1
|
Alemán-Villalón A, Moheno-Gallardo AJ, Elizalde-Martínez E, Quiroz-Williams J, González-Ross JA. COST-EFFECTIVENESS OF VANCOMYCIN POWDER FOR DEEP WOUND INFECTION PROPHYLAXIS IN SPINE FUSION. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212001218059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify the cost effectiveness of vancomycin powder in the prophylaxis of posterior lumbar spine instrumentation, seeking potential savings. Methods: A retrospective, observational study was performed to evaluate the cost effectiveness. Data were retrieved from patients’ files from March 2016 to April 2017; costs were considered for the procedures, as well as which antibiotic was used. Results: A total of 184 patients were included. Of these, 102 received prophylactic treatment with 1g of cephalothin and 82 received 1g of cephalothin and 1g of vancomycin powder, which was applied to the wound prior to tissue closure. Of the 184 patients, 110 were women (59%) and 74 were men (41%), and the mean age was 55 years (24-77). The participants had a median BMI of 28.9 kg/m2 (19-39). The average cost per hospitalized patient was $3974 USD and the average cost of rehospitalization due to infection was, on average, $7700 USD. The use of vancomycin powder led to cost savings of $75,008.79 USD per 100 posterior spinal fusions performed for degenerative spine. Conclusion: The use of vancomycin powder is a cost-effective option for prophylaxis of surgical site infection in spine fusion. Level of evidence III; Economic and decision analysis.
Collapse
|
2
|
Braima OA, Ali MA, Abdulla EM. Bacteriological profile and antibiotic resistance in newborn infants with possible community-acquired neonatal sepsis in Khartoum State, Sudan. Sudan J Paediatr 2021; 21:13-22. [PMID: 33879938 DOI: 10.24911/sjp.106-1601909519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neonatal sepsis is a leading cause of morbidity and mortality, and knowledge of bacterial patterns and susceptibility to antibiotics is essential to design therapeutic guidelines. To determine the bacterial aetiology and antibiotic resistance patterns in neonatal sepsis, a prospective, cross-sectional, hospital-based study was conducted in a large paediatric emergency hospital in Khartoum State, Sudan, over a 6-month period. All newborn infants with a clinical diagnosis of sepsis were included in the study and had a blood sample collected for culture and sensitivity. The World Health Organization case definition of neonatal sepsis in conjunction with the Integrated Management of Childhood Illnesses criteria was used to select patients. A total of 170 newborn infants fulfilled the study inclusion criteria. The median age at presentation was 4-7 days and blood culture was positive in 31%. Early-onset neonatal sepsis was present in 30% of cases, while 70% were late-onset. Gram-positive organisms accounted for 58% of the total isolates, and 38% were Gram-negative organisms. Staphylococcus aureus was the most prevalent organism (55% of all isolates) and 72% of these were methicillin-resistant which showed 100% sensitivity to vancomycin and 90% to gentamycin. Pseudomonas aeruginosa was the commonest Gram-negative organism in both early and late-onset sepsis and the second commonest isolated organism, accounting for 19% of cases. All Gram-negative organisms were 100% sensitive to imipenem, meropenem and ciprofloxacin. Both Gram-positive and Gram-negative organisms were highly resistant to benzylpenicillin and cefotaxime, the commonly used empiric antibiotics in neonatal sepsis.
Collapse
Affiliation(s)
- Osama Ahmed Braima
- Department of Paediatrics, University Hospitals of Morecambe, NHS Foundation Trust, United Kingdom
| | | | | |
Collapse
|
3
|
Molki B, Call DR, Ha PT, Omsland A, Gang DR, Lindemann SR, Killiny N, Beyenal H. Growth of 'Candidatus Liberibacter asiaticus' in a host-free microbial culture is associated with microbial community composition. Enzyme Microb Technol 2020; 142:109691. [PMID: 33220870 DOI: 10.1016/j.enzmictec.2020.109691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022]
Abstract
'Candidatus Liberibacter asiaticus' ('Ca. L. asiaticus'), the suspected causative agent of citrus greening disease, is one of many phloem-restricted plant pathogens that have not been isolated and grown in an axenic culture. In this study, infected Asian citrus psyllids were used to prepare a host-free source of 'Ca. L. asiaticus'. Host-free mixed microbial cultures of 'Ca. L. asiaticus' were grown in the presence of various antibiotic treatments to alter the composition of the microbial communities. Our hypothesis was that the presence of selected antibiotics would enhance or reduce the presence of 'Ca. L. asiaticus' in a host-free culture composed of a mixed bacterial population through changes in the microbial community structure. We determined how 'Ca. L. asiaticus' growth changed with the various treatments. Treatment with vancomycin (50 μg/mL), streptomycin (0.02 μg/mL), or polymyxin B (4 μg/mL) was associated with an increased abundance of 'Ca. L. asiaticus' of 7.35 ± 0.27, 5.56 ± 0.15, or 4.54 ± 0.83 fold, respectively, compared to untreated mixed microbial cultures, while treatment with 100 μg/mL vancomycin; 0.5, 1, or 2 μg/mL streptomycin; or 0.5 μg/mL of polymyxin B was associated with reduced growth. In addition, the growth of 'Ca. L. asiaticus' was associated with the microbial community composition of the mixed microbial cultures. A positive relationship between the presence of the Pseudomonadaceae family and 'Ca. L. asiaticus' growth was observed, while the presence of 'Ca. L. asiaticus' was below the detection limit in cultures that displayed high abundances of Bacillus cereus. Our findings offer strategies for developing effective axenic culture conditions and suggest that enrichment of the Bacillaceae family could serve as a paratransgenic approach to controlling citrus greening disease.
Collapse
Affiliation(s)
- Banafsheh Molki
- Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, WA, USA
| | - Douglas R Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Phuc T Ha
- Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, WA, USA
| | - Anders Omsland
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - David R Gang
- Institute of Biological Chemistry, Washington State University, Pullman, WA, USA
| | | | - Nabil Killiny
- Department of Plant Pathology, Citrus Research and Education Center, IFAS, University of Florida, Lake Alfred, FL, USA
| | - Haluk Beyenal
- Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, WA, USA.
| |
Collapse
|
4
|
Kwon HJ, Mohammed AE, Eltom KH, Albrahim JS, Alburae NA. Evaluation of antibiotic-induced behavioral changes in mice. Physiol Behav 2020; 223:113015. [PMID: 32553641 DOI: 10.1016/j.physbeh.2020.113015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
Abstract
Gut microbiota (GM) plays a critical role in health maintenance. Previous reports connected GM with metabolic, immunologic and neurologic pathways. The main purpose of the current investigation was to study whether antibiotic-induced disturbances of GM affects psychological or behavioral conditions on mice as animal model. Mice were exposed to clindamycin or amoxicillin, and their behaviors were evaluated. Antibiotic-treated groups displayed reduced recognition memory and increased depression. No significant changes in the locomotor activity and anxiety were observed. Our data suggested that changes in GM composition by antibiotics may lead to the cognitive and behavioral deficit.
Collapse
Affiliation(s)
- Hye-Joo Kwon
- Biology Department, Faculty of Science, Princess Nourah bint Abdulrahman University, Riyadh 84428, Saudi Arabia; The University of Utah Asia Campus, Incheon, Korea
| | - Afrah E Mohammed
- Biology Department, Faculty of Science, Princess Nourah bint Abdulrahman University, Riyadh 84428, Saudi Arabia.
| | - Kamal H Eltom
- Unit of Animal Health and Safety of Animal Products, Institute for Studies and Promotion of Animal Exports, University of Khartoum, Shambat Postal Code 13314, Khartoum North, Sudan
| | - Jehan S Albrahim
- Biology Department, Faculty of Science, Princess Nourah bint Abdulrahman University, Riyadh 84428, Saudi Arabia
| | - Najla Ali Alburae
- Department of Biology, Faculty of Science, King Abdulaziz University, P.O. Box 80203, Jeddah 21589, Saudi Arabia
| |
Collapse
|
5
|
Chu Y, Luo Y, Quan X, Jiang M, Zhou B. Intermittent vs. continuous vancomycin infusion for gram-positive infections: A systematic review and meta-analysis. J Infect Public Health 2020; 13:591-597. [DOI: 10.1016/j.jiph.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/15/2018] [Accepted: 09/03/2019] [Indexed: 01/29/2023] Open
|
6
|
You JS, Yong JH, Kim GH, Moon S, Nam KT, Ryu JH, Yoon MY, Yoon SS. Commensal-derived metabolites govern Vibrio cholerae pathogenesis in host intestine. MICROBIOME 2019; 7:132. [PMID: 31521198 PMCID: PMC6744661 DOI: 10.1186/s40168-019-0746-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/03/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND Recent evidence suggests that the commensal microbes act as a barrier against invading pathogens and enteric infections are the consequences of multi-layered interactions among commensals, pathogens, and the host intestinal tissue. However, it remains unclear how perturbations of the gut microbiota compromise host infection resistance, especially through changes at species and metabolite levels. RESULTS Here, we illustrate how Bacteroides vulgatus, a dominant species of the Bacteroidetes phylum in mouse intestine, suppresses infection by Vibrio cholerae, an important human pathogen. Clindamycin (CL) is an antibiotic that selectively kills anaerobic bacteria, and accordingly Bacteroidetes are completely eradicated from CL-treated mouse intestines. The Bacteroidetes-depleted adult mice developed severe cholera-like symptoms, when infected with V. cholerae. Germ-free mice mono-associated with B. vulgatus became resistant to V. cholerae infection. Levels of V. cholerae growth-inhibitory metabolites including short-chain fatty acids plummeted upon CL treatment, while levels of compounds that enhance V. cholerae proliferation were elevated. Furthermore, the intestinal colonization process of V. cholerae was well-simulated in CL-treated adult mice. CONCLUSIONS Overall, we provide insights into how a symbiotic microbe and a pathogenic intruder interact inside host intestine. We identified B. vulgatus as an indigenous microbial species that can suppress intestinal infection. Our results also demonstrate that commensal-derived metabolites are a critical determinant for host resistance against V. cholerae infection, and that CL pretreatment of adult mice generates a simple yet useful model of cholera infection.
Collapse
Affiliation(s)
- Jin Sun You
- Department of Microbiology and Immunology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Seoul, 03722, Korea
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Ji Hyun Yong
- Department of Microbiology and Immunology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Seoul, 03722, Korea
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Gwang Hee Kim
- Department of Microbiology and Immunology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Seoul, 03722, Korea
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Sungmin Moon
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, 03722, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Ki Taek Nam
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, 03722, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Ji Hwan Ryu
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, 03722, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Mi Young Yoon
- Department of Microbiology and Immunology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Seoul, 03722, Korea.
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, 03722, Korea.
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, 03722, Korea.
| | - Sang Sun Yoon
- Department of Microbiology and Immunology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Seoul, 03722, Korea.
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, 03722, Korea.
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, 03722, Korea.
| |
Collapse
|
7
|
Monk IR, Shaikh N, Begg SL, Gajdiss M, Sharkey LKR, Lee JYH, Pidot SJ, Seemann T, Kuiper M, Winnen B, Hvorup R, Collins BM, Bierbaum G, Udagedara SR, Morey JR, Pulyani N, Howden BP, Maher MJ, McDevitt CA, King GF, Stinear TP. Zinc-binding to the cytoplasmic PAS domain regulates the essential WalK histidine kinase of Staphylococcus aureus. Nat Commun 2019; 10:3067. [PMID: 31296851 PMCID: PMC6624279 DOI: 10.1038/s41467-019-10932-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 06/05/2019] [Indexed: 01/23/2023] Open
Abstract
WalKR (YycFG) is the only essential two-component regulator in the human pathogen Staphylococcus aureus. WalKR regulates peptidoglycan synthesis, but this function alone does not explain its essentiality. Here, to further understand WalKR function, we investigate a suppressor mutant that arose when WalKR activity was impaired; a histidine to tyrosine substitution (H271Y) in the cytoplasmic Per-Arnt-Sim (PASCYT) domain of the histidine kinase WalK. Introducing the WalKH271Y mutation into wild-type S. aureus activates the WalKR regulon. Structural analyses of the WalK PASCYT domain reveal a metal-binding site, in which a zinc ion (Zn2+) is tetrahedrally-coordinated by four amino acids including H271. The WalKH271Y mutation abrogates metal binding, increasing WalK kinase activity and WalR phosphorylation. Thus, Zn2+-binding negatively regulates WalKR. Promoter-reporter experiments using S. aureus confirm Zn2+ sensing by this system. Identification of a metal ligand recognized by the WalKR system broadens our understanding of this critical S. aureus regulon.
Collapse
Affiliation(s)
- Ian R Monk
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia.
| | - Nausad Shaikh
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, 4067, Australia
| | - Stephanie L Begg
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Mike Gajdiss
- University Clinics of Bonn, Institute of Medical Microbiology, Immunology and Parasitology, 53127, Bonn, Germany
| | - Liam K R Sharkey
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Jean Y H Lee
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sacha J Pidot
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Torsten Seemann
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia.,Melbourne Bioinformatics, University of Melbourne, Melbourne, VIC, 3000, Australia
| | | | | | - Rikki Hvorup
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, 4067, Australia
| | - Brett M Collins
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, 4067, Australia
| | - Gabriele Bierbaum
- University Clinics of Bonn, Institute of Medical Microbiology, Immunology and Parasitology, 53127, Bonn, Germany
| | - Saumya R Udagedara
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Jacqueline R Morey
- Department of Molecular and Biomedical Sciences, School of Biological Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Neha Pulyani
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Benjamin P Howden
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Megan J Maher
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Christopher A McDevitt
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia.,Department of Molecular and Biomedical Sciences, School of Biological Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Glenn F King
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, 4067, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia.
| |
Collapse
|
8
|
Wang D, Liu Y, Liu Y, Yan L, Zaat SAJ, Wismeijer D, Pathak JL, Wu G. A dual functional bone-defect-filling material with sequential antibacterial and osteoinductive properties for infected bone defect repair. J Biomed Mater Res A 2019; 107:2360-2370. [PMID: 31173657 DOI: 10.1002/jbm.a.36744] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/19/2019] [Accepted: 05/27/2019] [Indexed: 12/27/2022]
Abstract
Infected bone defect healing is hindered by infection and compromised bone regenerative capacity. In this study, we designed a dual functional bone-defect-filling material with a sequential release system, that is, a burst release of a potent antibacterial agent, hydroxypropyltrimethyl ammonium chloride chitosan (HACC), followed by a controlled release of osteoinductive bone morphogenic protein (BMP2) to repair the infected bone defect. Minimum bactericidal concentration (MBC) of HACC against methicillin-resistant Staphylococcus aureus was 40 μg/mL. HACC at 40 μg/mL did not affect preosteoblast proliferation and did not influence the BMP2-induced alkaline phosphatase activity, osteocalcin expression, and matrix mineralization. in vitro release profile revealed burst release of HACC followed by a slow release of BMP2. in vivo bone formation was observed only in the BMP2-containing groups. HACC did not influence of biomimetic calcium phosphate (BioCaP) resorption and BMP2-induced bone formation. In conclusion, the optimized HACC/BMP2-incorporated BioCaP complex showed strong antibacterial effect and robustly enhanced osteoinduction both in vitro and in vivo.
Collapse
Affiliation(s)
- Dongyun Wang
- Department of Stomatology, Peking University Shenzhen Hospital, Shenzhen, China.,Department of Oral Implantology and Prosthetic Dentistry, Academic Centre of Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| | - Yi Liu
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuelian Liu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre of Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| | - Liang Yan
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre of Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, The Netherlands.,Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sebastian A J Zaat
- Department of Medical Microbiology, Amsterdam Infection and Immunity Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel Wismeijer
- Department of Stomatology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Janak L Pathak
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre of Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Zhang Y, Zhang Y, Zhang Y, Zhu L, He P, Wang Q. Selective fluorescence labeling and sensitive determination of Staphylococcus aureus by microchip electrophoresis with a multiple-concentration approach. CHINESE CHEM LETT 2018. [DOI: 10.1016/j.cclet.2017.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
10
|
Mohsen L, Ramy N, Saied D, Akmal D, Salama N, Abdel Haleim MM, Aly H. Emerging antimicrobial resistance in early and late-onset neonatal sepsis. Antimicrob Resist Infect Control 2017. [PMID: 28630687 PMCID: PMC5470277 DOI: 10.1186/s13756-017-0225-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to developed countries, the use of antimicrobials in Egypt is less regulated and is available over the counter without the need for prescriptions. The impact of such policy on antimicrobial resistance has not been studied. This study aimed to determine the prevalence of early and late onset sepsis, and the frequency of antimicrobial resistance in a major referral neonatal intensive care unit (NICU). METHODS The study included all neonates admitted to the NICU over a 12-month period. Prospectively collected clinical and laboratory data were retrieved, including blood cultures and endotracheal aspirate cultures if performed. RESULTS A total of 953 neonates were admitted, of them 314 neonates were diagnosed with sepsis; 123 with early onset sepsis (EOS) and 191 with late onset sepsis (LOS). A total of 388 blood cultures were obtained, with 166 positive results. Total endotracheal aspirate samples were 127; of them 79 were culture-positive. The most frequently isolated organisms in blood were Klebsiella pneumoniae (42%) and Coagulase negative staphylococcus (19%) whereas in endotracheal cultures were Klebsiella pneumoniae (41%) and Pseudomonas aeruginosa (19%). Gram negative organisms were most resistant to ampicillins (100%), cephalosporins (93%-100%) and piperacillin-tazobactam (99%) with less resistance to aminoglycosides (36%-52%). Gram positive isolates were least resistant to vancomycin (18%). Multidrug resistance was detected in 92 (38%) cultures, mainly among gram negative isolates (78/92). CONCLUSIONS Antibiotic resistance constitutes a challenge to the management of neonatal sepsis in Egypt. Resistance was predominant in both early and late onset sepsis. This study supports the need to implement policies that prohibits the non-prescription community use of antibiotics.
Collapse
Affiliation(s)
- Lamiaa Mohsen
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.,New Children Hospital, (Abu El Rish), Cairo University Hospitals, Ali Basha Ebrahim, PO Box 11562, Cairo, Egypt
| | - Nermin Ramy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.,New Children Hospital, (Abu El Rish), Cairo University Hospitals, Ali Basha Ebrahim, PO Box 11562, Cairo, Egypt
| | - Dalia Saied
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.,New Children Hospital, (Abu El Rish), Cairo University Hospitals, Ali Basha Ebrahim, PO Box 11562, Cairo, Egypt
| | - Dina Akmal
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.,New Children Hospital, (Abu El Rish), Cairo University Hospitals, Ali Basha Ebrahim, PO Box 11562, Cairo, Egypt
| | - Niveen Salama
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.,New Children Hospital, (Abu El Rish), Cairo University Hospitals, Ali Basha Ebrahim, PO Box 11562, Cairo, Egypt
| | - Mona M Abdel Haleim
- Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt.,New Children Hospital, (Abu El Rish), Cairo University Hospitals, Ali Basha Ebrahim, PO Box 11562, Cairo, Egypt
| | - Hany Aly
- Division of Neonatology, the George Washington University and Children's National Health System, 900 23rd Street, N.W. Suite G2092, Washington, DC 20037 USA
| |
Collapse
|
11
|
Stockmann C, Roberts JK, Yu T, Constance JE, Knibbe CAJ, Spigarelli MG, Sherwin CMT. Vancomycin pharmacokinetic models: informing the clinical management of drug-resistant bacterial infections. Expert Rev Anti Infect Ther 2015; 12:1371-88. [PMID: 25301231 DOI: 10.1586/14787210.2014.966081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This review aims to critically evaluate the pharmacokinetic literature describing the use of vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. Guidelines recommend that trough concentrations be used to guide vancomycin dosing for the treatment of MRSA infections; however, numerous in vitro, animal model and clinical studies have demonstrated that the therapeutic effectiveness of vancomycin is best described by the area under the concentration versus time curve (AUC) divided by the minimum inhibitory concentration (MIC) of the infecting organism (AUC/MIC). Among patients with lower respiratory tract infections, an AUC/MIC ≥400 was associated with a superior clinical and bacteriological response. Similarly, patients with MRSA bacteremia who achieved an Etest AUC/MIC ≥320 within 48 h were 50% less likely to experience treatment failure. For other patient populations and different clinical syndromes (e.g., children, the elderly, patients with osteomyelitis, etc.), pharmacokinetic/pharmacodynamic studies and prospective clinical trials are needed to establish appropriate therapeutic targets.
Collapse
Affiliation(s)
- Chris Stockmann
- Department of Pediatrics, Division of Clinical Pharmacology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, Utah 84108, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
Alcalá-Cerra G, Paternina-Caicedo A, Moscote-Salazar L, Gutiérrez-Paternina J, Niño-Hernández L. Application of vancomycin powder into the wound during spine surgery: Systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
13
|
[Application of vancomycin powder into the wound during spine surgery: systematic review and meta-analysis]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:182-91. [PMID: 24703108 DOI: 10.1016/j.recot.2013.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/29/2013] [Accepted: 10/05/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the effects of applying vancomycin powder within the surgical wound on the risk of surgical infections, pseudo-arthrosis and adverse events, in patients undergoing spinal surgery. MATERIAL AND METHODS A meta-analysis was carried out, including controlled studies that evaluated the risk of postoperative infections and/or pseudo-arthrosis in patients undergoing spinal surgery in which vancomycin powder was applied within the surgical wound. RESULTS were presented as pooled relative risks, with its 95% confidence intervals. Additionally, the frequency of complications attributable to vancomycin was also assessed. RESULTS A total of six controlled studies (3,379 subjects) were included. Pooled relative risks were: surgical site infection, 0.11 (95%CI: 0.05-0.25; P<.00001), and pseudo-arthrosis, 0.87 (95%CI; 0.34-2.21; P=.77). No statistically significant heterogeneity was found in both analyses. In 1,437 patients treated with vancomycin, there were no recorded vancomycin-related adverse events. CONCLUSIONS Application of vancomycin powder into the wound was associated with a significantly reduced risk of surgical site infections, without increasing pseudo-arthrosis or adverse events. However, randomized controlled trials are needed, in order to confirm the present results and make recommendations with more certainty.
Collapse
|
14
|
Lomaestro BM. Vancomycin dosing and monitoring 2 years after the guidelines. Expert Rev Anti Infect Ther 2014; 9:657-67. [DOI: 10.1586/eri.11.46] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
15
|
Castagnola E, Ginocchio F. Rescue therapy of difficult-to-treat indwelling central venous catheter-related bacteremias in cancer patients: a review for practical purposes. Expert Rev Anti Infect Ther 2014; 11:179-86. [DOI: 10.1586/eri.12.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
16
|
Saugel B, Gramm C, Wagner JY, Messer M, Lahmer T, Meidert AS, Schmid RM, Huber W. Evaluation of a dosing regimen for continuous vancomycin infusion in critically ill patients: an observational study in intensive care unit patients. J Crit Care 2013; 29:351-5. [PMID: 24456810 DOI: 10.1016/j.jcrc.2013.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 12/09/2013] [Accepted: 12/16/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to evaluate a dosing algorithm for continuous vancomycin administration in intensive care unit patients. MATERIALS AND METHODS This observational study was conducted in a medical intensive care unit (German university hospital; June 2012-February 2013). Following a loading dose of 20 mg per kg actual body weight, vancomycin was administered continuously (20 or 30 mg of vancomycin per kg actual body weight over 24 hours depending on renal function). The vancomycin infusion rate was adjusted to achieve a target serum vancomycin concentration of 20-30 mg/L. RESULTS Vancomycin was administered for a median (interquartile range) of 7 (5-9) days. The median vancomycin dose given as an initial bolus was 1750 (1400-2000) mg. The median daily vancomycin dose ranged from 480 (180-960) mg (day 6) to 3.120 (2596-3980) mg (day 1). Altogether, the achieved median serum vancomycin concentration was 29.0 (25.2-33.2) mg/L. On treatment days 1 to 7, we observed target serum vancomycin levels (20-30 mg/L) in 48%, 39%, 33%, 26%, 43%, 57%, and 69% of patients. Supra-therapeutic serum vancomycin concentrations (>30 mg/L) were observed in 36%, 52%, 61%, 63%, 39%, 19%, and 15% of patients on treatment days 1 to 7. CONCLUSIONS The evaluated vancomycin dosing regimen for continuous infusion allowed rapid achievement of sufficient vancomycin serum levels. However, we frequently observed supra-therapeutic serum vancomycin concentrations in the first days of vancomycin treatment.
Collapse
Affiliation(s)
- Bernd Saugel
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany.
| | - Carolin Gramm
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
| | - Julia Y Wagner
- III. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
| | - Marlena Messer
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
| | - Tobias Lahmer
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
| | - Agnes S Meidert
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
| | - Roland M Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
| | - Wolfgang Huber
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
| |
Collapse
|
17
|
Guidelines for the use of long-term central venous catheter in children with hemato-oncological disorders. On behalf of supportive therapy working group of Italian Association of Pediatric Hematology and Oncology (AIEOP). Ann Hematol 2013; 92:1405-12. [DOI: 10.1007/s00277-013-1794-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/13/2013] [Indexed: 12/22/2022]
|
18
|
Saugel B, Nowack MC, Hapfelmeier A, Umgelter A, Schultheiss C, Thies P, Phillip V, Eyer F, Schmid RM, Huber W. Continuous intravenous administration of vancomycin in medical intensive care unit patients. J Crit Care 2013; 28:9-13. [DOI: 10.1016/j.jcrc.2012.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 11/12/2011] [Accepted: 02/04/2012] [Indexed: 01/07/2023]
|
19
|
Sotozono C, Fukuda M, Ohishi M, Yano K, Origasa H, Saiki Y, Shimomura Y, Kinoshita S. Vancomycin Ophthalmic Ointment 1% for methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis infections: a case series. BMJ Open 2013; 3:bmjopen-2012-001206. [PMID: 23364319 PMCID: PMC3563129 DOI: 10.1136/bmjopen-2012-001206] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the efficacy and safety of Vancomycin Ophthalmic Ointment 1% (Toa Pharmaceutical Co., Ltd, Toyama, Japan) in patients with external ocular infections caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE). DESIGN A case series. SETTING This study was a multicentre, open-label, uncontrolled study in Japan approved as orphan drug status. PARTICIPANTS Patients with MRSA or MRSE external ocular infections unresponsive to the treatment of fluoroquinolone eye drops. INTERVENTIONS Vancomycin Ophthalmic Ointment 1% was administered four times daily. PRIMARY AND SECONDARY OUTCOME MEASURES The subjective and objective clinical scores and bacterial cultures were collected at days 0 (baseline), 3, 7 and 14. The primary outcome was clinical response evaluation (efficacy rate) determined as complete response, partial response, no response and worsening. Secondary outcome was the eradication of the bacteria. Safety was assessed by adverse events including cases in which neither MRSA nor MRSE was detected. RESULTS Twenty-five cases with MRSA (20) or MRSE (5) infections were enrolled. Of these 25 cases, 4 discontinued the treatment due to the negative results for bacterial culture during screening or at baseline. Of the 21 cases with conjunctivitis (14), blepharitis (3), meibomitis (1), dacryocystitis (2) or keratitis (1), 14 (66.7%) cases were evaluated as being excellently (complete response, 2 cases) or well (partial response, 12 cases) treated. The eradication rates were 68.4% in MRSA (13 of 19 cases) and 100% in MRSE (2 of 2 cases). Ten adverse events occurred in 7 (28.0%) of 25 cases at the local administration site. CONCLUSIONS Vancomycin Ophthalmic Ointment 1% was considered to be useful for the treatment of intractable ocular MRSA/MRSE infections.
Collapse
Affiliation(s)
- Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiko Fukuda
- Department of Ophthalmology, Kinki University Faculty of Medicine, Osaka, Japan
| | | | | | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine, Toyama, Japan
| | | | - Yoshikazu Shimomura
- Department of Ophthalmology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
20
|
Population-based study of the increased incidence of skin and soft tissue infections and associated antimicrobial use. Antimicrob Agents Chemother 2012; 56:6243-9. [PMID: 23006762 DOI: 10.1128/aac.00649-12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has spread rapidly throughout the world in the last decade. We sought to demonstrate the impact of the emergence of CA-MRSA in Western Canada on physician visits, incision-and-drainage procedures, and antibiotic prescribing for skin and soft tissue infections (SSTI). We used the provincial physician billing system to determine the rate of physician visits (per 1,000 population per year) of SSTI and incision-and-drainage procedures. A database capturing all outpatient prescriptions in the province was anonymously linked to associated physician billing codes to quantify prescriptions associated with SSTI. Antibiotic prescriptions (overall and class specific) were expressed as their defined daily dose (DDD) per 1,000 inhabitants per day. Between 1996 and 2008, the rate of visits for all SSTI increased by 15%, and the majority of visits did not include an incision-and-drainage procedure. The rate of antibiotic prescribing for SSTI increased by 49%. The majority of this increase was attributable to the higher rates of use of clindamycin (627%), trimethoprim-sulfamethoxazole (380%), cephalosporins (160%), and amoxicillin-clavulanate (627%). Health care utilization and antibiotic prescribing rates for SSTI, but not incision-and-drainage procedures, have increased in association with the CA-MRSA epidemic. While much of the increase in antibiotic use reflects an appropriate change to trimethoprim-sulfamethoxazole, there is room for education regarding the limitations of cephalosporins and clindamycin, given current susceptibility profiles.
Collapse
|
21
|
Belen C, Budhiraja P, Bracamonte E, Popovtzer M. Biopsy-proven acute tubular necrosis associated with vancomycin in an adult patient. Ren Fail 2012; 34:502-5. [PMID: 22329801 DOI: 10.3109/0886022x.2012.655683] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vancomycin causing acute kidney injury has traditionally been associated with acute interstitial nephritis. There have been a few case reports of biopsy-proven acute tubular necrosis (ATN) from vancomycin in the pediatric literature and only one previous report in the adult population. Here, we report a second case of biopsy-proven ATN resulting from vancomycin toxicity.
Collapse
Affiliation(s)
- Cary Belen
- Department of Nephrology, University of Arizona, Tucson, AZ, USA
| | | | | | | |
Collapse
|
22
|
Traditional weight-based vancomycin dosing is inadequate in critically ill trauma patients. Eur J Trauma Emerg Surg 2011; 38:301-6. [PMID: 26815962 DOI: 10.1007/s00068-011-0164-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/25/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Our aim was to evaluate our institution's compliance with weight-based vancomycin dosing recommendations for pneumonia in critically ill injured patients and to assess the success rate in achieving therapeutic serum vancomycin levels. Additionally, we sought to assess the incidence of vancomycin-induced nephrotoxicity. METHODS All injured intensive care unit (ICU) patients receiving intravenous vancomycin between May 1, 2004 and July 31, 2010 were identified through our trauma database and pharmacy records. The initial weight-based dose was calculated and compared with vancomycin trough levels. RESULTS Thirty patients were identified who satisfied the inclusion/exclusion criteria. Only 12 patients (40%) received adequate weight-based dosing (weight-based, 30 mg/kg/day). Weight-based patients weighed significantly less than non-weight-based patients (62.7 vs. 84.2 kg, p = 0.0008). Weight-based patients were more likely to achieve therapeutic trough levels than non-weight-based patients (58 vs. 33%, p = 0.176). Of patients who achieved therapeutic trough levels, more weight-based patients achieved it at first trough than non-weight-based patients (33 vs. 5.6%, p = 0.046). CONCLUSIONS When prescribing commonly used dosing regimens, appropriate weight-based administration of vancomycin occurred in only approximately one-third of patients. Those patients who did receive weight-based vancomycin dosing were more likely to achieve therapeutic levels, both initially (33 vs. 5.6%) and overall (58 vs. 33%).
Collapse
|
23
|
van Hal SJ, Jones M, Gosbell IB, Paterson DL. Vancomycin heteroresistance is associated with reduced mortality in ST239 methicillin-resistant Staphylococcus aureus blood stream infections. PLoS One 2011; 6:e21217. [PMID: 21713004 PMCID: PMC3119693 DOI: 10.1371/journal.pone.0021217] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/23/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite hVISA infections being associated with vancomycin treatment failure, no previous study has been able to detect a mortality difference between heteroresistant vancomycin intermediate Staphylococcus aureus (hVISA) and vancomycin susceptible Staphylococcus aureus (VSSA) bloodstream infections (BSI). METHODOLOGY Consecutive methicillin-resistant S. aureus (MRSA) BSI episodes between 1996 and 2008 were reviewed. Patient demographics, clinical presentation, treatment and overall mortality at 30 days were extracted from the medical records. All isolates underwent vancomycin minimum inhibitory concentration (VMIC) testing by broth microdilution and Etest. hVISA was confirmed by population analysis profiling using the area under the curve method (PAP-AUC). PRINCIPAL FINDINGS 401 evaluable MRSA BSI episodes were identified over the 12 years. Of these, 46 (11.5%) and 2 (0.5%) were confirmed as hVISA and VISA by PAP-AUC respectively. hVISA predominantly occurred in ST239-like MRSA isolates with high VMIC (2 mg/L). Compared to VSSA, hVISA was associated with chronic renal failure (p<0.001), device related infections (haemodialysis access) (p<0.001) and previous vancomycin usage (p = 0.004). On multivariate analysis, independent predictors of mortality included age, presence of multiple co-morbidities, principal diagnosis, transit to ICU and severity of illness while infection related surgery and hVISA phenotype were associated with increased survival. CONCLUSIONS/SIGNIFICANCE The presence of hVISA is dependent on the appropriate interplay between host and pathogen factors. hVISA in ST239 MRSA is an independent predictor of survival. Whether these findings would be replicated across all MRSA clones is unknown and warrants further study.
Collapse
Affiliation(s)
- Sebastiaan J van Hal
- Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service-Liverpool Hospital, Sydney, New South Wales, Australia.
| | | | | | | |
Collapse
|
24
|
Preferential emergence of reduced vancomycin susceptibility in health care-associated methicillin-resistant Staphylococcus aureus isolates during continuous-infusion vancomycin therapy in an in vitro dynamic model. Antimicrob Agents Chemother 2011; 55:3627-30. [PMID: 21502616 DOI: 10.1128/aac.01472-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bacterial killing and the development of reduced vancomycin susceptibility during continuous-infusion vancomycin (CIV) therapy were dependent on the area under the concentration-time curve over 24 h divided by the MIC (ƒAUC(24)/MIC), with values of ≥ 240 (equivalent total serum AUC(24)/MICs of ≥ 480) being bactericidal and suppressing emerging resistance in methicillin-resistant Staphylococcus aureus (MRSA). Also, vancomycin therapy was less likely to be bactericidal and 4.4 times more likely to lead to reduced vancomycin susceptibility in health care-associated MRSA than in community-associated MRSA.
Collapse
|
25
|
Hemels MAC, van den Hoogen A, Verboon-Maciolek MA, Fleer A, Krediet TG. A seven-year survey of management of coagulase-negative staphylococcal sepsis in the neonatal intensive care unit: vancomycin may not be necessary as empiric therapy. Neonatology 2011; 100:180-5. [PMID: 21455008 DOI: 10.1159/000324852] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 02/03/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The typical empiric therapy for coagulase-negative staphylococcal (CONS) sepsis includes vancomycin. In our neonatal intensive care unit, we have consistently avoided the use of vancomycin to treat CONS sepsis, except for specific cases, and have used instead cefazolin as empiric agent. OBJECTIVES The clinical outcome of infants with CONS sepsis was evaluated in relation to the susceptibility of CONS blood isolates to cefazolin over a period of 7 years. METHODS Clinical characteristics, symptoms of sepsis and antibiotic use were studied retrospectively. Susceptibility of CONS blood isolates to cefazolin was determined by E-test. RESULTS Of 163 infants with proven CONS sepsis, 121/140 (86%) infants with a cefazolin-susceptible (minimum inhibition concentration (MIC) ≤8 mg/l) and 21/23 (91%) with a cefazolin-resistant (MIC ≥32 mg/l) blood isolate were treated with cefazolin. 21 (13%) infants were switched to vancomycin, in only 3 of them CONS had become resistant to cefazolin. The majority (81%) of the infants with a good response to cefazolin had the indwelling central venous catheter removed, in contrast to only 22% of the infants with cefazolin treatment failure. Median cefazolin MIC values were 0.75-2 mg/l during the study period. CONCLUSIONS The great majority of infants with CONS sepsis was successfully treated with cefazolin. The use of vancomycin could be restricted to specific cases. Despite the consistent use of cefazolin in neonatal CONS sepsis over an extended period of time, cefazolin MIC values remained low and in the susceptible range. Removal of the central venous catheter in infants with clinical symptoms of sepsis is an important therapeutic measure.
Collapse
Affiliation(s)
- Marieke A C Hemels
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
26
|
Chua K, Laurent F, Coombs G, Grayson ML, Howden BP. Not Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA)! A Clinician's Guide to Community MRSA - Its Evolving Antimicrobial Resistance and Implications for Therapy. Clin Infect Dis 2011; 52:99-114. [DOI: 10.1093/cid/ciq067] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
27
|
Shukla A, Avadhany SN, Fang JC, Hammond PT. Tunable vancomycin releasing surfaces for biomedical applications. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2010; 6:2392-404. [PMID: 20925040 DOI: 10.1002/smll.201001150] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Local drug delivery methods allow for the opportunity to supply potent multispectrum antibiotics such as vancomycin hydrochloride to sites of infection, while avoiding systemic toxicity. In this work, layer-by-layer assembly of polymer multilayer films is applied to create vancomycin delivery coatings. By taking advantage of the versatile layer-by-layer spray and dip coating techniques, thin films were generated based on electrostatic and other secondary interactions discovered to exist between the film components. The importance of film interdiffusion during growth in promoting interactions between film components is found to be critical in the direct incorporation of the weakly charged vancomycin drug in these multilayer films. The resulting coatings are engineered with unprecedented drug densities ranging from 17-220 μg mm(-3) (approximately 20 wt%) for films that are micron to submicron scale in thickness, delivering vancomycin over timescales of 4 h to 2.5 days. The released drug is highly effective in inhibiting Staphylococcus aureus growth in vitro. Taking advantage of the difference in release characteristics between dip and spray assembled films, a composite film architecture was engineered to have both a bolus vancomycin release followed by a period of linear sustained drug release. The control over drug densities and release profiles displayed in this work is necessary to address the requirements of varying medical conditions, including those where immediate infection elimination is needed or long term infection prevention is required.
Collapse
Affiliation(s)
- Anita Shukla
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | | | | | | |
Collapse
|
28
|
Management of Staphylococcus aureus bacteremia and endocarditis: progresses and challenges. Curr Opin Infect Dis 2010; 23:346-58. [DOI: 10.1097/qco.0b013e32833bcc8a] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|