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Davis KP, McDermott LA, Snydman DR, Aldridge BB. In vitro identification of underutilized β-lactam combinations against methicillin-resistant Staphylococcus aureus bacteremia isolates. Microbiol Spectr 2024; 12:e0097624. [PMID: 38916355 PMCID: PMC11302340 DOI: 10.1128/spectrum.00976-24] [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: 04/17/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a serious clinical challenge with high mortality rates. Antibiotic combination therapy is currently used in cases of persistent infection; however, the limited development of new antibiotics will likely increase the need for combination therapy, and better methods are needed for identifying effective combinations for treating persistent bacteremia. To identify pairwise combinations with the most consistent potential for benefit compared to monotherapy with a primary anti-MRSA agent, we conducted a systematic study with an in vitro high-throughput methodology. We tested daptomycin and vancomycin each in combination with gentamicin, rifampicin, cefazolin, and oxacillin, and ceftaroline with daptomycin, gentamicin, and rifampicin. Combining cefazolin with daptomycin lowered the daptomycin concentration required to reach 95% growth inhibition (IC95) for all isolates tested and lowered daptomycin IC95 below the sensitivity breakpoint for five out of six isolates that had daptomycin minimum inhibitory concentrations at or above the sensitivity breakpoint. Similarly, vancomycin IC95s were decreased when vancomycin was combined with cefazolin for 86.7% of the isolates tested. This was a higher percentage than was achieved by adding any other secondary antibiotic to vancomycin. Adding rifampicin to daptomycin or vancomycin did not always reduce IC95s and failed to produce synergistic interaction in any of the isolates tested; the addition of rifampicin to ceftaroline was frequently synergistic and always lowered the amount of ceftaroline required to reach the IC95. These analyses rationalize further in vivo evaluation of three drug pairs for MRSA bacteremia: daptomycin+cefazolin, vancomycin+cefazolin, and ceftaroline+rifampicin.IMPORTANCEBloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have a high mortality rate despite the availability of vancomycin, daptomycin, and newer antibiotics including ceftaroline. With the slow output of the antibiotic pipeline and the serious clinical challenge posed by persistent MRSA infections, better strategies for utilizing combination therapy are becoming increasingly necessary. We demonstrated the value of a systematic high-throughput approach, adapted from prior work testing antibiotic combinations against tuberculosis and other mycobacteria, by using this approach to test antibiotic pairs against a panel of MRSA isolates with diverse patterns of antibiotic susceptibility. We identified three antibiotic pairs-daptomycin+cefazolin, vancomycin+cefazolin, and ceftaroline+rifampicin-where the addition of the second antibiotic improved the potency of the first antibiotic across all or most isolates tested. Our results indicate that these pairs warrant further evaluation in the clinical setting.
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Affiliation(s)
- Kathleen P. Davis
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
- The Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Laura A. McDermott
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - David R. Snydman
- The Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University School of Medicine, Boston, Massachusetts, USA
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Bree B. Aldridge
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
- The Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Tufts University School of Engineering, Medford, Massachusetts, USA
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Zhanel GG, Kosar J, Baxter M, Dhami R, Borgia S, Irfan N, Dow G, Dube M, von den Baumen TR, Tascini C, Lee A, Chagla Z, Girouard G, Bourassa-Blanchette S, Wu M, Keynan Y, Walkty A, Karlowsky JA. How is ceftobiprole used in Canada: the CLEAR study final results. Expert Rev Anti Infect Ther 2024:1-8. [PMID: 39008122 DOI: 10.1080/14787210.2024.2374280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND We report the final results of the clinical usage of ceftobiprole in patients in Canada from data in the national CLEAR (Canadian Le adership on Antimicrobial Real-Life Usage) registry. RESEARCH DESIGN AND METHODS The authors review the final data using the national ethics approved CLEAR study. Thereafter, the literature is surveyed regarding the usage of ceftobiprole to treat patients with infectious diseases via PubMed (up to March 2024). RESULTS In Canada, ceftobiprole is primarily used as directed therapy to treat a variety of severe infections caused by MRSA. It is primarily used in patients failing previous antimicrobials, is frequently added to daptomycin and/or vancomycin with high microbiological and clinical cure rates, along with an excellent safety profile. Several reports attest to the microbiological/clinical efficacy and safety of ceftobiprole. Ceftobiprole is also reported to be used empirically in select patients with community-acquired bacterial pneumonia (CABP), as well as hospital-acquired bacterial pneumonia (HABP). CONCLUSIONS In Canada, ceftobiprole is used mostly as directed therapy to treat a variety of severe infections caused by MRSA, in patients failing previous antimicrobials. It is frequently added to, and thus used in combination with daptomycin and/or vancomycin with high microbiological/clinical cure rates, and an excellent safety profile.
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Affiliation(s)
- George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin Kosar
- Department of Pharmacy, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Melanie Baxter
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rita Dhami
- Department of Pharmacy, London Health Sciences Centre, London, Ontario, Canada
| | - Sergio Borgia
- Section of Infectious Diseases, William Osler Health System, Brampton, Ontario, Canada
| | - Neal Irfan
- Department of Pharmacy, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - Gordon Dow
- Section of Infectious Diseases, Department of Medicine, The Moncton Hospital, New Brunswick, Canada
| | - Maxime Dube
- Department of Pharmacy, Sainte-Croix Hospital, Drummondville, Québec, Canada
| | | | - Carlo Tascini
- Infectious Diseases Clinic, DAME, Udine University Hospital, Udine, Italy
| | - Anna Lee
- Department of Pharmacy, Scarborough Health Network, Toronto, Ontario, Canada
| | - Zain Chagla
- Section of Infectious Diseases, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Gabriel Girouard
- Section of Infectious Diseases, Dr. Georges-L.-Dumont University Hospital, Moncton, New Brunswich, Canada
| | - Samuel Bourassa-Blanchette
- Medical Microbiology and Infectious Diseases, Memorial University of Newfoundland Faculty of Medicine, St. John's, Newfoundland, Canada
| | - May Wu
- Department of Pharmacy, Surrey Memorial Hospital, Vancouver, British Columbia, Canada
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Walkty
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James A Karlowsky
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Russo A, Serraino R, Serapide F, Trecarichi EM, Torti C. New advances in management and treatment of cardiac implantable electronic devices infections. Infection 2024; 52:323-336. [PMID: 37996646 PMCID: PMC10955036 DOI: 10.1007/s15010-023-02130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Cardiac implantable electronic devices (CIED) are increasingly used worldwide, and infection of these devices remains one of the most feared complications.CIED infections (CDIs) represent a challenge for physicians and the healthcare system in general as they require prolonged hospitalization and antibiotic treatment and are burdened by high mortality and high costs, so management of CDIs must be multidisciplinary.The exact incidence of CDIs is difficult to define, considering that it is influenced by various factors mainly represented by the implanted device and the type of procedure. Risk factors for CDIs could be divided into three categories: device related, patient related, and procedural related and the etiology is mainly sustained by Gram-positive bacteria; however, other etiologies cannot be underestimated. As a matter of fact, the two cornerstones in the treatment of these infections are device removal and antimicrobial treatment. Finally, therapeutic drug monitoring and PK/PD correlations should be encouraged in all patients with CDIs receiving antibiotic therapy and may result in a better clinical outcome and a reduction in antibiotic resistance and economic costs.In this narrative review, we look at what is new in the management of these difficult-to-treat infections.
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Affiliation(s)
- Alessandro Russo
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Riccardo Serraino
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Francesca Serapide
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
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Bavaro DF, Belati A, Bussini L, Cento V, Diella L, Gatti M, Saracino A, Pea F, Viale P, Bartoletti M. Safety and effectiveness of fifth generation cephalosporins for the treatment of methicillin-resistant staphylococcus aureus bloodstream infections: a narrative review exploring past, present, and future. Expert Opin Drug Saf 2024; 23:9-36. [PMID: 38145925 DOI: 10.1080/14740338.2023.2299377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) is a major issue in healthcare, since it is often associated with endocarditis or deep site foci. Relevant morbidity and mortality associated with MRSA-BSIs forced the development of new antibiotic strategies; in particular, this review will focus the attention on fifth-generation cephalosporins (ceftaroline/ceftobiprole), that are the only ß-lactams active against MRSA. AREAS COVERED The review discusses the available randomized controlled trials and real-world observational studies conducted on safety and effectiveness of ceftaroline/ceftobiprole for the treatment of MRSA-BSIs. Finally, a proposal of MRSA-BSI treatment flowchart, based on fifth-generation cephalosporins, is described. EXPERT OPINION The use of anti-MRSA cephalosporins is an acceptable choice either in monotherapy or combination therapy for the treatment of MRSA-BSIs due to their relevant effectiveness and safety. Particularly, their use may be advisable in combination therapy in case of severe infections (including endocarditis or persistent bacteriemia) or in monotherapy in subjects at higher risk of drugs-induced toxicity with older regimens. On the contrary, caution should be taken in case of suspected/ascertained central nervous system infections due to inconsistent data regarding penetration of these drugs in cerebrospinal fluid and brain tissues.
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Affiliation(s)
- Davide Fiore Bavaro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Belati
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Linda Bussini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valeria Cento
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Microbiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lucia Diella
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Oliva A, Cogliati Dezza F, Cancelli F, Curtolo A, Falletta A, Volpicelli L, Venditti M. New Antimicrobials and New Therapy Strategies for Endocarditis: Weapons That Should Be Defended. J Clin Med 2023; 12:7693. [PMID: 38137762 PMCID: PMC10743892 DOI: 10.3390/jcm12247693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
The overall low-quality evidence concerning the clinical benefits of different antibiotic regimens for the treatment of infective endocarditis (IE), which has made it difficult to strongly support or reject any regimen of antibiotic therapy, has led to a discrepancy between the available guidelines and clinical practice. In this complex scenario, very recently published guidelines have attempted to fill this gap. Indeed, in recent years several antimicrobials have entered the market, including ceftobiprole, ceftaroline, and the long-acting lipoglycopeptides dalbavancin and oritavancin. Despite being approved for different indications, real-world data on their use for the treatment of IE, alone or in combination, has accumulated over time. Furthermore, an old antibiotic, fosfomycin, has gained renewed interest for the treatment of complicated infections such as IE. In this narrative review, we focused on new antimicrobials and therapeutic strategies that we believe may provide important contributions to the advancement of Gram-positive IE treatment, providing a summary of the current in vitro, in vivo, and clinical evidence supporting their use in clinical practice.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.C.); (A.C.); (A.F.); (L.V.); (M.V.)
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Arnés García D, Pitto-Robles I, Calderón Parra J, Calvo Salvador M, Herrero Rodríguez C, Gisbert L, Hidalgo-Tenorio C. Ceft-to-Ceft Study: Real-Life Experience with Ceftaroline and Ceftobiprole in Treatment of the Principal Infectious Syndromes in a Spanish Multicenter Hospital Cohort. Antibiotics (Basel) 2023; 12:1692. [PMID: 38136726 PMCID: PMC10740782 DOI: 10.3390/antibiotics12121692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND To compare the real-life effectiveness and safety of ceftaroline fosamil (ceftaroline-F) and ceftobiprole medocaril (ceftobiprole-M) for infections in hospitalized patients. METHODS This comparative, observational, retrospective, and multicenter Spanish study included patients receiving outpatient parenteral antimicrobial therapy (OPAT) and hospitalized patients treated for at least 48 h with ceftaroline-F or ceftobiprole-M between their first incorporation in the clinical protocol of each hospital and 31 July 2022. RESULTS Ceftaroline-F was administered to 227 patients and ceftobiprole-M to 212. In comparison to the latter, ceftaroline-F-treated participants were younger (63.02 vs. 66.40 years, OR 1.1; 95%CI: 1.001-1.05) and had higher rates of septic shock (OR 0.27; 95%CI: 0.09-0.81) and higher frequencies of targeted (57.7 vs. 29.7%; OR: 0.35; 95%CI: 0.18-0.69) and combined (89.0 vs. 45.8%, OR: 0.13; 95%CI: 0.06-0.28) therapies that were second line or more (82.4% vs. 64.6%%; OR 0.35; 95%CI: 0.18-0.69), and higher rates of infections due to Gram-positive cocci (92.7 vs. 64.7%, p = 0.001), bacteremia (51.9 vs. 21.7%, p = 0.001), infective endocarditis (24.2 vs. 2.4%, p = 0.0001), and mechanical ventilation-associated pneumonia (8.8 vs. 2.4%, p = 0.0001). Ceftobiprole-M was more frequently administered against polymicrobial infections (38.1 vs. 14.0%, p = 0.001), those produced by Gram-negative bacilli (19.7 vs. 6.0%, p = 0.0001), nosocomial pneumonia (33 vs. 10.6%, p = 0.0001), and skin and soft-tissue infections (25.4 vs. 10.1%, p = 0.0001). Patients treated with ceftaroline-F had a longer hospital stay (36 (IQR: 19-60) vs. 19.50 (IQR: 12-30.75, p = 0.0001) days), with no difference in infection-related mortality at 14 (13.2 vs. 8.0%, p = 0.078) or 28 (4.8 vs. 3.3%, p = 0.415) days or in dropout rate for adverse effects (2.2 vs. 0.9%; p = 1). CONCLUSIONS The fifth-generation cephalosporins, ceftaroline-F and ceftobiprole-M, are safe and effective in real life, with no difference between them in health outcomes.
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Affiliation(s)
- Daniel Arnés García
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; (D.A.G.); (I.P.-R.)
| | - Inés Pitto-Robles
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; (D.A.G.); (I.P.-R.)
| | - Jorge Calderón Parra
- Unidad Enfermedades Infecciosas, Hospital Puerta de Hierro de Majadahonda, 28222 Madrid, Spain;
| | - Marina Calvo Salvador
- Servicio de Farmacia, Hospital Puerta de Hierro de Majadahonda, 28222 Madrid, Spain;
| | - Carmen Herrero Rodríguez
- Unidad de Enfermedades Infecciosas y Microbiología, Complejo Hospitalario de Jaén, 23007 Jaén, Spain;
| | - Laura Gisbert
- Unidad de Enfermedades Infecciosas, Hospital Universitario Mútua de Terrassa, 08221 Barcelona, Spain;
| | - Carmen Hidalgo-Tenorio
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada (IBS-Granada), 18014 Granada, Spain
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Gatti M, Tedeschi S, Zamparini E, Pea F, Viale P. Pharmacokinetic and pharmacodynamic considerations for optimizing antimicrobial therapy used to treat bone and joint infections: an evidence-based algorithmic approach. Expert Opin Drug Metab Toxicol 2023; 19:511-535. [PMID: 37671793 DOI: 10.1080/17425255.2023.2255525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Bone and joint infections (BJIs) are a major health concern causing remarkable morbidity and mortality. However, which antimicrobial treatment could be the best according to specific clinical scenarios and/or to the pharmacokinetic/pharmacodynamic (PK/PD) features remains an unmet clinical need. This multidisciplinary opinion article aims to develop evidence-based algorithms for empirical and targeted antibiotic therapy of patients affected by BJIs. AREAS COVERED A multidisciplinary team of four experts had several rounds of assessment for developing algorithms devoted to empirical and targeted antimicrobial therapy of BJIs. A literature search was performed on PubMed-MEDLINE (until April 2023) to provide evidence for supporting therapeutic choices. Four different clinical scenarios were structured according to specific infection types (i.e. vertebral osteomyelitis, prosthetic joint infections, infected non-unions and other chronic osteomyelitis, and infectious arthritis), need or not of surgical intervention or revision, isolation or not of clinically relevant bacterial pathogens from blood and/or tissue cultures, and PK/PD features of antibiotics. EXPERT OPINION The proposed therapeutic algorithms were based on a multifaceted approach considering the peculiar features of each antibiotic (spectrum of activity, PK/PD properties, bone penetration rate, and anti-biofilm activity), and could be hopefully helpful in improving clinical outcome of BJIs.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Sara Tedeschi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eleonora Zamparini
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Tascini C, Giuliano S, Attanasio V, Segreti L, Ripoli A, Sbrana F, Severino S, Sordelli C, Weisz SH, Zanus-Fortes A, Leanza GM, Carannante N, Di Cori A, Bongiorni MG, Zucchelli G, De Vivo S. Safety and Efficacy of a Single Procedure of Extraction and Reimplantation of Infected Cardiovascular Implantable Electronic Device (CIED) in Comparison with Deferral Timing: An Observational Retrospective Multicentric Study. Antibiotics (Basel) 2023; 12:1001. [PMID: 37370320 DOI: 10.3390/antibiotics12061001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Infections are among the most frequent and life-threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single-procedure device extraction and contralateral implantation versus the standard-of-care (SoC) two-stage replacement for infected CIEDs. (2) Methods: We retrospectively included 66 patients with CIED infections who were treated at two Italian hospitals. Of the 66 patients enrolled in the study, 27 underwent a single procedure, whereas 39 received SoC treatment. All patients were followed up for 12 months after the procedure. (3) Results: Considering those lost to follow-up, there were no differences in the mortality rates between the two cohorts, with survival rates of 81.5% in the single-procedure group and 84.6% in the SoC group (p = 0.075). (4) Conclusions: Single-procedure reimplantation associated with an active antibiofilm therapy may be a feasible and effective therapeutic option in CIED-dependent and frail patients. Further studies are warranted to define the best treatment regimen and strategies to select patients suitable for the single-procedure reimplantation.
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Affiliation(s)
- Carlo Tascini
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Simone Giuliano
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Vittorio Attanasio
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, 56124 Pisa, Italy
| | - Sergio Severino
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Chiara Sordelli
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Sara Hana Weisz
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Agnese Zanus-Fortes
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Gabriele Maria Leanza
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Stefano De Vivo
- UOC di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, 80131 Napoli, Italy
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Abstract
Almost all bactericidal drugs require bacterial replication and/or metabolic activity for their killing activity. When these processes are inhibited by bacteriostatic antibiotics, bacterial killing is significantly reduced. One notable exception is the lipopeptide antibiotic daptomycin, which has been reported to efficiently kill growth-arrested bacteria. However, these studies employed only short periods of growth arrest (<1 h), which may not fully represent the duration of growth arrest that can occur in vivo. We found that a growth inhibitory concentration of the protein synthesis inhibitor tetracycline led to a time-dependent induction of daptomycin tolerance in S. aureus, with an approximately 100,000-fold increase in survival after 16 h of growth arrest, relative to exponential-phase bacteria. Daptomycin tolerance required glucose and was associated with increased production of the cell wall polymers peptidoglycan and wall-teichoic acids. However, while the accumulation of peptidoglycan was required for daptomycin tolerance, only a low abundance of wall teichoic acid was necessary. Therefore, whereas tolerance to most antibiotics occurs passively due to a lack of metabolic activity and/or replication, daptomycin tolerance arises via active cell wall remodelling. IMPORTANCE Understanding why antibiotics sometimes fail to cure infections is fundamental to improving treatment outcomes. This is a major challenge when it comes to Staphylococcus aureus because this pathogen causes several different chronic or recurrent infections. Previous work has shown that a lack of replication, as often occurs during infection, makes bacteria tolerant of most bactericidal antibiotics. However, one antibiotic that has been reported to kill nonreplicating bacteria is daptomycin. In this work, we show that the growth arrest of S. aureus does in fact lead to daptomycin tolerance, but it requires time, nutrients, and biosynthetic pathways, making it distinct from other types of antibiotic tolerance that occur in nonreplicating bacteria.
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Synergistic Combinations of FDA-Approved Drugs with Ceftobiprole against Methicillin-Resistant Staphylococcus aureus. Microbiol Spectr 2023; 11:e0372622. [PMID: 36519895 PMCID: PMC9927495 DOI: 10.1128/spectrum.03726-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
New strategies are urgently needed to address the public health threat of antimicrobial resistance. Synergistic agent combinations provide one possible pathway toward addressing this need and are also of fundamental mechanistic interest. Effective methods for comprehensively identifying synergistic agent combinations are required for such efforts. In this study, an FDA-approved drug library was screened against methicillin-resistant Staphylococcus aureus (MRSA) (ATCC 43300) in the absence and presence of sub-MIC levels of ceftobiprole, a PBP2a-targeted anti-MRSA β-lactam. This screening identified numerous potential synergistic agent combinations, which were then confirmed and characterized for synergy using checkerboard analyses. The initial group of synergistic agents (sum of the minimum fractional inhibitory concentration ∑FICmin ≤0.5) were all β-lactamase-resistant β-lactams (cloxacillin, dicloxacillin, flucloxacillin, oxacillin, nafcillin, and cefotaxime). Cloxacillin-the agent with the greatest synergy with ceftobiprole-is also highly synergistic with ceftaroline, another PBP2a-targeted β-lactam. Further follow-up studies revealed a range of ceftobiprole synergies with other β-lactams, including with imipenem, meropenem, piperacillin, tazobactam, and cefoxitin. Interestingly, given that essentially all other ceftobiprole-β-lactam combinations showed synergy, ceftaroline and ceftobiprole showed no synergy. Modest to no synergy (0.5 < ∑FICmin ≤ 1.0) was observed for several non-β-lactam agents, including vancomycin, daptomycin, balofloxacin, and floxuridine. Mupirocin had antagonistic activity with ceftobiprole. Flucloxacillin appeared particularly promising, with both a low intrinsic MIC and good synergy with ceftobiprole. That so many β-lactam combinations with ceftobiprole show synergy suggests that β-lactam combinations can generally increase β-lactam effectiveness and may also be useful in reducing resistance emergence and spread in MRSA. IMPORTANCE Antimicrobial resistance represents a serious threat to public health. Antibacterial agent combinations provide a potential approach to combating this problem, and synergistic agent combinations-in which each agent enhances the antimicrobial activity of the other-are particularly valuable in this regard. Ceftobiprole is a late-generation β-lactam antibiotic developed for MRSA infections. Resistance has emerged to ceftobiprole, jeopardizing this agent's effectiveness. To identify synergistic agent combinations with ceftobiprole, an FDA-approved drug library was screened for potential synergistic combinations with ceftobiprole. This screening and follow-up studies identified numerous β-lactams with ceftobiprole synergy.
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Targeted Therapy of Severe Infections Caused by Staphylococcus aureus in Critically Ill Adult Patients: A Multidisciplinary Proposal of Therapeutic Algorithms Based on Real-World Evidence. Microorganisms 2023; 11:microorganisms11020394. [PMID: 36838359 PMCID: PMC9960997 DOI: 10.3390/microorganisms11020394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
(1) Introduction: To develop evidence-based algorithms for targeted antibiotic therapy of infections caused by Staphylococcus aureus in critically ill adult patients. (2) Methods: A multidisciplinary team of four experts had several rounds of assessment for developing algorithms concerning targeted antimicrobial therapy of severe infections caused by Staphylococcus aureus in critically ill patients. The literature search was performed by a researcher on PubMed-MEDLINE (until August 2022) to provide evidence for supporting therapeutic choices. Quality and strength of evidence was established according to a hierarchical scale of the study design. Two different algorithms were created, one for methicillin-susceptible Staphylococcus aureus (MSSA) and the other for methicillin-resistant Staphylococcus aureus (MRSA). The therapeutic options were categorized for each different site of infection and were selected also on the basis of pharmacokinetic/pharmacodynamic features. (3) Results: Cefazolin or oxacillin were the agents proposed for all of the different types of severe MSSA infections. The proposed targeted therapies for severe MRSA infections were different according to the infection site: daptomycin plus fosfomycin or ceftaroline or ceftobiprole for bloodstream infections, infective endocarditis, and/or infections associated with intracardiac/intravascular devices; ceftaroline or ceftobiprole for community-acquired pneumonia; linezolid alone or plus fosfomycin for infection-related ventilator-associated complications or for central nervous system infections; daptomycin alone or plus clindamycin for necrotizing skin and soft tissue infections. (4) Conclusions: We are confident that targeted therapies based on scientific evidence and optimization of the pharmacokinetic/pharmacodynamic features of antibiotic monotherapy or combo therapy may represent valuable strategies for treating MSSA and MRSA infections.
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Gómez-Sánchez E, Franco-de la Torre L, Hernández-Gómez A, Alonso-Castro ÁJ, Serafín-Higuera N, Terán-Rosales F, Bologna-Molina RE, Isiordia-Espinoza MA. Antagonistic, synergistic, and additive antibacterial interaction between ciprofloxacin and amoxicillin against Staphylococcus aureus. Fundam Clin Pharmacol 2023; 37:174-181. [PMID: 36099212 DOI: 10.1111/fcp.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023]
Abstract
The aim of this in vitro study was to evaluate the interaction between ciprofloxacin and amoxicillin against beta-lactamase-producing Staphylococcus aureus. Concentration-dependent curves for each individual drug were carried out to obtain the mean inhibitory concentration in the agar well diffusion assay. Then, different ratios of the ciprofloxacin-amoxicillin combination (0.5:0.5, 0.8:0.2, 0.2:0.8, 0.9:0.1, 0.1:0.9, 0.95:0.05, and 0.05:0.95) were assessed. Data were analyzed using the isobolographic analysis and interaction index. The isobolographic evaluation shows that the 0.9:0.1 and 0.95:0.05 ratios of the ciprofloxacin-amoxicillin combination produced a synergistic antimicrobial interaction, the 0.8:0.2, 0.2:0.8, 0.1:0.9, and 0.05:0.95 proportions showed an additive antibacterial effect, and the 0.5:0.5 proportion induced antagonistic antimicrobial effects. The interaction index showed similar outcomes to the isobolographic analysis. In conclusion, the data of this study mainly show antimicrobial additive results of the ciprofloxacin-amoxicillin combination against beta-lactamase-producing S. aureus.
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Affiliation(s)
- Eduardo Gómez-Sánchez
- Departamento de Ciencias Fisiológicas, División de Disciplinas Básicas para la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Tepatitlán de Morelos, Jalisco, Mexico
| | - Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Jalisco, Mexico
| | - Adriana Hernández-Gómez
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Jalisco, Mexico
| | - Ángel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico
| | - Nicolás Serafín-Higuera
- Facultad de Odontología, Universidad Autónoma de Baja California, Mexicali, Baja California, Mexico
| | - Flavio Terán-Rosales
- Sección de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | | | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Jalisco, Mexico
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Antonello RM, Canetti D, Riccardi N. Daptomycin synergistic properties from in vitro and in vivo studies: a systematic review. J Antimicrob Chemother 2022; 78:52-77. [PMID: 36227704 DOI: 10.1093/jac/dkac346] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/21/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Daptomycin is a bactericidal lipopeptide antibiotic approved for the treatment of systemic infections (i.e. skin and soft tissue infections, bloodstream infections, infective endocarditis) caused by Gram-positive cocci. It is often prescribed in association with a partner drug to increase its bactericidal effect and to prevent the emergence of resistant strains during treatment; however, its synergistic properties are still under evaluation. METHODS We performed a systematic review to offer clinicians an updated overview of daptomycin synergistic properties from in vitro and in vivo studies. Moreover, we reported all in vitro and in vivo data evaluating daptomycin in combination with other antibiotic agents, subdivided by antibiotic classes, and a summary graph presenting the most favourable combinations at a glance. RESULTS A total of 92 studies and 1087 isolates (723 Staphylococcus aureus, 68 Staphylococcus epidermidis, 179 Enterococcus faecium, 105 Enterococcus faecalis, 12 Enterococcus durans) were included. Synergism accounted for 30.9% of total interactions, while indifferent effect was the most frequently observed interaction (41.9%). Antagonistic effect accounted for 0.7% of total interactions. The highest synergistic rates against S. aureus were observed with daptomycin in combination with fosfomycin (55.6%). For S. epidermidis and Enterococcus spp., the most effective combinations were daptomycin plus ceftobiprole (50%) and daptomycin plus fosfomycin (63.6%) or rifampicin (62.8%), respectively. FUTURE PERSPECTIVES We believe this systematic review could be useful for the future updates of guidelines on systemic infections where daptomycin plays a key role.
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Affiliation(s)
- Roberta Maria Antonello
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50121, Italy
| | - Diana Canetti
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Niccolò Riccardi
- Department of Clinical and Experimental Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa 56124, Italy
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Antibiotic sensitivity analysis of clinical coagulase-negative staphylococci. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. The increasing role of coagulase-negative staphylococci in the occurrence of staphylococcal infections leads to the need for close attention to them. Special control is required over the sensitivity of bacteria to antibiotics and the spread of methicillin resistance, as a sign of multiple resistance to antibacterial drugs. It is also important to identify the virulence factors of coagulase-negative staphylococci, which determine their behavior in the environment.The aim. To evaluate the sensitivity of strains of coagulase-negative staphylococci to clinically significant antibiotics daptomycin, vancomycin, linezolid and oxacillin and lantibiotic warnerin.Methods. Determination of the minimal inhibitory concentrations of antibacterial compounds for clinical coagulase-negative staphylococci by standard methods of serial dilutions and disc diffusion. Identification of the phenomenon of decreased susceptibility of bacteria to vancomycin by population analysis and concentration gradient. Lipid analysis by thin layer chromatography. Results. High antibacterial activity of vancomycin, daptomycin and linezolid against clinical strains of coagulase-negative staphylococci was shown. The upper limit of the minimum inhibitory concentrations of vancomycin within the sensitive phenotype and the expansion of the ranges of the minimum inhibitory concentrations of daptomycin and warnerin towards an increase in oxacillin-resistant isolates were revealed. The heterogeneous nature of sensitivity to vancomycin of the cultures of the studied strains and the possibility of their rapid enrichment with subpopulations with reduced sensitivity to this antibiotic have been established. The selection of resistance of coagulase-negative staphylococci to vancomycin was accompanied by an increase in the synthesis of lysylphosphatidylglycerol and a decrease in their sensitivity to cationic peptide compounds.Conclusion. The revealed prevalence of the methicillin-resistant phenotype of clinical strains of coagulase-negative staphylococci, along with the presence in the lipid spectrum of the universal factor of resistance to cationic antibacterial compounds, lysylphosphatidylglycerol, entails the need for new methodological solutions for diagnosing infections caused by coagulase-negative staphylococci.
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Phenotypic and genetic changes associated with the seesaw effect in MRSA strain N315 in a bioreactor model. J Glob Antimicrob Resist 2022; 28:249-253. [PMID: 35085792 PMCID: PMC9576143 DOI: 10.1016/j.jgar.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives: Over the past decade, daptomycin treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to the emergence of daptomycin nonsusceptible (DAP-NS) MRSA strains and a subsequent interest in combinatorial antibiotic therapies. We investigated the phenotypic and genetic changes associated with the seesaw effect, which describes the correlation between daptomycin resistance and increased β-lactam susceptibility in DAP-NS MRSA and the reverse phenomenon of DAP-NS strains acquiring renewed susceptibility to daptomycin after β-lactam exposure. Methods: A continuous bioreactor model was used to study the effects of incremental doses of daptomycin followed by oxacillin on MRSA strain N315. Minimum inhibitory concentrations for daptomycin and oxacillin were determined for the bioreactor-derived samples. Transmission electron microscopy and cytochrome C binding assays were used to measure cell wall thickness and cell membrane charge, respectively, in the bioreactor-derived samples. Whole-genome sequencing was used to identify mutations associated with the seesaw effect. Results: Although daptomycin resistance conferred enhanced susceptibility to oxacillin, oxacillin treatment of DAP-NS strains was accompanied by a lowered minimum inhibitory concentration for daptomycin. Additionally, there was a reduction in relative positive cell surface charge and cell wall thickness. However, the mutations acquired in our DAP-NS populations were not accompanied by additional genomic changes after treatment with oxacillin, implicating alternative mechanisms for the seesaw effect. Conclusion: In this study, we successfully produced and characterized the seesaw effect in MRSA strain N315 in a unique bioreactor model.
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Oh S, Chau R, Nguyen AT, Lenhard JR. Losing the Battle but Winning the War: Can Defeated Antibacterials Form Alliances to Combat Drug-Resistant Pathogens? Antibiotics (Basel) 2021; 10:antibiotics10060646. [PMID: 34071451 PMCID: PMC8227011 DOI: 10.3390/antibiotics10060646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Despite the recent development of antibacterials that are active against multidrug-resistant pathogens, drug combinations are often necessary to optimize the killing of difficult-to-treat organisms. Antimicrobial combinations typically are composed of multiple agents that are active against the target organism; however, many studies have investigated the potential utility of combinations that consist of one or more antibacterials that individually are incapable of killing the relevant pathogen. The current review summarizes in vitro, in vivo, and clinical studies that evaluate combinations that include at least one drug that is not active individually against Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, or Staphylococcus aureus. Polymyxins were often included in combinations against all three of the Gram-negative pathogens, and carbapenems were commonly incorporated into combinations against K. pneumoniae and A. baumannii. Minocycline, sulbactam, and rifampin were also frequently investigated in combinations against A. baumannii, whereas the addition of ceftaroline or another β-lactam to vancomycin or daptomycin showed promise against S. aureus with reduced susceptibility to vancomycin or daptomycin. Although additional clinical studies are needed to define the optimal combination against specific drug-resistant pathogens, the large amount of in vitro and in vivo studies available in the literature may provide some guidance on the rational design of antibacterial combinations.
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Real-Time Therapeutic Drug Monitoring-Based Pharmacokinetic/Pharmacodynamic Optimization of Complex Antimicrobial Therapy in a Critically Ill Morbidly Obese Patient. Grand Round/A Case Study. Ther Drug Monit 2021; 42:349-352. [PMID: 32039939 DOI: 10.1097/ftd.0000000000000740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The authors present the case of a critically ill morbidly obese patient (body mass index, 51.2 kg/m) who suffered from methicillin-resistant Staphylococcus epidermidis, and Candida albicans bloodstream infections. Initial treatment with caspofungin and daptomycin was deemed inappropriate, because blood cultures remained positive for both isolates after 14 days. The clinical pharmacological consultant suggested adding fluconazole and ceftobiprole to the ongoing antimicrobial therapy, and starting a real-time therapeutic drug monitoring program of daptomycin, ceftobiprole, and fluconazole, aimed at optimizing plasma exposures. Punctual minimum inhibitory concentration knowledge on the clinical isolates allowed attainment of the desired pharmacodynamic efficacy targets. Within few days, the patient greatly improved, as blood cultures became negative, and the inflammatory markers decreased to near normal values. This is a proof-of-concept of the importance of a therapeutic drug monitoring-based multidisciplinary approach in the proper management of complex antimicrobial therapy in special populations.
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18
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Xu E, Pérez-Torres D, Fragkou PC, Zahar JR, Koulenti D. Nosocomial Pneumonia in the Era of Multidrug-Resistance: Updates in Diagnosis and Management. Microorganisms 2021; 9:534. [PMID: 33807623 PMCID: PMC8001201 DOI: 10.3390/microorganisms9030534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Nosocomial pneumonia (NP), including hospital-acquired pneumonia in non-intubated patients and ventilator-associated pneumonia, is one of the most frequent hospital-acquired infections, especially in the intensive care unit. NP has a significant impact on morbidity, mortality and health care costs, especially when the implicated pathogens are multidrug-resistant ones. This narrative review aims to critically review what is new in the field of NP, specifically, diagnosis and antibiotic treatment. Regarding novel imaging modalities, the current role of lung ultrasound and low radiation computed tomography are discussed, while regarding etiological diagnosis, recent developments in rapid microbiological confirmation, such as syndromic rapid multiplex Polymerase Chain Reaction panels are presented and compared with conventional cultures. Additionally, the volatile compounds/electronic nose, a promising diagnostic tool for the future is briefly presented. With respect to NP management, antibiotics approved for the indication of NP during the last decade are discussed, namely, ceftobiprole medocaril, telavancin, ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam.
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Affiliation(s)
- Elena Xu
- Burns, Trauma and Critical Care Research Centre, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia;
| | - David Pérez-Torres
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, 47012 Valladolid, Spain;
| | - Paraskevi C. Fragkou
- Fourth Department of Internal Medicine, Attikon University Hospital, 12462 Athens, Greece;
| | - Jean-Ralph Zahar
- Microbiology Department, Infection Control Unit, Hospital Avicenne, 93000 Bobigny, France;
| | - Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia;
- Second Critical Care Department, Attikon University Hospital, 12462 Athens, Greece
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Lupia T, Pallotto C, Corcione S, Boglione L, De Rosa FG. Ceftobiprole Perspective: Current and Potential Future Indications. Antibiotics (Basel) 2021; 10:170. [PMID: 33567771 PMCID: PMC7915564 DOI: 10.3390/antibiotics10020170] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
Ceftobiprole combines an excellent spectrum for community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) pathogens, with a low/medium MDR risk, and the β-lactams' safety in frail patients admitted to the hospital in internal medicine wards which may be at high risk of adverse events by anti-MRSA coverage as oxazolidinones or glycopeptides. We aimed to report the available evidence regarding ceftobiprole use in pneumonia and invasive bacterial infections, shedding light on ceftobiprole stewardship. The clinical application and real-life experiences of using ceftobiprole for bloodstream infections, including infective endocarditis, are limited but nevertheless promising. In addition, extended-spectrum ceftobiprole activity, including Enterococcus faecalis, Enterobacteriaceae, and Pseudomonas aeruginosa, has theoretical advantages for use as empirical therapy in bacteremia potentially caused by a broad spectrum of microorganisms, such as catheter-related bacteremia. In the future, the desirable approach to sepsis and severe infections will be administered to patients according to their clinical situation, the intrinsic host characteristics, the susceptibility profile, and local epidemiology, while the "universal antibiotic strategy" will no longer be adequate.
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Affiliation(s)
- Tommaso Lupia
- Infectious Diseases Unit, Cardinal Massaia Hospital, 14100 Asti, Italy;
| | - Carlo Pallotto
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Central District, Tuscany Health Care, Bagno a Ripoli, 500012 Florence, Italy;
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy;
- Infectious Diseases, Tufts University School of Medicine, Boston, MA 02109, USA
| | - Lucio Boglione
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Francesco Giuseppe De Rosa
- Infectious Diseases Unit, Cardinal Massaia Hospital, 14100 Asti, Italy;
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy;
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Zhanel GG, Kosar J, Baxter M, Dhami R, Borgia S, Irfan N, MacDonald KS, Dow G, Lagacé-Wiens P, Dube M, Bergevin M, Tascini C, Keynan Y, Walkty A, Karlowsky J. Real-life experience with ceftobiprole in Canada: Results from the CLEAR (CanadianLEadership onAntimicrobialReal-life usage) registry. J Glob Antimicrob Resist 2021; 24:335-339. [PMID: 33540083 DOI: 10.1016/j.jgar.2021.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Ceftobiprole is an advanced-generation cephalosporin with a favourable safety profile. Published data on the clinical use of ceftobiprole are limited. We report use of ceftobiprole in Canadian patients using data captured by the CLEAR registry. METHODS The CLEAR registry uses the web-based research data management program REDCap™ (online survey) to facilitate clinicians entering details associated with their clinical experiences using ceftobiprole. RESULTS Data were available for 38 patients treated with ceftobiprole. The most common infections treated were endocarditis (42.1% of patients), bone and joint infection (23.7%) and hospital-associated bacterial pneumonia (15.8%). 92.1% of patients had bacteraemia and 21.1% were in intensive care. Ceftobiprole was used because of failure of (71.1%), resistance to (18.4%) or adverse effects from (10.5%) previously prescribed antimicrobial agents. Ceftobiprole was primarily used as directed therapy for methicillin-resistant Staphylococcus aureus (MRSA) infections (94.7% of patients). Ceftobiprole susceptibility testing was performed on isolates from 47.4% of patients. It was used concomitantly with daptomycin in 55.3% of patients and with vancomycin in 18.4% of patients. Treatment duration was primarily >10 days (65.8% of patients) with microbiological success in 97.0% and clinical success in 84.8% of patients. 2.6% of patients had gastrointestinal adverse effects. CONCLUSION In Canada to date, ceftobiprole is used as directed therapy to treat a variety of severe infections caused by MRSA. It is primarily used in patients failing previous antimicrobials, is frequently added to, and thus used in combination with daptomycin or vancomycin with high microbiological and clinical cure rates and an excellent safety profile.
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Affiliation(s)
- George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Justin Kosar
- Department of Pharmacy, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Melanie Baxter
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rita Dhami
- Department of Pharmacy, London Health Sciences Centre, London, Ontario, Canada
| | - Sergio Borgia
- Section of Infectious Diseases, William Osler Health System, Brampton, Ontario, Canada
| | - Neal Irfan
- Department of Pharmacy, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - Kelly S MacDonald
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gordon Dow
- Section of Infectious Diseases, Department of Medicine, The Moncton Hospital, New Brunswick, Canada
| | - Philippe Lagacé-Wiens
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maxime Dube
- Department of Pharmacy, Sainte-Croix Hospital, Drummondville, Québec, Canada
| | - Marco Bergevin
- Section of Infectious Diseases, Department of Medicine, Cité de la Santé, Montreal, Québec, Canada
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Walkty
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Karlowsky
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Sakoulas G. Case Commentary: Imipenem/Cilastatin and Fosfomycin for Refractory Methicillin-Resistant Staphylococcus aureus Infection: a Novel Combination Therapy. Antimicrob Agents Chemother 2020; 65:e02039-20. [PMID: 33020155 PMCID: PMC7927839 DOI: 10.1128/aac.02039-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Given that it is unlikely that randomized clinical trials will yield answers for treating the most challenging bacteremic infections caused by methicillin-resistant Staphylococcus aureus, clinicians, microbiologists, and pharmacists will have to cooperate to discover novel ways to select successful individualized antimicrobial therapy for these patients. An example of such a strategy was demonstrated in the identification and utilization of imipenem/cilastatin plus fosfomycin to treat a particularly recalcitrant MRSA bacteremia and spinal abscess.
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Affiliation(s)
- George Sakoulas
- Division of Host-Microbe Systems & Therapeutics, Center for Immunity, Infection & Inflammation, Collaborative to Halt Antimicrobial Resistant Microbes, University of California-San Diego School of Medicine, La Jolla, California, USA
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Morrisette T, Alosaimy S, Abdul-Mutakabbir JC, Kebriaei R, Rybak MJ. The Evolving Reduction of Vancomycin and Daptomycin Susceptibility in MRSA-Salvaging the Gold Standards with Combination Therapy. Antibiotics (Basel) 2020; 9:E762. [PMID: 33143290 PMCID: PMC7692208 DOI: 10.3390/antibiotics9110762] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 01/27/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is associated with substantial morbidity and mortality. Vancomycin (VAN) has been used as the gold standard treatment for invasive MRSA infections for decades but, unfortunately, the reliance of VAN as the primary treatment option against these infections has led to a reduction in VAN susceptibility in MRSA isolates. Although daptomycin (DAP) is another common treatment option against invasive MRSA infections, it has been shown that the development of VAN resistance can lead to DAP nonsusceptibility. VAN or DAP backbone regimens in combination with other antibiotics has been advocated as an alternative approach to improve patient outcomes in VAN/DAP-susceptible infections, enhance outcomes in infections caused by isolates with reduced VAN/DAP susceptibility, and/or prevent the emergence of VAN/DAP resistance or further resistance. A peer-reviewed literature search was conducted using Medline, Google Scholar and PubMed databases. The primary purpose of this review is to describe the mechanisms and epidemiology of MRSA isolates with a reduction in VAN and/or DAP susceptibility, evaluate in vitro and in vivo literature describing combination therapy (CT) against MRSA isolates with reduced VAN and/or DAP susceptibility and describe studies involving the clinical outcomes of patients treated with CT against invasive MRSA infections.
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
| | - Jacinda C. Abdul-Mutakabbir
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
| | - Razieh Kebriaei
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
- Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI 48201, USA
- Department of Pharmacy, Detroit Receiving Hospital, Detroit, MI 48201, USA
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Bassetti M, Carnelutti A, Castaldo N, Peghin M. Important new therapies for methicillin-resistant Staphylococcus aureus. Expert Opin Pharmacother 2019; 20:2317-2334. [PMID: 31622115 DOI: 10.1080/14656566.2019.1675637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) infections represent a leading cause of infection-related morbidity and mortality worldwide. There has been a welcome increase in the number of agents available for the treatment of MRSA infection over the last decade and several clinical trials are currently investigating the role of new experimental strategies.Areas covered: The purpose of this manuscript is to review the efficacy and safety of recently approved anti-MRSA molecules as well as some newer agents currently under investigation with a specific focus on the potential role of these drugs in everyday clinical practice.Expert opinion: Many new drugs with an activity against MRSA have been recently approved or are in an advanced stage of development. All these compounds represent promising options to enhance our antibiotic armamentarium. However, data regarding the use of these new compounds in real-life terms are limited and their best placement in therapy and in terms of optimization of medical resources and balance of cost-effectiveness requires further investigation.
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Affiliation(s)
- Matteo Bassetti
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Alessia Carnelutti
- Department of Medicine, Infectious Disease Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Nadia Castaldo
- Department of Medicine, Infectious Disease Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Maddalena Peghin
- Department of Medicine, Infectious Disease Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
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Giacobbe DR, De Rosa FG, Del Bono V, Grossi PA, Pea F, Petrosillo N, Rossolini GM, Tascini C, Tumbarello M, Viale P, Bassetti M. Ceftobiprole: drug evaluation and place in therapy. Expert Rev Anti Infect Ther 2019; 17:689-698. [PMID: 31553250 DOI: 10.1080/14787210.2019.1667229] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Ceftobiprole is a fifth-generation cephalosporin with a broad spectrum of antimicrobial activity, including also methicillin-resistant Staphylococcus aureus (MRSA). Ceftobiprole is approved for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia, in several European and non-European countries. Areas covered: In this narrative review, we discuss the current place in therapy of ceftobiprole, both within and outside approved indications. An inductive MEDLINE/PubMed search of the available literature was conducted. Expert opinion: There are three main reasons which render ceftobiprole an attractive option for the empirical and targeted treatment of CAP and HAP: (i) its broad spectrum of activity; (ii) its activity against MRSA; (iii) its good safety profile. For these indications, ceftobiprole should be employed thoughtfully, in those scenarios in which its intrinsic advantages could be maximized. The use of ceftobiprole outside approved indications could be justified in specific scenarios, such as when other approved alternatives are ineffective, when the risk of toxicity due to other agents is unacceptable, and for salvage therapy. In the near future, ongoing phase 3 studies and further observational experiences could both enlarge the current panel of approved indications and enrich our knowledge on the use of ceftobiprole for off-label indications.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa , Genoa , Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS , Genoa , Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences , Turin , Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle , Cuneo , Italy
| | | | - Federico Pea
- Department of Medicine, University of Udine and Institute of Clinical Pharmacology, Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia , Udine , Italy
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS , Rome , Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence , Florence , Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital , Florence , Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli , Naples , Italy
| | - Mario Tumbarello
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italy.,Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna , Bologna , Italy
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa , Genoa , Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS , Genoa , Italy.,Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine , Udine , Italy
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Antimicrobial resistance in methicillin-resistant Staphylococcus aureus to newer antimicrobial agents. Antimicrob Agents Chemother 2019:AAC.01216-19. [PMID: 31527033 DOI: 10.1128/aac.01216-19] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) result in significant morbidity and mortality for patients in both community and health care settings. This is primarily due to the difficulty in treating MRSA, which is often resistant to multiple classes of antibiotics. Understanding the mechanisms of antimicrobial resistance (AMR) in MRSA provides insight into the optimal use of antimicrobial agents in clinical practice and also underpins critical aspects of antimicrobial stewardship programs. In this review we delineate the mechanisms, prevalence, and clinical importance of resistance to antibiotics licensed in the past 20 years that target MRSA, as well as new drugs in the pipeline which are likely to be licensed soon. Current gaps in scientific knowledge about MRSA resistance mechanisms are discussed, and topics in the epidemiology of AMR in S. aureus that require further investigation are highlighted.
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Tascini C, Attanasio V, Ripa M, Carozza A, Pallotto C, Bernardo M, Francisci D, Oltolini C, Palmiero G, Scarpellini P. Ceftobiprole for the treatment of infective endocarditis: A case series. J Glob Antimicrob Resist 2019; 20:56-59. [PMID: 31351247 DOI: 10.1016/j.jgar.2019.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Ceftobiprole is a relatively new cephalosporin with broad-spectrum activity and good tolerability. Despite its promising characteristics, to our knowledge, only two case reports, previously published also by some of us, is available concerning its administration for the treatment of infective endocarditis. Hereby we report our experience in this field. METHODS All the patients with infective endocarditis treated with ceftobiprole were enrolled. RESULTS 12 cases of endocarditis were treated with ceftobiprole, 11/12 in combination with daptomycin and 1/12 as monotherapy. Gram-positive bacteria were isolated in 12/12 patients; 3 cases were polymicrobial. Cure rate was 83% (10/12 patients). In 9/12 (75%) cases, patients were switched to ceftobiprole following failure of previous antimicrobial regimen. In 3/3 patients in which ceftobiprole was administered because of persistently positive blood culture, bacteraemia clearance was rapidly achieved. CONCLUSIONS Ceftobiprole, especially in combination, could be a promising alternative treatment for infective endocarditis.
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Affiliation(s)
- Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, via Bianchi snc, Naples, Italy.
| | - Vittorio Attanasio
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, via Bianchi snc, Naples, Italy.
| | - Marco Ripa
- Department of Infectious Disease, San Raffaele Hospital, via Stamira d'Ancona, Milan, Italy.
| | - Antonio Carozza
- UOSD Advanced Techniques in Cardiosurgery, Monaldi Hospital, AORN dei Colli, via Bianchi, snc, Naples, Italy.
| | - Carlo Pallotto
- Section of Infectious Diseases, Department of Medicine, University of Perugia, Piazzale Gambuli, 1, Perugia, Italy; UOC Infectious Diseases, San Donato Hospital, Azienda USL Toscana Sud Est, via Nenni, 22, Arezzo, Italy.
| | - Mariano Bernardo
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, via Bianchi snc, Naples, Italy.
| | - Daniela Francisci
- Section of Infectious Diseases, Department of Medicine, University of Perugia, Piazzale Gambuli, 1, Perugia, Italy.
| | - Chiara Oltolini
- Department of Infectious Disease, San Raffaele Hospital, via Stamira d'Ancona, Milan, Italy.
| | - Giulia Palmiero
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, via Bianchi snc, Naples, Italy.
| | - Paolo Scarpellini
- Department of Infectious Disease, San Raffaele Hospital, via Stamira d'Ancona, Milan, Italy.
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Giacobbe DR, Corcione S, Salsano A, Del Puente F, Mornese Pinna S, De Rosa FG, Mikulska M, Santini F, Viscoli C. Current and emerging pharmacotherapy for the treatment of infections following open-heart surgery. Expert Opin Pharmacother 2019; 20:751-772. [PMID: 30785333 DOI: 10.1080/14656566.2019.1574753] [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] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Patients undergoing open-heart surgery may suffer from postoperative complications, including severe infections. Antimicrobials to treat infectious complications in this population should be selected thoughtfully, taking into account three different and fundamental issues: (i) the site of infection; (ii) the suspected or proven causative agent and its susceptibility pattern; and (iii) the risk of suboptimal pharmacokinetic characteristics and potential toxicity of the chosen drug/s. AREAS COVERED The present narrative review summarizes the current and future antimicrobial options for the treatment of infections developing after open-heart surgery. EXPERT OPINION The pharmacological treatment of infections developing in cardiac surgery patients poses peculiar challenges, including the need for an active empirical therapy for severe events such as bloodstream infections, deep sternal wound infections, or early-onset postoperative prosthetic endocarditis. In addition, the risk for multidrug-resistant pathogens should also be taken into account in endemic areas. A multidisciplinary evaluation on a patient-by-patient basis, deeply involving infectious diseases specialists and cardiothoracic surgeons, remains essential for appropriately balancing both short-term and long-term risks and benefits of any possible surgical reintervention in combination with adequate pharmacotherapy.
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Affiliation(s)
| | - Silvia Corcione
- b Department of Medical Sciences, Infectious Diseases , University of Turin , Turin , Italy
| | - Antonio Salsano
- c Division of Cardiac Surgery, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Filippo Del Puente
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy
| | - Simone Mornese Pinna
- b Department of Medical Sciences, Infectious Diseases , University of Turin , Turin , Italy
| | | | - Malgorzata Mikulska
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Francesco Santini
- c Division of Cardiac Surgery, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Claudio Viscoli
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
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Bactericidal activity of ceftobiprole combined with different antibiotics against selected Gram-positive isolates. Diagn Microbiol Infect Dis 2018; 93:77-81. [PMID: 30291042 DOI: 10.1016/j.diagmicrobio.2018.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/16/2018] [Accepted: 07/25/2018] [Indexed: 11/24/2022]
Abstract
This study investigated the in vitro susceptibility of ceftobiprole and its potential synergistic activity in combination with other antimicrobials against 46 selected Gram-positive pathogens displaying resistance or decrease susceptibility to several drugs. The gradient-cross method was used to assess synergism between ceftobiprole and daptomycin, levofloxacin, linezolid, rifampicin and piperacillin/tazobactam. Time-kill curves were performed for seven representative isolates. Ceftobiprole MICs ranged from 0.25-6 mg/L for staphylococci; 4-≥32 mg/L for Enterococcus faecalis, and 0.38-≥32 mg/L for E. faecium. Ceftobiprole plus daptomycin was synergistic against all isolates. Ceftobiprole plus linezolid was synergistic against 4 isolates belonging to different species. Ceftobiprole plus levofloxacin was synergistic only against enterococci. In conclusion, ceftobiprole exhibited a potent in vitro antibacterial activity and exhibited synergy with daptomycin against all Gram-positive isolates, despite their antibiotic resistance phenotypes. The use of ceftobiprole in combination may provide a promising alternative therapy for the treatment of resistant Gram-positive infections.
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Werth BJ. Exploring the pharmacodynamic interactions between tedizolid and other orally bioavailable antimicrobials against Staphylococcus aureus and Staphylococcus epidermidis. J Antimicrob Chemother 2018; 72:1410-1414. [PMID: 28158617 DOI: 10.1093/jac/dkw588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/22/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Tedizolid is an orally bioavailable oxazolidinone with once-daily dosing and broad-spectrum Gram-positive activity. Combination therapy is commonly indicated to improve efficacy against difficult-to-treat pathogens and biofilms. There are no studies describing the pharmacodynamic interactions between tedizolid and other orally bioavailable antimicrobials. Methods MICs of tedizolid, rifampicin, trimethoprim/sulfamethoxazole, doxycycline and moxifloxacin were determined by broth microdilution against a convenience sample of 45 staphylococcal isolates. Seven MRSA isolates and three Staphylococcus epidermidis were evaluated by time-kill using concentrations equal to 0.5× the MIC. These strains had variable susceptibility to the investigated antimicrobials. Synergy was defined as a ≥2 log 10 cfu/mL reduction of the combination over the most active single agent, antagonism was defined as ≥1 log 10 cfu/mL growth compared with the most active single agent, and other interactions were indifferent. Results Three of 45 strains tested were non-susceptible to tedizolid (MIC = 1 mg/L), but the MIC 90 was 0.5 mg/L. Interactions between tedizolid and other agents were largely indifferent (80%). Tedizolid was synergistic with doxycycline and rifampicin against 2/10 and 3/10 strains, respectively. Tedizolid was antagonistic with moxifloxacin against 3/10 strains. Other interactions were indifferent. Conclusions The addition of rifampicin to tedizolid appears to be the most likely to improve activity but synergy was not universal. The combination of tedizolid plus moxifloxacin should be avoided due to the risk of antagonism. The addition of other orally bioavailable anti-staphylococcal agents to tedizolid may be unlikely to improve killing but further research is warranted to assess the impact of these combinations on resistance prevention, or against biofilm-embedded organisms.
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Bal AM, David MZ, Garau J, Gottlieb T, Mazzei T, Scaglione F, Tattevin P, Gould IM. Future trends in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection: An in-depth review of newer antibiotics active against an enduring pathogen. J Glob Antimicrob Resist 2017; 10:295-303. [PMID: 28732783 DOI: 10.1016/j.jgar.2017.05.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/20/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major public health problem. Vancomycin and teicoplanin have been in clinical use for several decades but their drawbacks are well described. In the last 10 years, several antibiotics have been made available for clinical use. Daptomycin and linezolid have been extensively used during this period. Other agents such as ceftaroline, ceftobiprole, dalbavancin, oritavancin, tedizolid and telavancin have been approved by regulatory agencies since 2009. Many others, such as the newer tetracyclines, fluoroquinolones, oxazolidinones and pleuromutilins, are in various stages of development. In addition, an ongoing multicentre trial is investigating the role of combination of vancomycin or daptomycin with β-lactam antibiotics. This review discusses the role of the newer antibiotics, reflecting the views of the 6th MRSA Consensus Conference meeting of the International Society of Chemotherapy MRSA Working Group that took place in 2016.
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Affiliation(s)
- A M Bal
- Department of Microbiology, University Hospital Crosshouse, Kilmarnock KA2 0BE, UK.
| | - M Z David
- Departments of Medicine, Paediatrics, and Public Health Sciences, University of Chicago, Chicago, IL 60637, USA
| | - J Garau
- Department of Medicine, Hospital Universitari Mútua de Terrassa, Plaza Dr Robert 5, Barcelona 08221, Spain
| | - T Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW 2139, Australia
| | - T Mazzei
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Firenze, Firenze, Italy
| | - F Scaglione
- Department of Oncology and Onco-Haematology, University of Milan, Via Vanvitelli 32, 20129 Milan, Italy
| | - P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 35033 Rennes, France
| | - I M Gould
- Department of Microbiology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
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Daptomycin-β-Lactam Combinations in a Rabbit Model of Daptomycin-Nonsusceptible Methicillin-Resistant Staphylococcus aureus Endocarditis. Antimicrob Agents Chemother 2016; 60:3976-9. [PMID: 27090173 DOI: 10.1128/aac.00589-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/10/2016] [Indexed: 11/20/2022] Open
Abstract
Beta-lactams enhance the in vitro activity of daptomycin against methicillin-resistant strains of Staphylococcus aureus Experiments were performed in a rabbit model of aortic valve endocarditis caused by methicillin-resistant daptomycin-nonsusceptible S. aureus strain CB5054 to determine if a cephalosporin, ceftriaxone, administered as a once-daily dose of 100 mg/kg of body weight, or a carbapenem, ertapenem, administered as a once-daily dose of 40 mg/kg, improved the efficacy of daptomycin, administered as a once-daily dose of 12 mg/kg. Daptomycin was ineffective alone in reducing organism densities compared to untreated controls in vegetations and spleen, but densities were 1.4 log10 CFU/g lower in kidney. The combination of daptomycin plus ceftriaxone or daptomycin plus ertapenem reduced bacterial densities in all tissues compared to single agents, with 0.6 to 1.0 log10 CFU/g fewer organisms in vegetations, 1.5 to 2.5 log10 CFU/g fewer organisms in spleen, and 1.8 to 2.5 log10 CFU/g fewer organisms in kidney, although differences were statistically significant only in spleen for daptomycin plus ceftriaxone and in kidney for daptomycin plus ertapenem. Drug exposures in rabbits were less than those achievable in humans, which may have limited the in vivo activity, particularly in vegetations.
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Daptomycin in Combination with Ceftolozane-Tazobactam or Cefazolin against Daptomycin-Susceptible and -Nonsusceptible Staphylococcus aureus in an In Vitro, Hollow-Fiber Model. Antimicrob Agents Chemother 2016; 60:3970-5. [PMID: 27090172 DOI: 10.1128/aac.01666-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/04/2016] [Indexed: 11/20/2022] Open
Abstract
Ceftolozane-tazobactam (TOL-TAZ) is a novel cephalosporin/beta-lactamase inhibitor with activity against several Gram-negative pathogens. Daptomycin (DAP) has demonstrated synergistic activity with beta-lactams against methicillin-resistant Staphylococcus aureus (MRSA) isolates with reduced lipopeptide and glycopeptide susceptibilities. Our objective was to determine if DAP and TOL-TAZ possess synergy in hollow-fiber pharmacokinetic/pharmacodynamic (PK/PD) models. One isogenic pair of daptomycin-susceptible and daptomycin-nonsusceptible MRSA strains was evaluated. DAP, TOL-TAZ, and cefazolin (CFZ) MIC determinations were performed. DAP MIC determinations were also performed in the presence of subinhibitory concentrations of TOL-TAZ and CFZ. Ninety-six-hour in vitro models were run, simulating DAP at 10 mg/kg of body weight/day; TOL-TAZ at 1,500 mg every 8 h; TOL at 1,000 mg every 8 h; and DAP combined with TOL-TAZ (DAP+TOL-TAZ), DAP+TOL, DAP+TAZ, and DAP+CFZ at 2,000 mg every 8 h. DAP MICs were 0.5 and 4 μg/ml for strains R8845 and R8846, respectively. In the presence of CFZ, R8845 and R8846 DAP MICs were reduced 8-fold and 16-fold, respectively. TOL and TAZ had no effect on DAP MICs. PK/PD models demonstrated bactericidal activity with DAP+CFZ against both strains. The combination of DAP+TOL-TAZ was bactericidal against R8845 but was not bactericidal against daptomycin-nonsusceptible strain R8846. DAP+TOL and DAP+TAZ were not bactericidal. No other regimens were bactericidal. DAP+TOL-TAZ did not demonstrate synergistic activity against daptomycin-nonsusceptible S. aureus but prevented daptomycin-nonsusceptible MRSA emergence. Because DAP+TOL or TAZ alone did not prevent daptomycin-nonsusceptible MRSA emergence, the combination TOL-TAZ may be necessary for synergy with DAP. DAP+CFZ demonstrated enhancement against both strains. The combination of DAP+CFZ warrants further clinical study.
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Meticillin-resistant Staphylococcus aureus endocarditis: first report of daptomycin plus ceftobiprole combination as salvage therapy. Int J Antimicrob Agents 2016; 47:502-4. [DOI: 10.1016/j.ijantimicag.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/07/2016] [Accepted: 04/16/2016] [Indexed: 11/20/2022]
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Gonzalez-Ruiz A, Seaton RA, Hamed K. Daptomycin: an evidence-based review of its role in the treatment of Gram-positive infections. Infect Drug Resist 2016; 9:47-58. [PMID: 27143941 PMCID: PMC4846043 DOI: 10.2147/idr.s99046] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Infections caused by Gram-positive pathogens remain a major public health burden and are associated with high morbidity and mortality. Increasing rates of infection with Gram-positive bacteria and the emergence of resistance to commonly used antibiotics have led to the need for novel antibiotics. Daptomycin, a cyclic lipopeptide with rapid bactericidal activity against a wide range of Gram-positive bacteria including methicillin-resistant Staphylococcus aureus, has been shown to be effective and has a good safety profile for the approved indications of complicated skin and soft tissue infections (4 mg/kg/day), right-sided infective endocarditis caused by S. aureus, and bacteremia associated with complicated skin and soft tissue infections or right-sided infective endocarditis (6 mg/kg/day). Based on its pharmacokinetic profile and concentration-dependent bactericidal activity, high-dose (>6 mg/kg/day) daptomycin is considered an important treatment option in the management of various difficult-to-treat Gram-positive infections. Although daptomycin resistance has been documented, it remains uncommon despite the increasing use of daptomycin. To enhance activity and to minimize resistance, daptomycin in combination with other antibiotics has also been explored and found to be beneficial in certain severe infections. The availability of daptomycin via a 2-minute intravenous bolus facilitates its outpatient administration, providing an opportunity to reduce risk of health care-associated infections, improve patient satisfaction, and minimize health care costs. Daptomycin, not currently approved for use in the pediatric population, has been shown to be widely used for treating Gram-positive infections in children.
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Affiliation(s)
| | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Smith JR, Yim J, Raut A, Rybak MJ. Oritavancin Combinations with β-Lactams against Multidrug-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. Antimicrob Agents Chemother 2016; 60:2352-8. [PMID: 26833159 PMCID: PMC4808215 DOI: 10.1128/aac.03006-15] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/28/2016] [Indexed: 12/20/2022] Open
Abstract
Oritavancin possesses activity against vancomycin-resistant enterococci (VRE) and methicillin-resistantStaphylococcus aureus(MRSA).In vitrodata suggest synergy between beta-lactams (BLs) and vancomycin or daptomycin, agents similar to oritavancin. We evaluated the activities of BLs combined with oritavancin against MRSA and VRE. Oritavancin MICs were determined for 30 strains, 5 each of MRSA, daptomycin-nonsusceptible (DNS) MRSA, vancomycin-intermediate MRSA (VISA), heteroresistant VISA (hVISA), vancomycin-resistantEnterococcus faecalis, and vancomycin-resistantEnterococcus faecium Oritavancin MICs were determined in the presence of subinhibitory concentrations of BLs. Oritavancin combined with ceftaroline, cefazolin, or nafcillin was evaluated for lethal synergy against MRSA, and oritavancin combined with ceftaroline, ampicillin, or ertapenem was evaluated for lethal synergy against VRE in 24-h time-kill assays. Oritavancin at 0.5× the MIC was combined with BLs at 0.5× the MIC or the biological free peak concentration, whichever one was lower. Synergy was defined as a ≥2-log10-CFU/ml difference between the killing achieved with the combination and that achieved with the most active single agent at 24 h. Oritavancin MICs were ≤0.125 μg/ml for all MRSA isolates except three VISA isolates with MICs of 0.25 μg/ml. Oritavancin MICs for VRE ranged from 0.03 to 0.125 μg/ml. Oritavancin in combination with ceftaroline was synergistic against all MRSA phenotypes and statistically superior to all other combinations against DNS MRSA, hVISA, and MRSA isolates (P< 0.02). Oritavancin in combination with cefazolin and oritavancin in combination with nafcillin were also synergistic against all MRSA strains. Synergy between oritavancin and all BLs was revealed against VRE strain 8019, while synergy between oritavancin and ampicillin or ertapenem but not ceftaroline was demonstrated against VRE strain R7164. The data support the potential use of oritavancin in combination with BLs, especially oritavancin in combination with ceftaroline, for the treatment of infections caused by MRSA. The data from the present study are not as strong for oritavancin in combination with BLs for VRE. Further study of both MRSA and VRE in more complex models is warranted.
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Affiliation(s)
- Jordan R Smith
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Juwon Yim
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Animesh Raut
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA Wayne State University, School of Medicine, Detroit, Michigan, USA
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36
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Tong SYC, Nelson J, Paterson DL, Fowler VG, Howden BP, Cheng AC, Chatfield M, Lipman J, Van Hal S, O’Sullivan M, Robinson JO, Yahav D, Lye D, Davis JS. CAMERA2 - combination antibiotic therapy for methicillin-resistant Staphylococcus aureus infection: study protocol for a randomised controlled trial. Trials 2016; 17:170. [PMID: 27029920 PMCID: PMC4815121 DOI: 10.1186/s13063-016-1295-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a serious infection resulting in 20-50 % 90-day mortality. The limitations of vancomycin, the current standard therapy for MRSA, make treatment difficult. The only other approved drug for treatment of MRSA bacteraemia, daptomycin, has not been shown to be superior to vancomycin. Surprisingly, there has been consistent in-vitro and in-vivo laboratory data demonstrating synergy between vancomycin or daptomycin and an anti-staphylococcal β-lactam antibiotic. There is also growing clinical data to support such combinations, including a recent pilot randomised controlled trial (RCT) that demonstrated a trend towards a reduction in the duration of bacteraemia in patients treated with vancomycin plus flucloxacillin compared to vancomycin alone. Our aim is to determine whether the addition of an anti-staphylococcal penicillin to standard therapy results in improved clinical outcomes in MRSA bacteraemia. METHODS/DESIGN We will perform an open-label, parallel-group, randomised (1:1) controlled trial at 29 sites in Australia, New Zealand, Singapore, and Israel. Adults (aged 18 years or older) with MRSA grown from at least one blood culture and able to be randomised within 72 hours of the index blood culture collection will be eligible for inclusion. Participants will be randomised to vancomycin or daptomycin (standard therapy) given intravenously or to standard therapy plus 7 days of an anti-staphylococcal β-lactam (flucloxacillin, cloxacillin, or cefazolin). The primary endpoint will be a composite outcome at 90 days of (1) all-cause mortality, (2) persistent bacteraemia at day 5 or beyond, (3) microbiological relapse, or (4) microbiological treatment failure. The recruitment target of 440 patients is based on an expected failure rate for the primary outcome of 30 % in the control arm and the ability to detect a clinically meaningful absolute decrease of 12.5 %, with a two-sided alpha of 0.05, a power of 80 %, and assuming 10 % of patients will not be evaluable for the primary endpoint. DISCUSSION Key potential advantages of adding anti-staphylococcal β-lactams to standard therapy for MRSA bacteraemia include their safety profile, low cost, and wide availability. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02365493 . Registered 24 February 2015.
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Affiliation(s)
- Steven Y. C. Tong
- />Menzies School of Health Research, Charles Darwin University, Darwin, NT Australia
- />Royal Darwin Hospital, Darwin, NT Australia
| | - Jane Nelson
- />Menzies School of Health Research, Charles Darwin University, Darwin, NT Australia
| | - David L. Paterson
- />University of Queensland, Centre for Clinical Research, Herston, QLD Australia
| | - Vance G. Fowler
- />Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC USA
- />Duke Clinical Research Institute, Duke University Medical Center, Durham, NC USA
| | - Benjamin P. Howden
- />Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Doherty Institute, Melbourne, VIC Australia
| | - Allen C. Cheng
- />Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC Australia
- />Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Mark Chatfield
- />Menzies School of Health Research, Charles Darwin University, Darwin, NT Australia
| | - Jeffrey Lipman
- />Burns, Trauma Critical Care Research Centre, The University of Queensland, Brisbane, QLD Australia
- />Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
| | - Sebastian Van Hal
- />Department of Microbiology and Infectious Disease Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Matthew O’Sullivan
- />Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW Australia
- />Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW Australia
| | - James O. Robinson
- />Department of Microbiology and Infectious Diseases, Pathwest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital, Perth, WA Australia
- />Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, School of Veterinary and Life Sciences, Murdoch University, Perth, WA Australia
| | - Dafna Yahav
- />Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
- />Rabin Medical Center, Petah Tikvah, Israel
| | - David Lye
- />Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
- />Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua S. Davis
- />Menzies School of Health Research, Charles Darwin University, Darwin, NT Australia
- />John Hunter Hospital, Newcastle, NSW Australia
| | - for the CAMERA2 study group and the Australasian Society for Infectious Diseases Clinical Research Network
- />Menzies School of Health Research, Charles Darwin University, Darwin, NT Australia
- />Royal Darwin Hospital, Darwin, NT Australia
- />University of Queensland, Centre for Clinical Research, Herston, QLD Australia
- />Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC USA
- />Duke Clinical Research Institute, Duke University Medical Center, Durham, NC USA
- />Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Doherty Institute, Melbourne, VIC Australia
- />Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC Australia
- />Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
- />Burns, Trauma Critical Care Research Centre, The University of Queensland, Brisbane, QLD Australia
- />Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
- />Department of Microbiology and Infectious Disease Royal Prince Alfred Hospital, Sydney, NSW Australia
- />Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW Australia
- />Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW Australia
- />Department of Microbiology and Infectious Diseases, Pathwest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital, Perth, WA Australia
- />Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, School of Veterinary and Life Sciences, Murdoch University, Perth, WA Australia
- />Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
- />Rabin Medical Center, Petah Tikvah, Israel
- />Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
- />Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- />John Hunter Hospital, Newcastle, NSW Australia
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Scheeren TWL. Ceftobiprole medocaril in the treatment of hospital-acquired pneumonia. Future Microbiol 2015; 10:1913-28. [DOI: 10.2217/fmb.15.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Ceftobiprole medocaril is a fifth-generation cephalosporin approved in Europe as single-agent therapy for hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia (VAP). It is rapidly converted to the active metabolite ceftobiprole following intravenous administration. Ceftobiprole has a broad spectrum of activity, notably against methicillin-resistant Staphylococcus aureus, ampicillin-susceptible enterococci, penicillin-resistant pneumococci and Enterobacteriaceae not producing extended-spectrum β-lactamase. Ceftobiprole is primarily excreted renally by glomerular filtration, with minimal propensity for interaction with co-administered drugs. Normal dose is ceftobiprole 500 mg, administered by 2-h intravenous infusion every 8 h, with dose adjustment according to renal function. In a pivotal Phase III trial in patients with HAP, ceftobiprole monotherapy was as efficacious as ceftazidime/linezolid for clinical and microbiological cure and was noninferior to ceftazidime/linezolid in the subgroup of patients with HAP excluding VAP. Ceftobiprole and ceftazidime/linezolid were similarly well tolerated. Ceftobiprole is an efficacious and well-tolerated option for empirical treatment of patients with HAP (excluding VAP).
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Affiliation(s)
- Thomas WL Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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38
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Penicillin Binding Protein 1 Is Important in the Compensatory Response of Staphylococcus aureus to Daptomycin-Induced Membrane Damage and Is a Potential Target for β-Lactam-Daptomycin Synergy. Antimicrob Agents Chemother 2015; 60:451-8. [PMID: 26525797 DOI: 10.1128/aac.02071-15] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/27/2015] [Indexed: 01/26/2023] Open
Abstract
The activity of daptomycin (DAP) against methicillin-resistant Staphylococcus aureus (MRSA) is enhanced in the presence of β-lactam antibiotics. This effect is more pronounced with β-lactam antibiotics that exhibit avid binding to penicillin binding protein 1 (PBP1). Here, we present evidence that PBP1 has a significant role in responding to DAP-induced stress on the cell. Expression of the pbpA transcript, encoding PBP1, was specifically induced by DAP exposure whereas expression of pbpB, pbpC, and pbpD, encoding PBP2, PBP3, and PBP4, respectively, remained unchanged. Using a MRSA COL strain with pbpA under an inducible promoter, increased pbpA transcription was accompanied by reduced susceptibility to, and killing by, DAP in vitro. Exposure to β-lactams that preferentially inactivate PBP1 was not associated with increased DAP binding, suggesting that synergy in the setting of anti-PBP1 pharmacotherapy results from increased DAP potency on a per-molecule basis. Combination exposure in an in vitro pharmacokinetic/pharmacodynamic model system with β-lactams that preferentially inactivate PBP1 (DAP-meropenem [MEM] or DAP-imipenem [IPM]) resulted in more-rapid killing than did combination exposure with DAP-nafcillin (NAF) (nonselective), DAP-ceftriaxone (CRO) or DAP-cefotaxime (CTX) (PBP2 selective), DAP-cefaclor (CEC) (PBP3 selective), or DAP-cefoxitin (FOX) (PBP4 selective). Compared to β-lactams with poor PBP1 binding specificity, exposure of S. aureus to DAP plus PBP1-selective β-lactams resulted in an increased frequency of septation and cell wall abnormalities. These data suggest that PBP1 activity may contribute to survival during DAP-induced metabolic stress. Therefore, targeted inactivation of PBP1 may enhance the antimicrobial efficiency of DAP, supporting the use of DAP-β-lactam combination therapy for serious MRSA infections, particularly when the β-lactam undermines the PBP1-mediated compensatory response.
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Abstract
Daptomycin (DAP) is a cyclic lipopeptide with in vitro activity against a variety of Gram-positive pathogens, including multidrug-resistant organisms. Since its introduction into clinical practice in 2003, DAP has become an important key frontline antibiotic for severe or deep-seated infections caused by Gram-positive organisms. Unfortunately, DAP resistance (DAP-R) has been extensively documented in clinically important organisms such as Staphylococcus aureus, Enterococcus spp., and Streptococcus spp. Studies on the mechanisms of DAP-R in Bacillus subtilis and other Gram-positive bacteria indicate that the genetic pathways of DAP-R are diverse and complex. However, a common phenomenon emerging from these mechanistic studies is that DAP-R is associated with important adaptive changes in cell wall and cell membrane homeostasis with critical changes in cell physiology. Findings related to these adaptive changes have provided novel insights into the genetics and molecular mechanisms of bacterial cell envelope stress response and the manner in which Gram-positive bacteria cope with the antimicrobial peptide attack and protect vital structures of the cell envelope, such as the cell membrane. In this review, we will examine the most recent findings related to the molecular mechanisms of resistance to DAP in relevant Gram-positive pathogens and discuss the clinical implications for therapy against these important bacteria.
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Affiliation(s)
- Truc T Tran
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.,International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Jose M Munita
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.,International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Cesar A Arias
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.,International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, Houston, Texas.,Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
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40
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New antibiotics against gram-positives: present and future indications. Curr Opin Pharmacol 2015; 24:45-51. [PMID: 26232669 DOI: 10.1016/j.coph.2015.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 11/23/2022]
Abstract
Gram-positive cocci are the most frequent aetiology of community and nosocomially bacterial acquired infections. The prevalence of multidrug-resistant gram-positive bacteria is increasing and is associated with high morbidity and mortality. New antibiotics will be available in the European market during the next months. This revision is focused on lipoglycopeptides, new cephalosporins active against methicillin-resistant Staphylococcus aureus (MRSA) and the new oxazolidinone, tedizolid. The purpose of this review is to describe their in vitro activity, pharmacokinetic and pharmacodynamic characteristics, and experience from clinical trials.
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Falcone M, Russo A, Venditti M. Optimizing antibiotic therapy of bacteremia and endocarditis due to staphylococci and enterococci: new insights and evidence from the literature. J Infect Chemother 2015; 21:330-9. [PMID: 25813608 DOI: 10.1016/j.jiac.2015.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/26/2022]
Abstract
Gram-positive cocci are a well-recognised major cause of nosocomial infection worldwide. Bloodstream infections due to methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, and multi-drug resistant enterococci are a cause of concern for physicians due to their related morbidity and mortality rates. Aim of this article is to review the current state of knowledge regarding the management of BSI caused by staphylococci and enterococci, including infective endocarditis, and to identify those factors that may help physicians to manage these infections appropriately. Moreover, we discuss the importance of an appropriate use of antimicrobial drugs, taking in consideration the in vitro activity, clinical efficacy data, pharmacokinetic/pharmacodynamic parameters, and potential side effects.
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Affiliation(s)
- Marco Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
| | - Alessandro Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
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Hadley S. Resistant Gram-Positive Infections: Where Have We Been, Where Are We Now, and Where Are We Going? Clin Ther 2014; 36:1298-302. [DOI: 10.1016/j.clinthera.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
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