/15/2023] [Revised: 04/01/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVAD) are a common strategy for management of end-stage heart failure. LVADs carry a risk of infection of the implanted device components, and skin flora are commonly implicated. Long-term antibiotics may be needed for management of deep device infection or recurrent superficial infections. In appropriately selected patients, dalbavancin can be a feasible option given its extended dosing interval. METHODS This is a retrospective, single-center review of patients presenting with an LVAD infection between January 2011 and November 2022, where management included the use of dalbavancin. Data regarding LVAD placement, details of index infection, dalbavancin use and outcomes was obtained from chart review, and documented in a RedCap database. RESULTS The mean time from LVAD placement to index infection was 131.6 weeks (standard deviation 87.2 weeks). The most common targeted organism was Corynebacterium striatum in six of 10 patients. Index infection presented as deep driveline infection in four patients and recurrent superficial driveline infection in three patients. Five patients had a concurrent bloodstream infection. Dalbavancin was discontinued in two patients due to breakthrough infection, with one patient requiring surgical intervention. No drug-related adverse events were noted. CONCLUSION Dalbavancin is an attractive option in the management of long-term LVAD infection in patients for whom alternative oral or parenteral antibiotics are not a feasible option. Additional studies are needed to determine the optimal dosing of dalbavancin in this setting, and to study adverse events and long-term outcomes of dalbavancin.
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Affiliation(s)
- Armaghan-E-Rehman Mansoor
- Department of Medicine, Division of Infectious Diseases, Washington University, St. Louis, Missouri, USA
| | - Tamara Krekel
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Nicolo L Cabrera
- Department of Medicine, Division of Infectious Diseases, Washington University, St. Louis, Missouri, USA
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12
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Adema JL, Ahiskali A, Fida M, Mediwala Hornback K, Stevens RW, Rivera CG. Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis. Pathogens 2023; 12:703. [PMID: 37242373 PMCID: PMC10223386 DOI: 10.3390/pathogens12050703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Infective endocarditis (IE) is a rare but increasingly prevalent disease with high morbidity and mortality, requiring antimicrobials and at times surgical intervention. Through the decades of healthcare professionals' experience with managing IE, certain dogmas and uncertainties have arisen around its pharmacotherapy. The introduction of new antimicrobials and novel combinations are exciting developments but also further complicate IE treatment choices. In this review, we provide and evaluate the relevant evidence focused around contemporary debates in IE treatment pharmacotherapy, including beta-lactam choice in MSSA IE, combination therapies (aminoglycosides, ceftaroline), the use of oral antimicrobials, the role of rifamycins, and long-acting lipoglycopeptides.
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Affiliation(s)
- Jennifer L. Adema
- Department of Pharmacy, East Carolina University Health, Greenville, NC 27834, USA
| | - Aileen Ahiskali
- Department of Pharmacy, Hennepin Healthcare, Minneapolis, MN 55415, USA
| | - Madiha Fida
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Krutika Mediwala Hornback
- Department of Pharmacy, Medical University of South Carolina (MUSC) Health, Charleston, SC 29425, USA
| | - Ryan W. Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, MN 55902, USA
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13
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Nguyen AH, Hood KS, Mileykovskaya E, Miller WR, Tran TT. Bacterial cell membranes and their role in daptomycin resistance: A review. Front Mol Biosci 2022; 9:1035574. [PMID: 36452455 PMCID: PMC9702088 DOI: 10.3389/fmolb.2022.1035574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Lipids play a major role in bacterial cells. Foremost, lipids are the primary constituents of the cell membrane bilayer, providing structure and separating the cell from the surrounding environment. This makes the lipid bilayer a prime target for antimicrobial peptides and membrane-acting antibiotics such as daptomycin. In response, bacteria have evolved mechanisms by which the membrane can be adapted to resist attack by these antimicrobial compounds. In this review, we focus on the membrane phospholipid changes associated with daptomycin resistance in enterococci, Staphylococcus aureus, and the Viridans group streptococci.
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Affiliation(s)
- April H. Nguyen
- Center for Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, United States,Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Kara S. Hood
- Center for Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, United States,Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Eugenia Mileykovskaya
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - William R. Miller
- Center for Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, United States,Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Truc T. Tran
- Center for Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX, United States,Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX, United States,*Correspondence: Truc T. Tran,
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14
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Ruch Y, Ursenbach A, Danion F, Reisz F, Nai T, Hoellinger B, Hansmann Y, Lefebvre N, Martzloff J. High Incidence of Acute Kidney Injury in Patients Treated with High-Dose Amoxicillin and Cloxacillin Combination Therapy. Antibiotics (Basel) 2022; 11:antibiotics11060770. [PMID: 35740176 PMCID: PMC9220067 DOI: 10.3390/antibiotics11060770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
High-dose amoxicillin and cloxacillin combination therapy is recommended for the empiric treatment of selected patients with infective endocarditis despite a low level of evidence. The main objective of this study was to evaluate the renal tolerance of high-dose intravenous amoxicillin and cloxacillin combination. We studied 27 patients treated with amoxicillin and cloxacillin (≥100 mg/kg daily) for at least 48 h. The primary endpoint was the occurrence of acute kidney injury (AKI). The median patient age was 68 ± 8 years, and 16 (59%) were male. The indication for this combination therapy was suspected or confirmed endocarditis with no bacterial identification in 22 (81%) patients. The primary endpoint occurred in 16 (59%) patients after initiating this combination therapy within an average of 4.4 ± 3.6 days. Among them, seven (26%) patients developed severe AKI, including four (15%) patients who required hemodialysis. Other risk factors for AKI were identified in all patients, including injection of iodinated contrast media in 21 (78%), acute heart failure in 18 (67%), cardiac surgery in 11 (41%), and aminoglycoside use in 9 (33%) patients. This study reports an incidence of 59% of AKI after initiating amoxicillin and cloxacillin combination therapy in a population at high renal risk.
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Affiliation(s)
- Yvon Ruch
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (A.U.); (F.D.); (B.H.); (Y.H.); (N.L.)
- Correspondence:
| | - Axel Ursenbach
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (A.U.); (F.D.); (B.H.); (Y.H.); (N.L.)
| | - François Danion
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (A.U.); (F.D.); (B.H.); (Y.H.); (N.L.)
| | - Fanny Reisz
- Department of Pharmacy, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (F.R.); (T.N.)
| | - Thierry Nai
- Department of Pharmacy, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (F.R.); (T.N.)
| | - Baptiste Hoellinger
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (A.U.); (F.D.); (B.H.); (Y.H.); (N.L.)
| | - Yves Hansmann
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (A.U.); (F.D.); (B.H.); (Y.H.); (N.L.)
| | - Nicolas Lefebvre
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (A.U.); (F.D.); (B.H.); (Y.H.); (N.L.)
| | - Jonas Martzloff
- Department of Nephrology, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
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