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Nguyen VT, Birhanu BT, Miguel-Ruano V, Kim C, Batuecas M, Yang J, El-Araby AM, Jiménez-Faraco E, Schroeder VA, Alba A, Rana N, Sader S, Thomas CA, Feltzer R, Lee M, Fisher JF, Hermoso JA, Chang M, Mobashery S. Restoring susceptibility to β-lactam antibiotics in methicillin-resistant Staphylococcus aureus. Nat Chem Biol 2024:10.1038/s41589-024-01688-0. [PMID: 39060390 DOI: 10.1038/s41589-024-01688-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
Infections by Staphylococcus aureus have been treated historically with β-lactam antibiotics. However, these antibiotics have become obsolete in methicillin-resistant S. aureus by acquisition of the bla and mec operons. The presence of the β-lactam antibiotic is detected by the sensor domains of BlaR and/or MecR, and the information is transmitted to the cytoplasm, resulting in derepression of the antibiotic-resistance genes. We hypothesized that inhibition of the sensor domain would shut down this response system, and β-lactam susceptibility would be restored. An in silico search of 11 million compounds led to a benzimidazole-based hit and, ultimately, to the boronate 4. The X-ray structure of 4 is covalently engaged with the active-site serine of BlaR. Compound 4 potentiates by 16- to 4,096-fold the activities of oxacillin and of meropenem against methicillin-resistant S. aureus strains. The combination of 4 with oxacillin or meropenem shows efficacy in infected mice, validating the strategy.
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Affiliation(s)
- Van T Nguyen
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Biruk T Birhanu
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Vega Miguel-Ruano
- Department of Crystallography and Structural Biology, Instituto de Química-Física 'Blas Cabrera', Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Choon Kim
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Mayte Batuecas
- Department of Crystallography and Structural Biology, Instituto de Química-Física 'Blas Cabrera', Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Jingdong Yang
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Amr M El-Araby
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Eva Jiménez-Faraco
- Department of Crystallography and Structural Biology, Instituto de Química-Física 'Blas Cabrera', Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Valerie A Schroeder
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Alejandra Alba
- Department of Crystallography and Structural Biology, Instituto de Química-Física 'Blas Cabrera', Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Neha Rana
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Safaa Sader
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Caitlyn A Thomas
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Rhona Feltzer
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Mijoon Lee
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Jed F Fisher
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Juan A Hermoso
- Department of Crystallography and Structural Biology, Instituto de Química-Física 'Blas Cabrera', Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Mayland Chang
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Shahriar Mobashery
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA.
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Karell J, Petzl W, Gangl A, Huber-Schlenstedt R, Sorge US. Changes in antimicrobial resistance of Staphylococcus aureus in bovine quarter milk samples from southern Germany between 2012 and 2022. J Dairy Sci 2024; 107:3802-3812. [PMID: 37977447 DOI: 10.3168/jds.2023-23997] [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: 07/21/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
The objective of this study was to describe the in vitro resistance of Staphylococcus aureus from bovine quarter milk samples obtained by the udder health laboratory of the Bavarian Animal Health Services between 2012 and 2022. All S. aureus samples were tested for β-lactamase production and only forwarded to further microbroth susceptibility testing either if the β-lactamase result was positive or upon explicit request by the submitter. The growth of most S. aureus isolates was inhibited at the lowest evaluated minimum inhibitory concentration (MIC) of tested antimicrobials, with the MIC50 and MIC90 (the MIC where 50% and 90% of isolates were inhibited by the tested antibiotics, respectively) mostly beneath the respective breakpoint. On average, about one-fourth (24%, n = 5,718) of tested isolates was resistant to erythromycin. However, the prevalence of resistant isolates dropped from 53% (n = 1,018) in 2012 to 8% (n = 113) in 2022. The second highest prevalence of in vitro resistance was to penicillin (17%, of all isolates tested for β-lactamase production, n = 28,069). Less than 14% of isolates were resistant to the remaining assessed antimicrobial agents (cefoperazone, pirlimycin, kanamycin-cefalexin, marbofloxacin, amoxicillin-clavulanate, cefquinome, or cefazolin, respectively). Over the years, 4% (n = 959) of the S. aureus isolates selected for microbroth susceptibility testing (and 0.8% (n = 1,392) of all submitted S. aureus isolates) were methicillin-resistant S. aureus, and 5% (n = 1,162) of S. aureus isolates were multidrug resistant. However, there was an overall trend toward fewer resistant isolates. These findings are consistent with those of several European monitoring programs that reported a slight decrease of antimicrobial resistance (AMR) of bovine S. aureus in countries where antibiotic use in veterinary medicine was reduced. Notably, isolates of clinical mastitis cases were consistently less likely to express in vitro resistance than isolates obtained from milk of healthy cows or subclinical mastitis cases. In conclusion, AMR of S. aureus was decreasing and penicillin should remain the first-choice antimicrobial in the attempt of treating S. aureus intramammary infections in Bavaria.
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Affiliation(s)
- J Karell
- Department of Udder Health and Milk Quality, Bavarian Animal Health Services, 85586 Poing, Germany; Center for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-University Munich, 80539 Munich, Germany.
| | - W Petzl
- Center for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-University Munich, 80539 Munich, Germany
| | - A Gangl
- Department of Udder Health and Milk Quality, Bavarian Animal Health Services, 85586 Poing, Germany
| | - R Huber-Schlenstedt
- Department of Udder Health and Milk Quality, Bavarian Animal Health Services, 85586 Poing, Germany
| | - U S Sorge
- Department of Udder Health and Milk Quality, Bavarian Animal Health Services, 85586 Poing, Germany
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Kovács M, Wojnárovits L, Homlok R, Tegze A, Mohácsi-Farkas C, Takács E, Belák Á. Changes in the behavior of Staphylococcus aureus strains in the presence of oxacillin under the effect of gamma radiation. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 340:122843. [PMID: 37918768 DOI: 10.1016/j.envpol.2023.122843] [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: 08/21/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
Staphylococcus aureus (S. aureus) as a major pathogen is implicated in a wide range of foodborne and hospital-acquired infections, its methicillin resistant variants contribute to the spread of β-lactam antibiotic resistance. It is essentially important to destroy these pathogens, their resistance genes and the antibiotics in wastewaters. For this purpose reactions of reactive radicals (advanced oxidation processes), first of all hydroxyl radicals (•OH), are suggested. Here the radiolysis of water supplied these radicals. In the experiments B.01755 oxacillin sensitive and B.02174 resistant S. aureus strains were used to study their behaviorr in suspensions under the effect of irradiation in presence and absence of oxacillin. Oxacillin inactivation depended on concentration of the antibiotic used (0.042 and 1 g dm-3), higher concentration required a higher dose. When 106-109 CFU cm-3 S. aureus suspensions were irradiated with γ-radiation the bacteria were inactivated at low absorbed doses: 4 orders of magnitude decrease ocurred in the number of culturable cells at ∼0.6 kGy dose. Both cell membrane and DNA suffered considerable damages during irradiation. Due to the membrane damage the cells could not be stained, and the DNA content of cells in several days period was released into the solution. In DNA damage the oxacillin resistance mecA gene was also modified, it did not multiply in PCR test. These findings are important from the point of view of applying irradiation technology to stop the spread of antibiotic resistance.
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Affiliation(s)
- Mónika Kovács
- Department of Food Microbiology, Hygiene and Safety, Institute of Food Science and Technology, Hungarian University of Agriculture and Life Sciences, H-1118, Budapest, Somlói út 14-16, Hungary.
| | - László Wojnárovits
- Radiation Chemistry Department, Institute for Energy Security and Environmental Safety, Centre for Energy Research, H-1121, Budapest, Konkoly-Thege Miklós út 29-33, Hungary.
| | - Renáta Homlok
- Radiation Chemistry Department, Institute for Energy Security and Environmental Safety, Centre for Energy Research, H-1121, Budapest, Konkoly-Thege Miklós út 29-33, Hungary.
| | - Anna Tegze
- Radiation Chemistry Department, Institute for Energy Security and Environmental Safety, Centre for Energy Research, H-1121, Budapest, Konkoly-Thege Miklós út 29-33, Hungary.
| | - Csilla Mohácsi-Farkas
- Department of Food Microbiology, Hygiene and Safety, Institute of Food Science and Technology, Hungarian University of Agriculture and Life Sciences, H-1118, Budapest, Somlói út 14-16, Hungary.
| | - Erzsébet Takács
- Radiation Chemistry Department, Institute for Energy Security and Environmental Safety, Centre for Energy Research, H-1121, Budapest, Konkoly-Thege Miklós út 29-33, Hungary.
| | - Ágnes Belák
- Department of Food Microbiology, Hygiene and Safety, Institute of Food Science and Technology, Hungarian University of Agriculture and Life Sciences, H-1118, Budapest, Somlói út 14-16, Hungary.
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4
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Barker CIS, Kipper K, Lonsdale DO, Wright K, Thompson G, Kim M, Turner MA, Johnston A, Sharland M, Standing JF. The Neonatal and Paediatric Pharmacokinetics of Antimicrobials study (NAPPA): investigating amoxicillin, benzylpenicillin, flucloxacillin and piperacillin pharmacokinetics from birth to adolescence. J Antimicrob Chemother 2023; 78:2148-2161. [PMID: 37531085 PMCID: PMC10477139 DOI: 10.1093/jac/dkad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/09/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Pharmacokinetic (PK) data underlying paediatric penicillin dosing remain limited, especially in critical care. OBJECTIVES The primary objective of the Neonatal and Paediatric Pharmacokinetics of Antimicrobials study (NAPPA) was to characterize PK profiles of commonly used penicillins using data obtained during routine care, to further understanding of PK variability and inform future evidence-based dosing. METHODS NAPPA was a multicentre study of amoxicillin, co-amoxiclav, benzylpenicillin, flucloxacillin and piperacillin/tazobactam. Patients were recruited with informed consent. Antibiotic dosing followed standard of care. PK samples were obtained opportunistically or at optimal times, frozen and analysed using UPLC with tandem MS. Pharmacometric analysis was undertaken using NONMEM software (v7.3). Model-based simulations (n = 10 000) tested PTA with British National Formulary for Children (BNFC) and WHO dosing. The study had ethical approval. RESULTS For the combined IV PK model, 963 PK samples from 370 participants were analysed simultaneously incorporating amoxicillin, benzylpenicillin, flucloxacillin and piperacillin data. BNFC high-dose regimen simulations gave these PTA results (median fT>MIC at breakpoints of specified pathogens): amoxicillin 100% (Streptococcus pneumoniae); benzylpenicillin 100% (Group B Streptococcus); flucloxacillin 48% (MSSA); and piperacillin 100% (Pseudomonas aeruginosa). Oral population PK models for flucloxacillin and amoxicillin enabled estimation of first-order absorption rate constants (1.16 h-1 and 1.3 h-1) and bioavailability terms (62.7% and 58.7%, respectively). CONCLUSIONS NAPPA represents, to our knowledge, the largest prospective combined paediatric penicillin PK study undertaken to date, and the first paediatric flucloxacillin oral PK model. The PTA results provide evidence supportive of BNFC high-dose IV regimens for amoxicillin, benzylpenicillin and piperacillin.
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Affiliation(s)
- Charlotte I S Barker
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Paediatric Infectious Diseases Department, St George’s University Hospitals NHS Foundation Trust, London, UK
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Medical & Molecular Genetics, King’s College London, London, UK
| | - Karin Kipper
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Analytical Services International, St George’s, University of London, London, UK
- Analytical Chemistry Department, Epilepsy Society, Chesham Lane, Chalfont St Peter, Buckinghamshire, UK
- Institute of Chemistry, University of Tartu, Tartu, Estonia
| | - Dagan O Lonsdale
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Paediatric Infectious Diseases Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Kirstie Wright
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
| | - Georgina Thompson
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
| | - Min Kim
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mark A Turner
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Atholl Johnston
- Analytical Services International, St George’s, University of London, London, UK
- Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Paediatric Infectious Diseases Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Joseph F Standing
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Pharmacy Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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George CRR, Lahra MM, Nguyen T, Gatus B. Disc Test for Detecting Staphylococcus aureus Strains Producing Type A and Type C β-Lactamases. Microbiol Spectr 2023; 11:e0022023. [PMID: 37409947 PMCID: PMC10434206 DOI: 10.1128/spectrum.00220-23] [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: 01/15/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023] Open
Abstract
Staphylococcus aureus can produce β-lactamases capable of hydrolyzing penicillins and first-generation cephalosporins. The propensity of type A and type C β-lactamase-producing S. aureus (TAPSA and TCPSA) to hydrolyze cefazolin at a high inoculum is termed the cefazolin inoculum effect (CIE). Strains with a CIE have a theoretical risk of causing treatment failure and are unable to be detected routinely by most laboratories. We developed a high-performing yet straightforward β-lactamase disc test that identifies and differentiates both TAPSA and TCPSA and is suitable for routine diagnostic laboratory workflows. Clinical isolates of S. aureus resistant to penicillin were identified, and their blaZ genes were sequenced. MICs were determined at low and high inocula (5 × 105 CFU/mL and 5 × 107 CFU/mL), and isolates demonstrating a CIE were characterized. A semimechanistic model was established to describe differential hydrolysis patterns, and candidate models were iteratively assessed using area-under-the-curve analysis from competitor receiver operating characteristic (ROC) curves. Biomarker thresholds were derived from Youdon index-derived optimal cutoff values. Genetic analysis of 99 isolates identified 26 TAPSA isolates and 45 TCPSA isolates. The model best differentiating TAPSA from non-TAPSA utilized cefazolin-to-cephalothin ratio analysis (sensitivity, 96.2%; specificity, 98.6%). The model best differentiating TCPSA from non-TCPSA incorporated cefazolin, cephalothin, and oxacillin (sensitivity, 88.6%; specificity, 96.6%). TAPSA and TCPSA can be differentiated using three antibiotic discs on a single agar plate. The test has potential value in typing the β-lactamase type from isolates from patients that are candidates for or have failed cefazolin therapy. IMPORTANCE The key significance of this article is that it details a straightforward method of performing a disc test that can differentiate Staphylococcus aureus isolates that are likely to be associated with a cefazolin inoculum effect and theoretical risk of cefazolin treatment failure from isolates that are less likely to be associated with a cefazolin inoculum effect.
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Affiliation(s)
- C. R. Robert George
- NSW Health Pathology, Microbiology, John Hunter Hospital, Newcastle, Australia
| | - Monica M. Lahra
- NSW Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, Australia
- School of Medical Sciences, Faculty of Medicine, the University of New South Wales, Sydney, Australia
| | - Thanh Nguyen
- NSW Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, Australia
| | - Barrie Gatus
- NSW Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, Australia
- School of Medical Sciences, Faculty of Medicine, the University of New South Wales, Sydney, Australia
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Ong'era E, Kagira J, Maina N, Kiboi D, Waititu K, Michira L, Ngotho M. Prevalence and Potential Risk Factors for the Acquisition of Antibiotic-Resistant Staphylococcus spp. Bacteria Among Pastoralist Farmers in Kajiado Central Subcounty, Kenya. BIOMED RESEARCH INTERNATIONAL 2023; 2023:3573056. [PMID: 37082192 PMCID: PMC10113052 DOI: 10.1155/2023/3573056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 04/22/2023]
Abstract
Antimicrobial resistance (AMR) is a growing health problem globally. To address this challenge, there is a need to generate baseline data on the prevalence and AMR profile of the main disease-causing bacteria. Here, we interrogated the prevalence of bacteria in the nasal cavity of healthy pastoralists in Kajiado Central Subcounty, Kenya, and the occurrence of AMR in Staphylococcus isolates among the study subjects. Nasal swabs from 176 pastoralists were cultured, and the bacteria isolates identified using standard phenotypic and biochemical bacteriological methods. Among the obtained 195 isolates, the most prevalent isolates were coagulase-negative Staphylococcus (CoNS) (44.9%), followed by Enterococci spp. (43.2%) while Staphylococcus aureus prevalence was 8%. Antimicrobial sensitivity of the Staphylococcus spp. isolates to 14 antibiotics representing six antibiotic groups was undertaken using the Kirby-Bauer disk diffusion method. Among the CoNS, the highest resistance was reported in amoxicillin (78.7%) and ceftazidime (76%), while the most resistance for S. aureus was reported in ceftazidime (100%), amoxicillin (71.4%), and streptomycin (71.4%). From an administered questionnaire looking at gender, animal contact frequency, history of hospital visitation and antibiotic usage, and habitual intake of raw milk, the study showed that male participants had a higher risk of carrying multiple drug resistant (MDR) bacteria than females (p = 0.02, OR = 1.3). Likewise, habitual intake of raw milk was significantly associated MDR acquisition (p = 0.02, OR = 1.82). This study reveals a high prevalence of AMR Staphylococcus isolates in the study area laying a foundation for further analysis of molecular characterization of the observed resistance as well as the development of interventions that can reduce the occurrence of AMR in the study area.
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Affiliation(s)
- Edidah Ong'era
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - John Kagira
- Department of Animal Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - Naomi Maina
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - Daniel Kiboi
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - Kenneth Waititu
- Department of Animal Science, Institute of Primate Research, P.O. Box 24481 Karen 00502 Nairobi, Kenya
| | - Lynda Michira
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - Maina Ngotho
- Department of Clinical Studies, University of Nairobi, Nairobi, Kenya P.O. Box 30197-GPO
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Haynes AS, Prinzi A, Silveira LJ, Parker SK, Lampe JN, Kavanaugh JS, Horswill AR, Fish D. Cefadroxil Comparable to Cephalexin: Minimum Inhibitory Concentrations among Methicillin-Susceptible Staphylococcus aureus Isolates from Pediatric Musculoskeletal Infections. Microbiol Spectr 2022; 10:e0103922. [PMID: 35730963 PMCID: PMC9431593 DOI: 10.1128/spectrum.01039-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/25/2022] [Indexed: 11/20/2022] Open
Abstract
Cephalexin and cefadroxil are oral first-generation cephalosporins used to treat methicillin-susceptible Staphylococcus aureus (MSSA) infections. Despite its shorter half-life, cephalexin is more frequently prescribed, although cefadroxil is an appealing alternative, given its slower clearance and possibility for less frequent dosing. We report comparative MIC distributions for cefadroxil and cephalexin, as well as for oxacillin, cephalothin, ceftaroline, and cefazolin, for 48 unique clinical MSSA isolates from pediatric patients with musculoskeletal infections. Both cefadroxil and cephalexin had MIC50 values of 2 μg/mL and MIC90 values of 4 μg/mL. MIC50s for oxacillin, cephalothin, and ceftaroline were ≤0.25 μg/mL, and cefazolin's MIC50 was 0.5 μg/mL. While cefadroxil and cephalexin MICs are higher than those for other active agents, the distributions of MICs for cefadroxil and cephalexin are statistically equivalent, suggesting similar in vitro MSSA activities. Cefadroxil should be further considered an alternative agent to cephalexin, although additional work is needed to identify the optimal dose and frequency of these antibiotics for the treatment of serious MSSA infections. IMPORTANCE Cephalexin and cefadroxil are oral antibiotics that are used to treat serious infections due to the bacteria MSSA. While cephalexin is used more commonly, cefadroxil is excreted from the body more slowly; this generally allows patients to take cefadroxil less frequently than cephalexin. In this study, we compared the abilities of cefadroxil, cephalexin, and several other representative intravenous antibiotics to inhibit the growth of MSSA in the laboratory. Bacterial samples were obtained from children with bone, joint, and/or muscle infections caused by MSSA. We found that cefadroxil and cephalexin inhibited the growth of MSSA at similar concentrations, suggesting similar antibacterial potencies. The selected intravenous antistaphylococcal antibiotics generally inhibited bacterial growth with lower antibiotic concentrations. Based on these results, cefadroxil should be further considered an alternative oral antibiotic to cephalexin, although future research is needed to identify the optimal dose and frequency of these antibiotics for serious infections.
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Affiliation(s)
- Andrew S. Haynes
- Children’s Hospital Colorado, Department of Pediatrics, Section of Pediatric Infectious Diseases, Aurora, Colorado, USA
- University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA
| | - Andrea Prinzi
- Children’s Hospital Colorado, Department of Pediatrics, Section of Pediatric Infectious Diseases, Aurora, Colorado, USA
- University of Colorado Anschutz Medical Campus, Graduate School, Aurora, Colorado, USA
| | - Lori J. Silveira
- University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA
| | - Sarah K. Parker
- Children’s Hospital Colorado, Department of Pediatrics, Section of Pediatric Infectious Diseases, Aurora, Colorado, USA
- University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA
| | - Jed N. Lampe
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Jeffrey S. Kavanaugh
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alexander R. Horswill
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Douglas Fish
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
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8
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The NaHCO 3-Responsive Phenotype in Methicillin-Resistant Staphylococcus aureus (MRSA) Is Influenced by mecA Genotype. Antimicrob Agents Chemother 2022; 66:e0025222. [PMID: 35575577 PMCID: PMC9211399 DOI: 10.1128/aac.00252-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) strains are a leading cause of many invasive clinical syndromes, and pose treatment difficulties due to their in vitro resistance to most β-lactams on standard laboratory testing. A novel phenotype frequently identified in MRSA strains, termed ‘NaHCO3-responsiveness’, is a property whereby strains are susceptible in vitro to many β-lactams in the presence of NaHCO3. Specific mecA genotypes, repression of mecA/PBP2a expression and perturbed maturation of PBP2a by NaHCO3 have all been associated with this phenotype. The aim of this study was to define the relationship between specific mecA genotypes and PBP2a substitutions, on the one hand, with NaHCO3-responsiveness in vitro. Mutations were made in the mecA ribosomal binding site (RBS -7) and at amino acid position 246 of its coding region in parental strains MW2 (NaHCO3-responsive) and C36 (NaHCO3- nonresponsive) to generate ‘swap’ variants, each harboring the other’s mecA-RBS/coding region genotypes. Successful swaps were confirmed by both sequencing, as well as predicted swap of in vitro penicillin-clavulanate susceptibility phenotypes. MW2 swap variants harboring the nonresponsive mecA genotypes became NaHCO3-nonresponsive (resistant to the β-lactam, oxacillin [OXA]), in the presence of NaHCO3. Moreover, these swap variants had lost NaHCO3-mediated repression of mecA/PBP2a expression. In contrast, C36 swap variants harboring the NaHCO3-responsive mecA genotypes remained NaHCO3-nonresponsive phenotypically, and still exhibited nonrepressible mecA/PBP2a expression. These data demonstrate that in addition to the mecA genotype, NaHCO3-responsiveness may also depend on strain-specific genetic backgrounds.
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Ersoy SC, Chan LC, Yeaman MR, Chambers HF, Proctor RA, Ludwig KC, Schneider T, Manna AC, Cheung A, Bayer AS. Impacts of NaHCO3 on β-Lactam Binding to PBP2a Protein Variants Associated with the NaHCO3-Responsive versus NaHCO3-Non-Responsive Phenotypes. Antibiotics (Basel) 2022; 11:antibiotics11040462. [PMID: 35453214 PMCID: PMC9028190 DOI: 10.3390/antibiotics11040462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 12/13/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) regulates resistance to β-lactams via preferential production of an alternative penicillin-binding protein (PBP), PBP2a. PBP2a binds many β-lactam antibiotics with less affinity than PBPs which are predominant in methicillin-susceptible (MSSA) strains. A novel, rather frequent in vitro phenotype was recently identified among clinical MRSA bloodstream isolates, termed “NaHCO3-responsiveness”. This phenotype features β-lactam susceptibility of certain MRSA strains only in the presence of NaHCO3. Two distinct PBP2a variants, 246G and 246E, have been linked to the NaHCO3-responsive and NaHCO3-non-responsive MRSA phenotypes, respectively. To determine the mechanistic impact of PBP2a variants on β-lactam susceptibility, binding profiles of a fluorescent penicillin probe (Bocillin-FL) to each purified PBP2a variant were assessed and compared to whole-cell binding profiles characterized by flow cytometry in the presence vs. absence of NaHCO3. These investigations revealed that NaHCO3 differentially influenced the binding of the fluorescent penicillin, Bocillin-FL, to the PBP2a variants, with binding intensity and rate of binding significantly enhanced in the 246G compared to the 246E variant. Of note, the NaHCO3-β-lactam (oxacillin)-responsive JE2 strain, which natively harbors the 246G variant, had enhanced Bocillin-FL whole-cell binding following exposure to NaHCO3. This NaHCO3-mediated increase in whole-cell Bocillin-FL binding was not observed in the NaHCO3-non-responsive parental strain, COL, which contains the 246E PBP2a variant. Surprisingly, genetic swaps of the mecA coding sites between JE2 and COL did not alter the NaHCO3-enhanced binding seen in JE2 vs. COL. These data suggest that the non-coding regions of mecA may be involved in NaHCO3-responsiveness. This investigation also provides strong evidence that the NaHCO3-responsive phenotype in MRSA may involve NaHCO3-mediated increases in both initial cell surface β-lactam binding, as well as ultimate PBP2a binding of β-lactams.
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Affiliation(s)
- Selvi C. Ersoy
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA 90502, USA; (S.C.E.); (L.C.C.); (M.R.Y.)
| | - Liana C. Chan
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA 90502, USA; (S.C.E.); (L.C.C.); (M.R.Y.)
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Division of Infectious Diseases, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- Division of Molecular Medicine, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Michael R. Yeaman
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA 90502, USA; (S.C.E.); (L.C.C.); (M.R.Y.)
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Division of Infectious Diseases, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- Division of Molecular Medicine, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Henry F. Chambers
- School of Medicine, University of California-San Francisco (UCSF), San Francisco, CA 94143, USA;
| | - Richard A. Proctor
- Departments of Medicine and Medical Microbiology/Immunology, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53715, USA;
| | - Kevin C. Ludwig
- Institute for Pharmaceutical Microbiology, University Hospital Bonn, University of Bonn, D-53113 Bonn, Germany; (K.C.L.); (T.S.)
| | - Tanja Schneider
- Institute for Pharmaceutical Microbiology, University Hospital Bonn, University of Bonn, D-53113 Bonn, Germany; (K.C.L.); (T.S.)
| | - Adhar C. Manna
- Department of Microbiology & Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA; (A.C.M.); (A.C.)
| | - Ambrose Cheung
- Department of Microbiology & Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA; (A.C.M.); (A.C.)
| | - Arnold S. Bayer
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA 90502, USA; (S.C.E.); (L.C.C.); (M.R.Y.)
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Division of Infectious Diseases, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- Correspondence: ; Tel.: +1-310-222-6422
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Saenhom N, Kansan R, Chopjitt P, Boueroy P, Hatrongjit R, Kerdsin A. Evaluation of in-house cefoxitin screening broth to determine methicillin-resistant staphylococci. Heliyon 2022; 8:e08950. [PMID: 35243072 PMCID: PMC8857472 DOI: 10.1016/j.heliyon.2022.e08950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/13/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
Abstract
Methicillin-resistant staphylococci (MRS), including methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS), have a global impact as a public health threat contributing significantly to morbidity, mortality, and socio-economic costs. Accurate and rapid detection of MRS results in effective antimicrobial therapy, immediate patient isolation, dissemination control, and appropriate disinfection measures. Herein, we developed an in-house cefoxitin screening broth and compared it to the cefoxitin disk diffusion method and polymerase chain reaction (PCR) for the detection of MRS. Verification of this screening broth on 52 MRSA, 37 MRCoNS, 44 methicillin-susceptible S. aureus (MSSA), and 11 MSCoNS revealed greater validity for MRSA/MSSA than for MRCoNS/MSCoNS. The kappa coefficient of 0.87 was superior for determination of MRSA and MSSA, whereas it was 0.54, which was considered poor, for determination of MRCoNS and MSCoNS. Application of this assay to screen MRSA should be useful in clinical laboratories and hospital infection-control units.
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Determination of drug-resistant bacteria in palmar surface and touchscreen cell phones from bystanders in an urban community. Microbiol Res 2021; 256:126958. [PMID: 34998184 DOI: 10.1016/j.micres.2021.126958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 12/05/2021] [Accepted: 12/27/2021] [Indexed: 11/22/2022]
Abstract
The dynamic microbiota of the human palmar surface (PS) is related to the various hygienic habits of humans and can be transmitted or exchanged upon contact with objects of daily use, such as the indispensable touchscreen cell phone (TCP); this interaction could allow the development of drug-resistant bacteria. The objective was to determine the drug-resistant bacterial contamination between PSs and TCPs in an urban community. Among the total bacterial colonies isolated and molecular and phylogenetically characterized based on the V4-V6 regions of the 16S rRNA gene from PSs and TCPs, the genera present in both types of samples were Staphylococcus (53.3 and 43.5 %, respectively), Bacillus (37.8, 37 %), Atlantibacter (2.2, 10.8 %) and Microbacterium (2.2, 4.3 %). The genera present in only one type of sample were Rothia, Paenibacillus, Escherichia and Micrococcus (2.2 % each). Resistance to penicillins (35.6-93.5 %) and nonsusceptibility to cephalosporins (8.9-37 %) and nitrofurantoin (13.3 and 15.2 %) were observed. The percentage of multidrug antibiotic resistance was 15.4 %. The prevalence of drug-resistant and multidrug-resistant bacteria in PSs and TCPs in the community could give rise to human health problems, and hygiene measures are recommended.
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12
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One-pot strategy for thiazole tethered 7-ethoxy quinoline hybrids: Synthesis and potential antimicrobial agents as dihydrofolate reductase (DHFR) inhibitors with molecular docking study. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2021.130748] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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13
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A Combined Phenotypic-Genotypic Predictive Algorithm for In Vitro Detection of Bicarbonate: β-Lactam Sensitization among Methicillin-Resistant Staphylococcus aureus (MRSA). Antibiotics (Basel) 2021; 10:antibiotics10091089. [PMID: 34572671 PMCID: PMC8469475 DOI: 10.3390/antibiotics10091089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial susceptibility testing (AST) is routinely used to establish predictive antibiotic resistance metrics to guide the treatment of bacterial pathogens. Recently, a novel phenotype termed "bicarbonate (NaHCO3)-responsiveness" was identified in a relatively high frequency of clinical MRSA strains, wherein isolates demonstrate in vitro "susceptibility" to standard β-lactams (oxacillin [OXA]; cefazolin [CFZ]) in the presence of NaHCO3, and in vivo susceptibility to these β-lactams in experimental endocarditis models. We investigated whether a targeted phenotypic-genotypic screening of MRSA could rule in or rule out NaHCO3 susceptibility upfront. We studied 30 well-characterized clinical MRSA bloodstream isolates, including 15 MIC-susceptible to CFZ and OXA in NaHCO3-supplemented Mueller-Hinton Broth (MHB); and 15 MIC-resistant to both β-lactams in this media. Using a two-tiered strategy, isolates were first screened by standard disk diffusion for susceptibility to a combination of amoxicillin-clavulanate [AMC]. Isolates then underwent genomic sequence typing: MLST (clonal complex [CC]); agr; SCCmec; and mecA promoter and coding region. The combination of AMC disk susceptibility testing plus mecA and spa genotyping was able to predict MRSA strains that were more or less likely to be NaHCO3-responsive in vitro, with a high degree of sensitivity and specificity. Validation of this screening algorithm was performed in six strains from the overall cohort using an ex vivo model of endocarditis. This ex vivo model recapitulated the in vitro predictions of NaHCO3-responsiveness vs. nonresponsiveness above in five of the six strains.
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Antimicrobial resistance spectrum conferred by pRErm46 of emerging macrolide (multidrug)-resistant Rhodococcus equi. J Clin Microbiol 2021; 59:e0114921. [PMID: 34319806 DOI: 10.1128/jcm.01149-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clonal multidrug resistance recently emerged in Rhodococcus equi, complicating the therapeutic management of this difficult-to-treat animal and human pathogenic actinomycete. The currently spreading multidrug-resistant (MDR) "2287" clone arose in equine farms upon acquisition, and co-selection by mass macrolide-rifampin therapy, of the pRErm46 plasmid carrying the erm(46) macrolides-lincosamides-streptogramins resistance determinant, and an rpoBS531F mutation. Here, we screened a collection of susceptible and macrolide-rifampin-resistant R. equi from equine clinical cases using a panel of 15 antimicrobials against rapidly growing mycobacteria (RGM), nocardiae and other aerobic actinomycetes (NAA). R. equi -including MDR isolates- was generally susceptible to linezolid, minocycline, tigecycline, amikacin and tobramycin according to Staphylococcus aureus interpretive criteria, plus imipenem, cefoxitin and ceftriaxone based on Clinical & Laboratory Standards Institute (CLSI) guidelines for RGM/NAA. Ciprofloxacin and moxifloxacin were in the borderline category according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Molecular analyses linked pRErm46 to significantly increased MICs for trimethoprim-sulfamethoxazole and doxycycline in addition to clarithromycin within the RGM/NAA panel, and to streptomycin, spectinomycin and tetracycline resistance. pRErm46 variants with spontaneous deletions in the class 1 integron (C1I) region, observed in ≈30% of erm(46)-positive isolates, indicated that the newly identified resistances were attributable to C1I's sulfonamide (sul1) and aminoglycoside (aaA9) resistance cassettes and adjacent tetRA(33) determinant. Most MDR isolates carried the rpoBS531F mutation of the 2287 clone, while different rpoB mutations (S531L, S531Y) detected in two cases suggest the emergence of novel MDR R. equi strains.
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Głowacka IE, Grabkowska-Drużyc M, Andrei G, Schols D, Snoeck R, Witek K, Podlewska S, Handzlik J, Piotrowska DG. Novel N-Substituted 3-Aryl-4-(diethoxyphosphoryl)azetidin-2-ones as Antibiotic Enhancers and Antiviral Agents in Search for a Successful Treatment of Complex Infections. Int J Mol Sci 2021; 22:8032. [PMID: 34360797 PMCID: PMC8348901 DOI: 10.3390/ijms22158032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 02/07/2023] Open
Abstract
A novel series of N-substituted cis- and trans-3-aryl-4-(diethoxyphosphoryl)azetidin-2-ones were synthesized by the Kinugasa reaction of N-methyl- or N-benzyl-(diethyoxyphosphoryl)nitrone and selected aryl alkynes. Stereochemistry of diastereoisomeric adducts was established based on vicinal H3-H4 coupling constants in azetidin-2-one ring. All the obtained azetidin-2-ones were evaluated for the antiviral activity against a broad range of DNA and RNA viruses. Azetidin-2-one trans-11f showed moderate inhibitory activity against human coronavirus (229E) with EC50 = 45 µM. The other isomer cis-11f was active against influenza A virus H1N1 subtype (EC50 = 12 µM by visual CPE score; EC50 = 8.3 µM by TMS score; MCC > 100 µM, CC50 = 39.9 µM). Several azetidin-2-ones 10 and 11 were tested for their cytostatic activity toward nine cancerous cell lines and several of them appeared slightly active for Capan-1, Hap1 and HCT-116 cells values of IC50 in the range 14.5-97.9 µM. Compound trans-11f was identified as adjuvant of oxacillin with significant ability to enhance the efficacy of this antibiotic toward the highly resistant S. aureus strain HEMSA 5. Docking and molecular dynamics simulations showed that enantiomer (3R,4S)-11f can be responsible for the promising activity due to the potency in displacing oxacillin at β-lactamase, thus protecting the antibiotic from undesirable biotransformation.
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Affiliation(s)
- Iwona E. Głowacka
- Bioorganic Chemistry Laboratory, Faculty of Pharmacy, Medical University of Lodz, ul. Muszynskiego 1, 90-151 Lodz, Poland; (I.E.G.); (M.G.-D.)
| | - Magdalena Grabkowska-Drużyc
- Bioorganic Chemistry Laboratory, Faculty of Pharmacy, Medical University of Lodz, ul. Muszynskiego 1, 90-151 Lodz, Poland; (I.E.G.); (M.G.-D.)
| | - Graciela Andrei
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Herestraat 49, Box 1030, B-3000 Leuven, Belgium; (G.A.); (D.S.); (R.S.)
| | - Dominique Schols
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Herestraat 49, Box 1030, B-3000 Leuven, Belgium; (G.A.); (D.S.); (R.S.)
| | - Robert Snoeck
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Herestraat 49, Box 1030, B-3000 Leuven, Belgium; (G.A.); (D.S.); (R.S.)
| | - Karolina Witek
- Department of Technology and Biotechnology of Drugs, Faculty of Pharmacy, Jagiellonian University, Medical College, ul. Medyczna 9, 30-688 Krakow, Poland; (K.W.); (S.P.); (J.H.)
| | - Sabina Podlewska
- Department of Technology and Biotechnology of Drugs, Faculty of Pharmacy, Jagiellonian University, Medical College, ul. Medyczna 9, 30-688 Krakow, Poland; (K.W.); (S.P.); (J.H.)
- Maj Institute of Pharmacology, Polish Academy of Sciences, Department of Medicinal Chemistry, ul. Smętna 12, 31-343 Krakow, Poland
| | - Jadwiga Handzlik
- Department of Technology and Biotechnology of Drugs, Faculty of Pharmacy, Jagiellonian University, Medical College, ul. Medyczna 9, 30-688 Krakow, Poland; (K.W.); (S.P.); (J.H.)
| | - Dorota G. Piotrowska
- Bioorganic Chemistry Laboratory, Faculty of Pharmacy, Medical University of Lodz, ul. Muszynskiego 1, 90-151 Lodz, Poland; (I.E.G.); (M.G.-D.)
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Impact of Bicarbonate on PBP2a Production, Maturation, and Functionality in Methicillin-Resistant Staphylococcus aureus (MRSA). Antimicrob Agents Chemother 2021; 65:AAC.02621-20. [PMID: 33649115 PMCID: PMC8092911 DOI: 10.1128/aac.02621-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Certain methicillin-resistant Staphylococcus aureus (MRSA) strains exhibit β-lactam-susceptibility in vitro, ex vivo and in vivo in the presence of NaHCO3 (NaHCO3-responsive MRSA). Herein, we investigate the impact of NaHCO3 on factors required for PBP2a functionality. Prototype NaHCO3-responsive and -nonresponsive MRSA strains (as defined in vitro) were assessed for the impact of NaHCO3 on: expression of genes involved in PBP2a production-maturation pathways (mecA, blaZ, pbp4, vraSR, prsA, sigB, and floA); membrane PBP2a and PrsA protein content; and membrane carotenoid content. Following NaHCO3 exposure in NaHCO3-responsive (vs - nonresponsive) MRSA, there was significantly reduced expression of: i) mecA and blaZ; ii) the vraSR-prsA gene axis; and iii) pbp4 Carotenoid production was reduced, while floA expression was increased by NaHCO3 exposure in all MRSA strains. This work underscores the distinct regulatory impact of NaHCO3 on a cadre of genes encoding factors required for maintenance of the MRSA phenotype through PBP2a functionality and maturation.
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Song HS, Choi TR, Bhatia SK, Lee SM, Park SL, Lee HS, Kim YG, Kim JS, Kim W, Yang YH. Combination Therapy Using Low-Concentration Oxacillin with Palmitic Acid and Span85 to Control Clinical Methicillin-Resistant Staphylococcus aureus. Antibiotics (Basel) 2020; 9:antibiotics9100682. [PMID: 33049970 PMCID: PMC7599641 DOI: 10.3390/antibiotics9100682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022] Open
Abstract
The overuse of antibiotics has led to the emergence of multidrug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA). MRSA is difficult to kill with a single antibiotic because it has evolved to be resistant to various antibiotics by increasing the PBP2a (mecA) expression level, building up biofilm, introducing SCCmec for multidrug resistance, and changing its membrane properties. Therefore, to overcome antibiotic resistance and decrease possible genetic mutations that can lead to the acquisition of higher antibiotic resistance, drug combination therapy was applied based on previous results indicating that MRSA shows increased susceptibility to free fatty acids and surfactants. The optimal ratio of three components and the synergistic effects of possible combinations were investigated. The combinations were directly applied to clinically isolated strains, and the combination containing 15 μg/mL of oxacillin was able to control SCCmec type III and IV isolates having an oxacillin minimum inhibitory concentration (MIC) up to 1024 μg/mL; moreover, the combination with a slightly increased oxacillin concentration was able to kill SCCmec type II. Phospholipid analysis revealed that clinical strains with higher resistance contained a high portion of 12-methyltetradecanoic acid (anteiso-C15:0) and 14-methylhexadecanoic acid (anteiso-C17:0), although individual strains showed different patterns. In summary, we showed that combinatorial therapy with a low concentration of oxacillin controlled different laboratory and highly diversified clinical MRSA strains.
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Affiliation(s)
- Hun-Suk Song
- Department of Biological Engineering, College of Engineering, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 05029, Korea; (H.-S.S.); (T.-R.C.); (S.K.B.); (S.M.L.); (S.L.P.); (H.S.L.)
| | - Tae-Rim Choi
- Department of Biological Engineering, College of Engineering, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 05029, Korea; (H.-S.S.); (T.-R.C.); (S.K.B.); (S.M.L.); (S.L.P.); (H.S.L.)
| | - Shashi Kant Bhatia
- Department of Biological Engineering, College of Engineering, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 05029, Korea; (H.-S.S.); (T.-R.C.); (S.K.B.); (S.M.L.); (S.L.P.); (H.S.L.)
- Institute for Ubiquitous Information Technology and Applications (CBRU), Konkuk University, Seoul 05029, Korea
| | - Sun Mi Lee
- Department of Biological Engineering, College of Engineering, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 05029, Korea; (H.-S.S.); (T.-R.C.); (S.K.B.); (S.M.L.); (S.L.P.); (H.S.L.)
| | - Sol Lee Park
- Department of Biological Engineering, College of Engineering, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 05029, Korea; (H.-S.S.); (T.-R.C.); (S.K.B.); (S.M.L.); (S.L.P.); (H.S.L.)
| | - Hye Soo Lee
- Department of Biological Engineering, College of Engineering, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 05029, Korea; (H.-S.S.); (T.-R.C.); (S.K.B.); (S.M.L.); (S.L.P.); (H.S.L.)
| | - Yun-Gon Kim
- Department of Chemical Engineering, Soongsil University, 511 Sangdo-dong, Seoul 156-743, Korea;
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea;
| | - Wooseong Kim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
| | - Yung-Hun Yang
- Department of Biological Engineering, College of Engineering, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 05029, Korea; (H.-S.S.); (T.-R.C.); (S.K.B.); (S.M.L.); (S.L.P.); (H.S.L.)
- Institute for Ubiquitous Information Technology and Applications (CBRU), Konkuk University, Seoul 05029, Korea
- Correspondence:
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Isolation of Gram-Positive, Antibiotic-Resistant Bacteria from Tactile Mobile Phones in a Northwestern Mexican City. J Community Health 2020; 45:1050-1060. [PMID: 32394120 DOI: 10.1007/s10900-020-00829-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The widespread use of touch-screen mobile devices renders them potential fomites for the transmission of bacterial pathogens among users of different ages. The objectives of the present research were to isolate bacteria from mobile phones, perform molecular and phylogenetic identification, and determine the antibiotic resistance profiles. The surfaces of 50 touch-screen mobile devices owned by bystanders were sampled in the city center of Culiacan, Sinaloa, Mexico. The samples were cultured on nutritive agar; 13 bacterial colonies were isolated and characterized based on their macroscopic and microscopic characteristics and then identified using PCR amplification and sequencing of the 16S rRNA gene V4 and V6 regions. Their taxonomic relationships were determined via a Bayesian inference approach. Antimicrobial resistance was evaluated via disc diffusion and broth microdilution assays. Species of the genera Staphylococcus, Bacillus, and Enterococcus were identified on 84.6, 7.7, and 7.7% of the mobile phones, respectively. A unique subgroup of Staphylococcus epidermidis was identified in strains FBOPL-23, CAEPL-28, and FREPL-28. Staphylococcus hominis novobiosepticus was also identified on mobile phones for the first time. Of the isolated bacteria, 92.3% were resistant to erythromycin, 76.9% to ampicillin and penicillin, 61.5% to dicloxacillin, 38.5% to cephalothin and 7.7% to cefotaxime and ceftriaxone. The presence of antibiotic-resistant bacteria of clinical relevance poses potential risks to users' health and the dissemination of antibiotic resistance mechanisms throughout the community; thus, we recommend regular cleaning to prevent cross-infection by multidrug-resistant bacteria when using touch-screen mobile devices.
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19
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Ersoy SC, Otmishi M, Milan VT, Li L, Pak Y, Mediavilla J, Chen L, Kreiswirth B, Chambers HF, Proctor RA, Xiong YQ, Fowler VG, Bayer AS. Scope and Predictive Genetic/Phenotypic Signatures of Bicarbonate (NaHCO 3) Responsiveness and β-Lactam Sensitization in Methicillin-Resistant Staphylococcus aureus. Antimicrob Agents Chemother 2020; 64:e02445-19. [PMID: 32041719 PMCID: PMC7179597 DOI: 10.1128/aac.02445-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022] Open
Abstract
Addition of sodium bicarbonate (NaHCO3) to standard antimicrobial susceptibility testing medium reveals certain methicillin-resistant Staphylococcus aureus (MRSA) strains to be highly susceptible to β-lactams. We investigated the prevalence of this phenotype (NaHCO3 responsiveness) to two β-lactams among 58 clinical MRSA bloodstream isolates. Of note, ∼75% and ∼36% of isolates displayed the NaHCO3 responsiveness phenotype to cefazolin (CFZ) and oxacillin (OXA), respectively. Neither intrinsic β-lactam MICs in standard Mueller-Hinton broth (MHB) nor population analysis profiles were predictive of this phenotype. Several genotypic markers (clonal complex 8 [CC8]; agr I and spa t008) were associated with NaHCO3 responsiveness for OXA.
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Affiliation(s)
| | - Mariam Otmishi
- California State University Dominguez Hills, Carson, California, USA
| | | | - Liang Li
- The Lundquist Institute, Torrance, California, USA
| | - Youngju Pak
- The Lundquist Institute, Torrance, California, USA
| | | | - Liang Chen
- Meridian Health, Nutley, New Jersey, USA
| | | | | | - Richard A Proctor
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yan Q Xiong
- The Lundquist Institute, Torrance, California, USA
- Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vance G Fowler
- Duke University Medical Center, School of Medicine, Durham, North Carolina, USA
| | - Arnold S Bayer
- The Lundquist Institute, Torrance, California, USA
- Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Gizaw F, Kekeba T, Teshome F, Kebede M, Abreham T, Hayishe H, Waktole H, Tufa TB, Edao BM, Ayana D, Abunna F, Beyi AF, Abdi RD. Distribution and antimicrobial resistance profile of coagulase-negative staphylococci from cattle, equipment, and personnel on dairy farm and abattoir settings. Heliyon 2020; 6:e03606. [PMID: 32258466 PMCID: PMC7114745 DOI: 10.1016/j.heliyon.2020.e03606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/20/2019] [Accepted: 03/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Safe food is central to social wellbeing. Coagulase-negative staphylococci (CNS) are a threat to food safety because they may harbor multiple enterotoxins and antimicrobial resistance (AMR) genes. CNS bacteria are an emerging nosocomial pathogen in public health. CNS also cause bovine mastitis with a significant economic loss in the dairy industry and may introduce toxins to the food supply chain resulting in foodborne illnesses. However, information on CNS and their AMR status are scarce in food animal production and processing lines in Ethiopia. METHODOLOGY This cross-sectional study evaluated the prevalence and AMR patterns of CNS in dairy farms and abattoirs using samples (n = 1001) from udder milk, beef carcass, personnel, and different abattoir and dairy equipment across five locations of central Oromia. The CNS isolates were identified via standard microbiological protocols and evaluated using disc diffusion test against 14 antimicrobials belonging to nine different broad classes. Uni-and-multivariable logistic regressions were used to analyze the association between potential risk factors (location, sample source, and sample type) and positivity to CNS. RESULTS The overall prevalence of CNS in the five different geographic locations studied was 9.6% (range: 6.7-12.4%) and varied between abattoirs (11.3%) and dairy farms (8.0%). CNS were prevalent on the carcass, milk, equipment, personnel hands, and nasal samples. Of all CNS isolates, 7.1, 10.7, 7.1, 12.5, 17.9, 10.7, 12.5, 7.1, 1.8, 5.4, 1.8, and 5.4% exhibited AMR simultaneously to single, double, 3, 4, 5, 6, 7, 7, 8, 9, 10, 11, and 13 antimicrobials, respectively. Overall, the isolates displayed 51 different AMR phenotypic patterns in which 50% of the isolates exhibited quadruple-resistance simultaneously based on the nine broad antimicrobial classes tested using 14 representative antimicrobials. The prevalence of multidrug-resistant (MDR) CNS (i.e. ≥ 3 classes of antimicrobials) was significantly (p = 0.037) different between locations with 100, 57.1, 50, 86.7, and 76.9% in Addis Ababa, Adama, Assela, Bishoftu, and Holeta, respectively. However, the prevalence of MDR CNS was not significantly (p = 0.20) different between dairy farms (87.5%) and abattoirs (71.9%). We evaluated the effect of acquiring cefoxitin-resistance of the isolates on the efficacy (i.e. inhibition zone) of the rest antimicrobials using General Linear Model after adjusting geographical locations as a random effect. Isolates with cefoxitin-resistance significantly displayed resistance to eight antimicrobials of 14 tested including amoxicillin, penicillin, cloxacillin, chloramphenicol, nalidixic acid, nitrofurantoin, and tetracycline (p = 0.000), and erythromycin (p = 0.02). On the other hand, cefoxitin-resistant isolates were susceptible to gentamicin, ciprofloxacin, kanamycin, streptomycin, and sulphamethoxazone trimethoprim (p = 0.000). Thus, antimicrobials such as gentamicin and ciprofloxacin may be an alternative therapy to treat cefoxitin-resistant CNS, as 96.4% of CNS isolates were susceptible to these antimicrobials. Overall, 94.1 and 54.5% of the CNS isolates among cefoxitin-resistant and cefoxitin-susceptible, respectively, harbored resistance to 3 or more classes of antimicrobials i.e. MDR. CONCLUSION The overall prevalence of CNS in milk, meat, equipment, and food handlers in central Oromia was 9.6% but varied by location and sample source. Some specific niches such as equipment, hands, and nasal cavities of personnel are significant sites for the source of CNS. Most, but not all, MDR CNS isolates were cefoxitin-resistant. Overall, 78.6% of the CNS tested were MDR and 50% had resistance to four or more broad classes of antimicrobials. CNS in food animals (raw milk and meat), equipment, and food handlers can be the source of MDR to the public. Personnel safety and hygienic food handling practices are needed. In addition, further investigation into the risk factors for the transmission and mechanisms of resistance of the CNS is required for intervention.
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Affiliation(s)
- Fikru Gizaw
- Samara University, College of Veterinary Medicine and Agriculture, P. O. Box 3015, Samara, Afar, Ethiopia
| | - Tolera Kekeba
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Fikadu Teshome
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Matewos Kebede
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Tekeste Abreham
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Halefom Hayishe
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Hika Waktole
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Takele Beyene Tufa
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Bedaso Mammo Edao
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Dinka Ayana
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Fufa Abunna
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Ashenafi Feyisa Beyi
- Addis Ababa University, College of Veterinary Medicine and Agriculture, P.O. Box 34, Bishoftu, Oromia, Ethiopia
| | - Reta Duguma Abdi
- Department of Biomedical Sciences, College of Veterinary Medicine, Long Island University, Greenvale, New York, 11548, USA
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Felsenstein S, Bira S, Altanmircheg N, Shonkhuuz E, Ochirpurev A, Warburton D. Microbiological and Susceptibility Profile of Clinical Gram Positive Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia. Cent Asian J Glob Health 2019; 8:380. [PMID: 32002315 DOI: 10.5195/cajgh.2019.380] [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: 11/20/2022] Open
Abstract
Introduction Information on microbiological and susceptibility profiles of Monoglian bacterial isolates is scarce. Resistance profiles, patient demographics and microbiological work-up of gram positive isolates were analyzed in order to develop infection control activities and policies at the National Center for Maternity and Children's Health (NCMCH) in Ulaanbataar, Mongolia. Methods All gram positive isolates of specimens submitted to the microbiology laboratory at NCMCH between January 2014 and August 2017 were included. Data collected included demographic data, specimen type, in-/outpatient status, hospital ward of sample origin, and antimicrobial susceptibility testing profile. Susceptibility testing was performed by trained microbiologists at the NCMCH microbiology laboratory. T-test, Mann-Whitney, Chi-square and Fisher exact tests were used as appropriate. Results Of 11,889 isolates, 4012 (33.7%) were gram positive, with most identified as S. aureus (62.6%, n=2512). Rates of methicillin resistance (MRSA) remained stable at a quarter, but was significantly higher among inpatients (inpatients: 630/2002, 31.5%; outpatients 67/290, 23.1%; p≤0.05) and sterile site isolates (sterile: 83/171, 48.5%; non-sterile: 416/1678, 24.8%; p≤0.01). The vast majority of S. pneumoniae isolates (12/14; 85%) was found to be penicillin resistant by oxacillin disk diffusion. While identification of Group B streptococci was rare (n=137) due to of lack of diagnostic measures available, the number of enterococcal isolates identified increased significantly due to implementation of improved microbiological work-up (2015: n=7; 2016: n=26; 2017: n=83). Conclusion Compared with published studies from neighboring nations, the rates of antimicrobial resistance among gram positive isolates at NCMCH, particularly with respect to S. aureus and S. pneumoniae, were much higher. Further improvement of microbiological diagnostics and collaboration of stakeholders is required to address the pressing infection control and stewardship issues and to ensure reliable identification of relevant pathogens in Mongolia.
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Affiliation(s)
- Susanna Felsenstein
- Cork University Hospital University College Cork, Wilton, Cork, Republic of Ireland
| | - Sarantsetseg Bira
- Central Laboratory Department, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Narangerel Altanmircheg
- Central Laboratory Department, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Enkhtur Shonkhuuz
- Critical Care Medicine, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Ariuntuya Ochirpurev
- Health emergencies and food safety, Office of the WHO Representative in Mongolia, Ulaanbaatar, Mongolia
| | - David Warburton
- Keck School of Medicine, University of Southern California, USA.,Ostrow School of Dentistry, University of Southern California, USA
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Bicarbonate Resensitization of Methicillin-Resistant Staphylococcus aureus to β-Lactam Antibiotics. Antimicrob Agents Chemother 2019; 63:AAC.00496-19. [PMID: 31010857 PMCID: PMC6591647 DOI: 10.1128/aac.00496-19] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/07/2019] [Indexed: 12/24/2022] Open
Abstract
Endovascular infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a major health care concern, especially infective endocarditis (IE). Standard antimicrobial susceptibility testing (AST) defines most MRSA strains as “resistant” to β-lactams, often leading to the use of costly and/or toxic treatment regimens. In this investigation, five prototype MRSA strains, representing the range of genotypes in current clinical circulation, were studied. Endovascular infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a major health care concern, especially infective endocarditis (IE). Standard antimicrobial susceptibility testing (AST) defines most MRSA strains as “resistant” to β-lactams, often leading to the use of costly and/or toxic treatment regimens. In this investigation, five prototype MRSA strains, representing the range of genotypes in current clinical circulation, were studied. We identified two distinct MRSA phenotypes upon AST using standard media, with or without sodium bicarbonate (NaHCO3) supplementation: one highly susceptible to the antistaphylococcal β-lactams oxacillin and cefazolin (NaHCO3 responsive) and one resistant to such agents (NaHCO3 nonresponsive). These phenotypes accurately predicted clearance profiles of MRSA from target tissues in experimental MRSA IE treated with each β-lactam. Mechanistically, NaHCO3 reduced the expression of two key genes involved in the MRSA phenotype, mecA and sarA, leading to decreased production of penicillin-binding protein 2a (that mediates methicillin resistance), in NaHCO3-responsive (but not in NaHCO3-nonresponsive) strains. Moreover, both cefazolin and oxacillin synergistically killed NaHCO3-responsive strains in the presence of the host defense antimicrobial peptide (LL-37) in NaHCO3-supplemented media. These findings suggest that AST of MRSA strains in NaHCO3-containing media may potentially identify infections caused by NaHCO3-responsive strains that are appropriate for β-lactam therapy.
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Badger S, Abraham S, O'Dea M, Saputra S, Abraham RJ, Worthing KA, Norris JM, Trott DJ, Jordan D, Caraguel CGB. Diagnostic accuracy of phenotypic assays for determining antimicrobial resistance status in Staphylococcus pseudintermedius isolates from canine clinical cases. Vet Microbiol 2019; 234:101-109. [PMID: 31213265 DOI: 10.1016/j.vetmic.2019.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 01/20/2023]
Abstract
This study evaluated the diagnostic test accuracy of disc diffusion relative to broth-microdilution for clinical Staphylococcus pseudintermedius isolated from dogs in Australia (n = 614). Accuracy of disc diffusion and broth-microdilution for oxacillin relative to mecA real-time PCR was also assessed. Each isolate had paired minimum inhibitory concentration and zone diameter values for ten antimicrobial agents. Data was dichotomised using Clinical and Laboratory Standards Institute susceptible and resistant clinical breakpoints. Test accuracy was reported using relative diagnostic sensitivity (RSe), specificity (RSp), likelihood ratio pairs, diagnostic odds ratio, and area-under-the receiver-operating characteristic (ROC AUC) analysis. Disc diffusion was found to have high test accuracy for most antimicrobials (ROC AUC range: 0.96 - 0.99) except rifampicin (ROC AUC = 0.80). The RSp of disc diffusion was high for all antimicrobials (range, 97.1%-100%). However, RSe was considerably variable (range, 35.7%-98.8%), particularly for amoxicillin-clavulanic acid (51.5%, 95% CI, 38.9%, 64.0%), cefoxitin (35.7%, 95% CI, 12.8%, 64.9%), and cephalothin (43.6%, 95% CI, 27.8%, 60.4%). When disc diffusion and broth-microdilution were compared to mecA real-time PCR, the overall accuracy of both assays was similar (ROC AUC, 0.99 respectively). However, the RSe for broth-microdilution (96.1%, 95% CI, 88.9%, 99.2%) was significantly higher than for disc diffusion (86.8%, 95% CI, 77.1%, 93.5%) (McNemars mid-p value 0.01). Overall, these findings demonstrate that for most antimicrobials, disc diffusion performed according to CLSI guidelines can be used to differentiate clinical S. pseudintermedius isolates that might otherwise be assessed by broth-microdilution, provided consideration is given to the performance estimates reported here.
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Affiliation(s)
- Skye Badger
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Mudla Wirra Rd, Roseworthy, 5371, Australia; School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, Perth, Western Australia, 6150, Australia.
| | - Sam Abraham
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Mudla Wirra Rd, Roseworthy, 5371, Australia.
| | - Mark O'Dea
- School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, Perth, Western Australia, 6150, Australia. M.O'
| | - Sugiyono Saputra
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Mudla Wirra Rd, Roseworthy, 5371, Australia.
| | - Rebecca J Abraham
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Mudla Wirra Rd, Roseworthy, 5371, Australia.
| | - Kate A Worthing
- University of Sydney, Sydney School of Veterinary Science, NSW, Australia; Department of Microbiology and Immunology, at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Victoria, Australia.
| | | | - Darren J Trott
- Australian Centre for Antimicrobial Resistance Ecology, The University of Adelaide, Roseworthy Campus, Mudla Wirra Rd, Roseworthy, 5371, Australia.
| | - David Jordan
- School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, Perth, Western Australia, 6150, Australia; Wollongbar Primary Industries Institute, NSW Department of Primary Industries, 1243 Bruxner Highway, Wollongbar, New South Wales, 2477, Australia.
| | - Charles G B Caraguel
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Mudla Wirra Rd, Roseworthy, 5371, Australia.
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Synergistic and Antagonistic Effects of Phenylalanine and Various Antibiotics on the Growth of Pathogenic Bacteria. BIONANOSCIENCE 2019. [DOI: 10.1007/s12668-019-0597-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Kulanthaivel L, Jeyaraman J, Biswas A, Subbaraj GK, Santhoshkumar S. Identification of potential inhibitors for Penicillinbinding protein (PBP) from Staphylococcus aureus. Bioinformation 2018; 14:471-476. [PMID: 31223205 PMCID: PMC6563657 DOI: 10.6026/97320630014471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/28/2022] Open
Abstract
Staphylococcus aureus is an infectious agent that causes severe skin and soft tissue infection in hospitalized patients. Therefore, it is of interest to develop potent inhibitors for S. aureus. Penicillin Binding protein (PBP) is a known drug target for inhibition of cell wall biosynthesis in S. aureus. Hence, PBP was screened with compounds from six databases using virtual screening approaches. Results shows that the screened lead compound produced higher docking score (-9.87 kcal/mol) compared to resistant drugs. Antimicrobial activity using screened lead compounds and resistant drugs showed maximum activity in potential screened compounds compared to resistant compounds.
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Affiliation(s)
- Langeswaran Kulanthaivel
- Cancer Genetics and Molecular Biology Laboratory, Department of Bioinformatics, Science Campus, Alagappa University, Karaikudi, Tamil Nadu, India
| | - Jeyakanthan Jeyaraman
- Structural Biology and Bio-computing, Department of Bioinformatics, Science Campus, Alagappa University, Karaikudi, Tamil Nadu, India
| | - Abir Biswas
- Abir Biswas, Molecular Gerontology Lab, Department of Biochemistry, Bharathidasan University,Thiruchirapalli, Tamil Nadu, India
| | - Gowtham Kumar Subbaraj
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India
| | - S Santhoshkumar
- Department of Computer Science, Alagappa University, Karaikudi, Tamil Nadu, India
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Zelenitsky SA, Beahm NP, Iacovides H, Ariano RE, Zhanel G. Limitations of ceftriaxone compared with cefazolin against MSSA: an integrated pharmacodynamic analysis. J Antimicrob Chemother 2018; 73:1888-1894. [DOI: 10.1093/jac/dky120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/12/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
- Sheryl A Zelenitsky
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Nathan P Beahm
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
- Yorkton Regional Health Centre, Yorkton, Saskatchewan, Canada
| | - Harris Iacovides
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert E Ariano
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - George Zhanel
- Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Pinheiro L, Mello PL, Abraão LM, Corrente JE, Lourdes Rs Cunha MD. Evaluation of reference values for phenotypic tests to detect oxacillin resistance in coagulase-negative staphylococci. Future Microbiol 2018. [PMID: 29521121 DOI: 10.2217/fmb-2017-0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate the adequacy of the disc-diffusion test and E-test® compared with detection of mecA for coagulase-negative staphylococci isolated from blood cultures, nasal swabs and wounds. RESULTS Agreement between all techniques was observed in 65.7% of cases. The greatest discrepancy between mecA/susceptible E-test was observed for non-epidermidis species. A resistance breakpoint ≤19 mm using the oxacillin disc was found to best classify all coagulase-negative staphylococci isolates; Staphylococcus epidermidis, ≤19 mm (oxacillin) and ≤27 mm (cefoxitin); Staphylococcus haemolyticus and Staphylococcus capitis, ≤21 mm (oxacillin) and ≤18 mm (cefoxitin); Staphylococcus warneri, MICs ≥0.75 mg/l. CONCLUSION Although no longer recommended by the Clinical Laboratory Standards Institute, we observed some cases in which only the oxacillin disc-diffusion test detected resistance. The discrepancy between phenotypic tests and mecA is probably due to heterogeneity and borderline resistance.
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Affiliation(s)
- Luiza Pinheiro
- Department of Microbiology & Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil.,Departament of Anatomic Pathology, Instituto Lauro de Souza Lima, Bauru 17034-971, Brazil
| | - Priscila L Mello
- Department of Microbiology & Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil
| | - Ligia M Abraão
- Department of Microbiology & Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil
| | - José Eduardo Corrente
- Department of Biostatistics, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil
| | - Maria de Lourdes Rs Cunha
- Department of Microbiology & Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista - UNESP, Botucatu 18618-970, Brazil
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Gern BH, Greninger AL, Weissman SJ, Stapp JR, Tao Y, Qin X. Continued in vitro cefazolin susceptibility in methicillin-susceptible Staphylococcus aureus. Ann Clin Microbiol Antimicrob 2018; 17:5. [PMID: 29463249 PMCID: PMC5819674 DOI: 10.1186/s12941-018-0257-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES In vitro trends of cefazolin and ceftriaxone susceptibilities from pediatric clinical isolates of methicillin-susceptible Staphylococcus aureus (MSSA) between 2011 and 2016 were analyzed for surveillance. METHODS Our laboratory continues to use agar disk diffusion for staphylococcal susceptibilities applying Clinical Laboratory Standard Institute's 2012 breakpoints. RESULTS A total of 3992 MSSA clinical isolates in the last 6 years were analyzed for their in vitro cefazolin and ceftriaxone susceptibilities. While all MSSA isolates exhibited cefazolin susceptibilities within the "susceptible" zone range, there have been a proportion of isolates with ceftriaxone susceptibilities falling in "intermediate" zones, ranging from 2.6% in 2011 to 8.3% in 2016. CONCLUSIONS Cefazolin continues to be the recommended agent for MSSA treatment at our institution, reflected by the finding that only 2% (6/321) of patients who received ceftriaxone as definitive therapy for MSSA bacteremia during the study period. We have confirmed the cefoxitin-predicted MSSA susceptibility to cefazolin, but have found concerning drifts in ceftriaxone susceptibilities by continued in vitro monitoring over the last 6 years.
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Affiliation(s)
- Benjamin H Gern
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | - Scott J Weissman
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Jennifer R Stapp
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Yue Tao
- Shanghai Children's Medical Center, Translational Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xuan Qin
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA. .,Seattle Children's Microbiology Laboratory, Seattle, USA. .,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
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Papich MG, Lindeman C. Cephalexin susceptibility breakpoint for veterinary isolates: Clinical Laboratory Standards Institute revision. J Vet Diagn Invest 2017; 30:113-120. [PMID: 29145786 DOI: 10.1177/1040638717742434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Clinical and Laboratory Standards Institute (CLSI) uses cephalothin as the class representative for testing veterinary isolates for susceptibility to other first-generation cephalosporins, including cephalexin. We examined replacing cephalothin with cephalexin because cephalexin is used more often clinically. Bacterial isolates were obtained from dogs and cats from a national surveillance program. CLSI testing methods were used to determine the MIC for 4 cephalosporins used in veterinary medicine. Cephalexin clinical breakpoints for canine isolates were established by using published pharmacokinetic data and Monte Carlo simulations to calculate the probability of target attainment (PTA). For 1,112 Staphylococcus pseudintermedius isolates, the mode, MIC50, and MIC90 were 1, 2, and 64 µg/mL, respectively, for cephalexin, and ≤0.06, 0.12, and 2 µg/mL for cephalothin. Susceptibility of S. pseudintermedius from 2011 to 2014 did not change for the 4 cephalosporins tested. Only 4.3% of the penicillin-binding protein 2a-positive S. pseudintermedius isolates had MIC values ≤2 µg/mL for cephalexin, but 66.3% of these isolates had MIC values ≤2 µg/mL for cephalothin. There were also discrepancies between cephalexin and cephalothin for other bacteria tested, but the largest difference was for S. pseudintermedius, with a MIC difference of 4 doubling dilutions. Cephalexin interpretive categories (breakpoints) of ≤2 μg/mL (susceptible), 4 μg/mL (intermediate), and ≥8 μg/mL (resistant) were established for isolates obtained from dogs. Cephalothin should not be used for susceptibility testing of cephalexin for veterinary bacterial pathogens, and canine-specific breakpoints should be used for testing susceptibility. Breakpoints determined using the methods described herein for the interpretive categories will be added to future CLSI tables to reflect this recommendation.
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Affiliation(s)
- Mark G Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC (Papich).,Zoetis Veterinary Medicine Research & Development, Kalamazoo, MI (Lindeman)
| | - Cindy Lindeman
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC (Papich).,Zoetis Veterinary Medicine Research & Development, Kalamazoo, MI (Lindeman)
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Uddin MJ, Ahn J. Associations between resistance phenotype and gene expression in response to serial exposure to oxacillin and ciprofloxacin in Staphylococcus aureus. Lett Appl Microbiol 2017; 65:462-468. [PMID: 28977678 DOI: 10.1111/lam.12808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 12/17/2022]
Abstract
This study was designed to delineate the relationship between resistance phenotypes and gene expression in wild-type (SAWT ), oxacillin-induced (SAOXA ), ciprofloxacin-induced (SACIP ) and clinically acquired antibiotic-resistant Staphylococcus aureus (SACA ) exposed to oxacillin (β-lactam) and ciprofloxacin (fluoroquinolone). The phenotypic response and gene expression were varied with the antibiotic exposure. SAWT was highly resistant to oxacillin (MIC = 8 μg ml-1 ) after serial exposure to oxacillin, while the oxacillin susceptibility was not changed in SAWT when exposed to ciprofloxacin (MIC = 0·25 μg ml-1 ). The clinical isolate, SACA , was highly resistant to all classes of antibiotics used in this study. The increased resistance of SAOXA and SACIP to penicillinase-labile penicillins was attributed to the production of β-lactamase, which is in good agreement with the overexpression of blaZ (>2-fold). The overexpression of efflux pump-related genes (norA, norB, norC, mdeA, mepR, mgrA and lmrS) was associated with the increased resistance of SACIP and SACA to aminoglycosides and quinolones. This study confirmed that the linkage between resistance phenotypes and molecular genotypes highly varied depending on intrinsic resistance profile, response to antibiotic exposure and genes conferring resistance. This study provides useful information for understanding the mechanisms of methicillin resistance in S. aureus in association with phenotypic and genotypic resistance determinants. SIGNIFICANCE AND IMPACT OF THE STUDY The improvement in current standards is essential to accurately detect methicillin-resistant Staphylococcus aureus in consideration of various resistance phenotypes and genotypes. The varied and distinctive expression patterns of antibiotic resistance-related genes were observed in S. aureus exposed to oxacillin and ciprofloxacin. It is worth noting the relationship between resistance phenotype and resistance genotype in terms of MIC values and expression of antibiotic resistance determinants. This study provides useful information for understanding the mechanisms of methicillin resistance in S. aureus in association with phenotypic and genotypic resistance determinants.
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Affiliation(s)
- M J Uddin
- Department of Medical Biomaterials Engineering, Kangwon National University, Chuncheon, Gangwon, Korea
| | - J Ahn
- Department of Medical Biomaterials Engineering, Kangwon National University, Chuncheon, Gangwon, Korea.,Institute of Bioscience & Biotechnology, Kangwon National University, Chuncheon, Gangwon, Korea
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Oniciuc EA, Nicolau AI, Hernández M, Rodríguez-Lázaro D. Presence of methicillin-resistant Staphylococcus aureus in the food chain. Trends Food Sci Technol 2017. [DOI: 10.1016/j.tifs.2016.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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Li J, Echevarria KL, Traugott KA. β-Lactam Therapy for Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Comparative Review of Cefazolin versus Antistaphylococcal Penicillins. Pharmacotherapy 2017; 37:346-360. [PMID: 28035690 DOI: 10.1002/phar.1892] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia is associated with high morbidity and mortality. Traditionally, antistaphylococcal penicillins (ASPs) have been considered the agents of choice for the treatment of MSSA bacteremia. Vancomycin has been demonstrated to have poorer outcomes in several studies and is only recommended for patients with severe penicillin allergies. Although cefazolin is considered as an alternative to the ASPs for patients with nonsevere penicillin allergies, cefazolin offers several pharmacologic advantages over ASPs, such as more convenient dosing regimens, and antimicrobial stewardship programs are increasingly using cefazolin as the preferential agent for MSSA infections as part of cost-saving initiatives. Concerns about susceptibility to hydrolysis by type A β-lactamases, particularly at high inocula seen in deep-seated infections such as endocarditis; selective pressures from unnecessary gram-negative coverage; and lack of comparative clinical data have precluded recommending cefazolin as a first-line therapy for MSSA bacteremia. Recent clinical studies, however, have suggested similar clinical efficacy but better tolerability, with lower rates of discontinuation due to adverse drug reactions, of cefazolin compared with ASPs. Other variables, such as adequate source control (e.g., intravascular catheter removal, debridement, or drainage) and enhanced pharmacodynamics through aggressive cefazolin dosing, may mitigate the role of cefazolin inoculum effect and factor into determining improved clinical outcomes. In this review, we highlight the utility of cefazolin versus ASPs in the treatment of MSSA bacteremia with a focus on clinical efficacy and safety.
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Affiliation(s)
- Julius Li
- Department of Pharmacy, Ochsner Medical Center, New Orleans, Louisiana
| | - Kelly L Echevarria
- South Texas Veterans Health Care System, San Antonio, Texas.,The University of Texas at Austin College of Pharmacy, Austin, Texas.,Pharmacotherapy Education and Research Center, University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Kristi A Traugott
- The University of Texas at Austin College of Pharmacy, Austin, Texas.,Pharmacotherapy Education and Research Center, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.,Department of Pharmacy, University Health System, San Antonio, Texas
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Reid MJA, Fischer RSB, Mannathoko N, Muthoga C, McHugh E, Essigmann H, Brown EL, Steenhoff AP. Prevalence of Staphylococcus aureus Nasal Carriage in Human Immunodeficiency Virus-Infected and Uninfected Children in Botswana: Prevalence and Risk Factors. Am J Trop Med Hyg 2017; 96:795-801. [PMID: 28167588 DOI: 10.4269/ajtmh.16-0650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractStaphylococcus aureus is an important cause of morbidity and mortality in children in sub-Saharan Africa (SSA). A major risk factor for staphylococcal infection is S. aureus colonization of the anterior nares. We sought to define risk factors for S. aureus carriage and characterize antimicrobial resistance patterns in children in Botswana. A cross-sectional study was conducted at two clinical sites in southern Botswana. Patients under 18 years of age underwent two nasal swabs and brief interviews, 4 weeks apart. Standard microbiological techniques were used. For persistent carriers, S. aureus was isolated from swabs at both time points, and for intermittent carriers, S. aureus was isolated from only one swab. Poisson regression with robust variance estimator was used to compare prevalence of carriage and the resistance phenotypes. Among 56 enrollees, prevalence of S. aureus colonization was 55% (N = 31), of whom 42% (N = 13) were persistent carriers. Of human immunodeficiency virus-infected children, 64% (N = 9) were carriers. Risk factors for nasal carriage included a history of tuberculosis (prevalence ratio [PR] = 1.60; 95% confidence interval [CI] = 1.02, 2.51; P = 0.040) and closer proximity to health care (PR = 0.89; 95% CI = 0.80, 0.99; P = 0.048). Prior pneumonia was more common among persistent rather than intermittent carriers (PR = 2.64; 95% CI = 1.64, 4.23; P < 0.001). Methicillin-resistant S. aureus (MRSA) prevalence was 13%. Of isolates tested, 16% were resistant to three or more drugs (N = 7/44). In summary, children in southern Botswana are frequently colonized with S. aureus. Antibiotic resistance, especially MRSA, is also widespread. Antibiotic recommendations for treatment of staphylococcal infections in SSA should take cognizance of these resistance patterns.
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Affiliation(s)
- Michael J A Reid
- University of California San Francisco, San Francisco, California
| | - Rebecca S B Fischer
- The University of Texas Health Science Center School of Public Health, Houston, Texas.,National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | | | | | - Erin McHugh
- The University of Texas Health Science Center School of Public Health, Houston, Texas
| | - Heather Essigmann
- The University of Texas Health Science Center School of Public Health, Houston, Texas
| | - Eric L Brown
- The University of Texas Health Science Center School of Public Health, Houston, Texas
| | - Andrew P Steenhoff
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.,Botswana-UPenn Partnership, Gaborone, Botswana.,University of Botswana, Gaborone, Botswana
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Bedenčič K, Kavčič M, Faganeli N, Mihalič R, Mavčič B, Dolenc J, Bajc Z, Trebše R. Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections? Clin Orthop Relat Res 2016; 474:258-64. [PMID: 26253269 PMCID: PMC4686528 DOI: 10.1007/s11999-015-4486-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/28/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions. QUESTIONS/PURPOSES We wished to determine whether administration of preoperative antibiotics decreases the likelihood of diagnosing PJI in patients undergoing revision hip or knee arthroplasty in whom infection is suspected. METHODS We prospectively enrolled and evaluated 40 patients (29 with THAs and 11 with TKAs) who met the following inclusion criteria: older than 18 years, with suspected PJI of unknown cause, undergoing surgical revision. After arthrotomy, three tissue samples were obtained for microbiologic analysis and diagnosis, and antimicrobial prophylaxis (cefazolin 2 g intravenously) then was administered. Later during the procedure, but before débridement and irrigation, the second set of three tissue samples was obtained from the same surgical area and was cultured. Tissue concentration of prophylactic antibiotic was verified with the second set of samples. A positive culture result was defined as one or more positive cultures (growth on agar at or before 14 days). We then compared the yield on the microbiologic cultures obtained before administration of antibiotics with the yield on the cultures obtained after antibiotics were administered. An a priori analysis was performed; with the numbers available, we had 98% power to detect a difference in diagnostic sensitivity of 33%. RESULTS With the numbers available, we found no difference in the likelihood that an infection would be diagnosed between the samples obtained before and after administration of antimicrobial prophylaxis (odds ratio [OR] for positive microbial culture = 0.99; 95% CI, 0.40-2.48; p = 0.99). All measured tissue concentrations of cefazolin were greater than the minimum inhibitory concentration, therefore we found that antibiotic prophylaxis was adequate at the time of second-set tissue specimen recovery. CONCLUSIONS Results from this small, prospective series suggest that preoperative antimicrobial prophylaxis may be administered safely even in patients undergoing revision hip or knee arthroplasty in which microbiologic sampling is planned without compromising the diagnostic sensitivity of tissue sample cultures. However, before applying our results more generally, our findings need to be confirmed in larger, multicenter studies that would allow evaluation by sex, procedure, bacteriology, and other potentially important factors. LEVEL OF EVIDENCE Level I, diagnostic study.
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Affiliation(s)
- Klemen Bedenčič
- Department of Orthopaedics, General Hospital Novo Mesto, Novo Mesto, Slovenia
| | - Martina Kavčič
- Medical Microbiology Department, Institute of Public Health, Koper, Slovenia
| | - Nataša Faganeli
- Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia
| | - Rene Mihalič
- Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia
| | - Blaž Mavčič
- Orthopaedic Clinic University Clinical Centre, Ljubljana, Slovenia
| | | | - Zlatka Bajc
- National Veterinary Institute, Ljubljana, Slovenia
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia.
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Kang N, Housman ST, Nicolau DP. Assessing the Surrogate Susceptibility of Oxacillin and Cefoxitin for Commonly Utilized Parenteral Agents against Methicillin-Susceptible Staphylococcus aureus: Focus on Ceftriaxone Discordance between Predictive Susceptibility and in Vivo Exposures. Pathogens 2015; 4:599-605. [PMID: 26264030 PMCID: PMC4584275 DOI: 10.3390/pathogens4030599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 11/16/2022] Open
Abstract
Susceptibility testing with the use of surrogate agents is common among clinical microbiology laboratories. One such example is oxacillin and cefoxitin for β-lactams against methicillin-susceptible Staphylococcus aureus (MSSA). This study aimed to assess the surrogate predictive value (SPV) of oxacillin and cefoxitin for the susceptibility of commonly utilized parenteral β-lactams against MSSA as well as to evaluate the concordance between predictive susceptibility testing and the in vivo exposures for ceftriaxone. Broth microdilution MICs were determined for cefazolin, cefoxitin, ceftaroline, ceftriaxone, nafcillin, and oxacillin against a national collection of 1238 MSSA from US hospitals. Pharmacodynamic profiling was utilized to establish a clinical breakpoint for commonly utilized doses of ceftriaxone. Oxacillin had good SPVs for all the β-lactams tested, whereas cefoxitin produced unacceptable major errors for all four agents and thus appears to be an unacceptable susceptibility surrogate. While oxacillin is an adequate surrogate based on the currently defined laboratory criteria, our data also suggest that caution should be exercised when incorporating this testing approach in the clinical setting in view of the fact that the MIC distribution of MSSA coupled with the commonly utilized low doses of ceftriaxone may result in inadequate in vivo exposures against this pathogen.
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Affiliation(s)
- Nayon Kang
- Department of Pharmacy Services, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
| | - Seth T Housman
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
- Division of Infectious Diseases, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Chen PY, Chuang YC, Wang JT, Chang SC. Impact of prior healthcare-associated exposure on clinical and molecular characterization of methicillin-susceptible Staphylococcus aureus bacteremia: results from a retrospective cohort study. Medicine (Baltimore) 2015; 94:e474. [PMID: 25654386 PMCID: PMC4602728 DOI: 10.1097/md.0000000000000474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
By virtue of medical advances and an aging society, people have increased opportunities for healthcare exposure. Little is known about the impact of healthcare exposure on the clinical features and molecular typing of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. We classified the onset of MSSA bacteremia into 3 mutually exclusive categories according to the Centers for Disease Control definition, and conducted a retrospective cohort study to investigate the differences among patients with community-associated (CA), healthcare-associated community onset (HACO), and hospital onset (HO) MSSA bacteremia at a medical center from January 1, 2002 through December 31, 2011. Antibiotic susceptibilities and multilocus sequence typing of MSSA isolates were also determined. A total of 290 patients with MSSA bacteremia, including of 165 (56.9%), 91 (31.4%), and 34 (11.7%) of HACO, HO, and CA, respectively, were studied. ST188 (29.3%) was the most common sequence type regardless of classification. Patients with HACO bacteremia were significantly older, had more solid tumors, higher Charlson scores, and more catheter-related bloodstream infections than those with CA bacteremia. The proportions of osteoarticular infections among patients with both HACO and CA bacteremia were higher than that of patients with HO bacteremia. By univariate analysis, patients with HO bacteremia had significantly higher in-hospital mortality compared to those with CA or HACO bacteremia (31.9% vs 18.8% and 20.4%). Multivariate analysis showed that Charlson score (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.10-1.52), septic shock (OR, 5.28; 95% CI, 2.37-11.78), liver cirrhosis (OR, 3.57; 95% CI, 1.14-11.24), receipt of β-lactams other than oxacillin and cefazolin as definitive therapy (OR, 9.27; 95% CI, 4.25-20.23), and higher oxacillin minimum inhibitory concentration (MIC) (≥0.5 mg/L) (OR, 2.35; 95% CI, 1.05-5.25) of the causative pathogen were independently associated with in-hospital mortality. In conclusion, patients with HACO bacteremia had different host factors compared with those with CA bacteremia. Infection foci varied with different onset settings. Overall, ST188 was the most predominant sequence type. Onset settings were not independently associated with outcomes.
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Affiliation(s)
- Pao-Yu Chen
- From the Department of Internal Medicine, National Taiwan University Hospital, Jin-Shan Branch, New Taipei, Taiwan (P-YC); Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y-CC, J-TW, S-CC); National Institute of Infectious Diseases and Vaccinology, Miaoli County, Taiwan (J-TW); College of Medicine, National Taiwan University, Taipei, Taiwan (S-CC)
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