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Duijzer R, Bernts LHP, Geerts A, van Hoek B, Coenraad MJ, Rovers C, Alvaro D, Kuijper EJ, Nevens F, Halbritter J, Colmenero J, Kupcinskas J, Salih M, Hogan MC, Ronot M, Vilgrain V, Hanemaaijer NM, Kamath PS, Strnad P, Taubert R, Gansevoort RT, Torra R, Nadalin S, Suwabe T, Gevers TJG, Cardinale V, Drenth JPH, Lantinga MA. Clinical management of liver cyst infections: an international, modified Delphi-based clinical decision framework. Lancet Gastroenterol Hepatol 2024; 9:884-894. [PMID: 38878785 DOI: 10.1016/s2468-1253(24)00094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 08/12/2024]
Abstract
Liver cyst infections often necessitate long-term hospital admission and are associated with considerable morbidity and mortality. We conducted a modified Delphi study to reach expert consensus for a clinical decision framework. The expert panel consisted of 24 medical specialists, including 12 hepatologists, from nine countries across Europe, North America, and Asia. The Delphi had three rounds. The first round (response rate 21/24 [88%]) was an online survey with questions constructed from literature review and expert opinion, in which experts were asked about their management preferences and rated possible management strategies for seven clinical scenarios. Experts also rated 14 clinical decision-making items for relevancy and defined treatment outcomes. During the second round (response rate 13/24 [54%]), items that did not reach consensus and newly suggested themes were discussed in an online panel meeting. In the third round (response rate 16/24 [67%]), experts voted on definitions and management strategies using an online survey based on previous answers. Consensus was predefined as a vote threshold of at least 75%. We identified five subclassifications of liver cyst infection according to cyst phenotypes and patient immune status and consensus on episode definitions (new, persistent, and recurrent) and criteria for treatment success or failure was reached. The experts agreed that fever and elevated C-reactive protein are pivotal decision-making items for initiating and evaluating the management of liver cyst infections. Consensus was reached on 26 management statements for patients with liver cyst infections across multiple clinical scenarios, including two treatment algorithms, which were merged into one after comments. We provide a clinical decision framework for physicians managing patients with liver cyst infections. This framework will facilitate uniformity in the management of liver cyst infections and can constitute the basis for the development of future guidelines.
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Affiliation(s)
- Renée Duijzer
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
| | - Lucas H P Bernts
- Department of Medical Microbiology, Radboudumc, Nijmegen, Netherlands
| | - Anja Geerts
- Department of Hepatology and Gastroenterology, Ghent University, Ghent, Belgium; European Reference Network RARE-LIVER, Hamburg, Germany
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Chantal Rovers
- Department of Internal Medicine, Radboudumc, Nijmegen, Netherlands
| | - Domenico Alvaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Frederik Nevens
- European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
| | - Jan Halbritter
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jordi Colmenero
- European Reference Network RARE-LIVER, Hamburg, Germany; Liver Unit, Hospital Clinic Barcelona, IDIBAPS-FRCB, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Juozas Kupcinskas
- European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mahdi Salih
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, Rotterdam, Netherlands
| | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Maxime Ronot
- European Reference Network RARE-LIVER, Hamburg, Germany; Service de Radiologie, Hôpital Beaujon, APHP Nord, Clichy & Université Paris Cité, CRI, UMR 1149, Paris, France
| | - Valerie Vilgrain
- European Reference Network RARE-LIVER, Hamburg, Germany; Service de Radiologie, Hôpital Beaujon, APHP Nord, Clichy & Université Paris Cité, CRI, UMR 1149, Paris, France
| | | | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Pavel Strnad
- European Reference Network RARE-LIVER, Hamburg, Germany; Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Richard Taubert
- European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Roser Torra
- Inherited Kidney Disorders, Department of Nephrology, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Tatsuya Suwabe
- Nephrology Center, Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tom J G Gevers
- European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Vincenzo Cardinale
- European Reference Network RARE-LIVER, Hamburg, Germany; Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joost P H Drenth
- European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marten A Lantinga
- European Reference Network RARE-LIVER, Hamburg, Germany; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands.
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Jongmans C, Muller AE, Van Den Broek P, Cruz De Almeida BDM, Van Den Berg C, Van Oldenrijk J, Bos PK, Koch BCP. An Overview of the Protein Binding of Cephalosporins in Human Body Fluids: A Systematic Review. Front Pharmacol 2022; 13:900551. [PMID: 35837288 PMCID: PMC9274189 DOI: 10.3389/fphar.2022.900551] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Protein binding can diminish the pharmacological effect of beta-lactam antibiotics. Only the free fraction has an antibacterial effect. The aim of this systematic literature review was to give an overview of the current knowledge of protein binding of cephalosporins in human body fluids as well as to describe patient characteristics influencing the level of protein binding. Method: A systematic literature search was performed in Embase, Medline ALL, Web of Science Core Collection and the Cochrane Central Register of Controlled Trials with the following search terms: "protein binding," "beta-lactam antibiotic," and "body fluid." Only studies were included where protein binding was measured in humans in vivo. Results: The majority of studies reporting protein binding were performed in serum or plasma. Other fluids included pericardial fluid, blister fluid, bronchial secretion, pleural exudate, wound exudate, cerebrospinal fluid, dialysate, and peritoneal fluid. Protein binding differs between diverse cephalosporins and between different patient categories. For cefazolin, ceftriaxone, cefpiramide, and cefonicid a non-linear pattern in protein binding in serum or plasma was described. Several patient characteristics were associated with low serum albumin concentrations and were found to have lower protein binding compared to healthy volunteers. This was for critically ill patients, dialysis patients, and patients undergoing cardiopulmonary bypass during surgery. While mean/median percentages of protein binding are lower in these patient groups, individual values may vary considerably. Age is not likely to influence protein binding by itself, however limited data suggest that lower protein binding in newborns. Obesity was not correlated with altered protein binding. Discussion/Conclusion: Conclusions on protein binding in other body fluids than blood cannot be drawn due to the scarcity of data. In serum and plasma, there is a large variability in protein binding per cephalosporin and between different categories of patients. Several characteristics were identified which lead to a lower protein binding. The finding that some of the cephalosporins display a non-linear pattern of protein binding makes it even more difficult to predict the unbound concentrations in individual patients. Taken all these factors, it is recommended to measure unbound concentrations to optimize antibiotic exposure in individual patients. Systematic Review Registration: PROSPERO, identifier (CRD42021252776).
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Affiliation(s)
- C. Jongmans
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
| | - A. E. Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Medical Microbiology, Haaglanden Medical Center, The Hague, Netherlands
| | - P. Van Den Broek
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - C. Van Den Berg
- Department of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J. Van Oldenrijk
- Department of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - P. K. Bos
- Department of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - B. C. P. Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
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Zhang YJ, Wang WM, Oelschlaeger P, Chen C, Lei JE, Lv M, Yang KW. Real-Time Monitoring of NDM-1 Activity in Live Bacterial Cells by Isothermal Titration Calorimetry: A New Approach To Measure Inhibition of Antibiotic-Resistant Bacteria. ACS Infect Dis 2018; 4:1671-1678. [PMID: 30383355 DOI: 10.1021/acsinfecdis.8b00147] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The "superbug" infection caused by New Delhi metallo-β-lactamase (NDM-1) has become an emerging threat. Monitoring NDM-1 has proven challenging due to its shuttling between pathogenic bacteria. Here, we report an isothermal titration calorimetry (ITC) method that can monitor activity and inhibition of NDM-1 in live bacterial cells in real time. This method has been exemplified by monitoring of the activity and inhibition of the target enzyme and evaluating the breakdown of antibiotics by pathogenic bacteria expressing β-lactamases. Cell-based studies demonstrate that the NDM-1 expressed in bacterial cells was inhibited by four known inhibitors ethylene diamine tetraacetic acid (EDTA), d-captopril, ebselen and azolylthioacetamide with fifty percent inhibitory concentration (IC50) values of 3.8, 48, 0.55, and 17.5 μM, respectively, which are in good agreement with the data from inhibition kinetics using UV-vis and NMR spectroscopy in vivo. This approach could be applied to screen and evaluate small molecule inhibitors of metallo-β-lactamases (MβLs) in whole cells or to identify drug resistant bacteria.
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Affiliation(s)
- Yue-Juan Zhang
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, Chemical Biology Innovation Laboratory, College of Chemistry and Materials Science, Northwest University, 1 Xuefu Avenue, Xi’an, Shaanxi 710127, P. R. China
| | - Wen-Ming Wang
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, Chemical Biology Innovation Laboratory, College of Chemistry and Materials Science, Northwest University, 1 Xuefu Avenue, Xi’an, Shaanxi 710127, P. R. China
| | - Peter Oelschlaeger
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, 309 East Second Street, Pomona, California 91766, United States
| | - Cheng Chen
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, Chemical Biology Innovation Laboratory, College of Chemistry and Materials Science, Northwest University, 1 Xuefu Avenue, Xi’an, Shaanxi 710127, P. R. China
| | - Jin-E Lei
- The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi’an, Shaanxi 710061, P.R. China
| | - Miao Lv
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, Chemical Biology Innovation Laboratory, College of Chemistry and Materials Science, Northwest University, 1 Xuefu Avenue, Xi’an, Shaanxi 710127, P. R. China
| | - Ke-Wu Yang
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, Chemical Biology Innovation Laboratory, College of Chemistry and Materials Science, Northwest University, 1 Xuefu Avenue, Xi’an, Shaanxi 710127, P. R. China
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