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Yoon S, Guk J, Lee SG, Chae D, Kim JH, Park K. Model-informed precision dosing in vancomycin treatment. Front Pharmacol 2023; 14:1252757. [PMID: 37876732 PMCID: PMC10593454 DOI: 10.3389/fphar.2023.1252757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/11/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction: While vancomycin remains a widely prescribed antibiotic, it can cause ototoxicity and nephrotoxicity, both of which are concentration-associated. Overtreatment can occur when the treatment lasts for an unnecessarily long time. Using a model-informed precision dosing scheme, this study aims to develop a population pharmacokinetic (PK) and pharmacodynamic (PD) model for vancomycin to determine the optimal dosage regimen and treatment duration in order to avoid drug-induced toxicity. Methods: The data were obtained from electronic medical records of 542 patients, including 40 children, and were analyzed using NONMEM software. For PK, vancomycin concentrations were described with a two-compartment model incorporating allometry scaling. Results and discussion: This revealed that systemic clearance decreased with creatinine and blood urea nitrogen levels, history of diabetes and renal diseases, and further decreased in women. On the other hand, the central volume of distribution increased with age. For PD, C-reactive protein (CRP) plasma concentrations were described by transit compartments and were found to decrease with the presence of pneumonia. Simulations demonstrated that, given the model informed optimal doses, peak and trough concentrations as well as the area under the concentration-time curve remained within the therapeutic range, even at doses smaller than routine doses, for most patients. Additionally, CRP levels decreased more rapidly with the higher dose starting from 10 days after treatment initiation. The developed R Shiny application efficiently visualized the time courses of vancomycin and CRP concentrations, indicating its applicability in designing optimal treatment schemes simply based on visual inspection.
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Affiliation(s)
- Sukyong Yoon
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Jinju Guk
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongwoo Chae
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungsoo Park
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
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2
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Mohammed EH, Lohan S, Ghaffari T, Gupta S, Tiwari RK, Parang K. Membrane-Active Cyclic Amphiphilic Peptides: Broad-Spectrum Antibacterial Activity Alone and in Combination with Antibiotics. J Med Chem 2022; 65:15819-15839. [PMID: 36442155 PMCID: PMC9743092 DOI: 10.1021/acs.jmedchem.2c01469] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We designed a library of 24 cyclic peptides containing arginine (R) and tryptophan (W) residues in a sequential manner [RnWn] (n = 2-7) to study the impact of the hydrophilic/hydrophobic ratio, charge, and ring size on the antibacterial activity against Gram-positive and Gram-negative strains. Among peptides, 5a and 6a demonstrated the highest antimicrobial activity. In combination with 11 commercially available antibiotics, 5a and 6a showed remarkable synergism against a large panel of resistant pathogens. Hemolysis (HC50 = 340 μg/mL) and cell viability against mammalian cells demonstrated the selective lethal action of 5a against bacteria over mammalian cells. Calcein dye leakage and scanning electron microscopy studies revealed the membranolytic effect of 5a. Moreover, the stability in human plasma (t1/2 = 3 h) and the negligible ability of pathogens to develop resistance further reflect the potential of 5a for further development as a peptide-based antibiotic.
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Affiliation(s)
- Eman H.
M. Mohammed
- Center
for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical
Sciences, Chapman University School of Pharmacy,
Harry and Diane Rinker Health Science Campus, Irvine, California92618, United States,Department
of Chemistry, Faculty of Science, Menoufia
University, Shebin
El-Koam51132, Egypt,AJK
Biopharmaceutical, Irvine, California92617, United States
| | - Sandeep Lohan
- Center
for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical
Sciences, Chapman University School of Pharmacy,
Harry and Diane Rinker Health Science Campus, Irvine, California92618, United States,AJK
Biopharmaceutical, Irvine, California92617, United States
| | - Tarra Ghaffari
- Center
for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical
Sciences, Chapman University School of Pharmacy,
Harry and Diane Rinker Health Science Campus, Irvine, California92618, United States
| | - Shilpi Gupta
- Center
for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical
Sciences, Chapman University School of Pharmacy,
Harry and Diane Rinker Health Science Campus, Irvine, California92618, United States
| | - Rakesh K. Tiwari
- Center
for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical
Sciences, Chapman University School of Pharmacy,
Harry and Diane Rinker Health Science Campus, Irvine, California92618, United States,. Fax: +1-714-516-548. Phone: +1-714-516-5483
| | - Keykavous Parang
- Center
for Targeted Drug Delivery, Department of Biomedical and Pharmaceutical
Sciences, Chapman University School of Pharmacy,
Harry and Diane Rinker Health Science Campus, Irvine, California92618, United States,. Fax: +1-714-516-5481. Phone: +1-714-516-5489
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3
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Yin WH, Zhou CH, Ju XJ, Deng Y, Zhang L, Xie R, Wang W, Liu Z, Chu LY. Dual-functional polyetheretherketone surface with programmed sequential drug release coating. Colloids Surf B Biointerfaces 2022; 219:112806. [PMID: 36088828 DOI: 10.1016/j.colsurfb.2022.112806] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 10/31/2022]
Abstract
The poor bacteriostasis and osseointegration properties of bioinert polyetheretherketone (PEEK) hinder its clinical application. This work reports a simple and versatile strategy for fabricating dual-functional coating with programmed sequential drug release properties on porous PEEK surfaces. The dual-drug-loaded composite coating composed of drug-loaded poly(lactic-co-glycolic acid) (PLGA) nanoparticles and drug-loaded polyvinyl alcohol (PVA) gel can be immobilized on the surface of sulfonated PEEK by a cyclic freeze-thaw method. Based on the swelling of PVA and the slow degradation of PLGA, the composite coating can realize rapid release of antibacterial drugs and sustained release of osteogenic drugs. The in vitro antibacterial evaluations show that the porous PEEK modified with drug-loaded composite gel coating exhibits an early effective fight against Staphylococcus aureus (S.aureus). The results of in vitro cell experiments show that the PEEK materials modified by the composite gel coating can well support the normal growth, adhesion and proliferation of cells. In addition, the PEEK material coated with the drug-loaded composite gel is found to have positive effects on the osteogenic differentiation of cells in detections of alkaline phosphatase (ALP) activity of cells and the amount of calcium deposition on the surface of the material. The results demonstrate that the proposed porous PEEK modified with dual-drug-loaded composite gel coating simultaneously exhibits excellent osseointegration and exerts early effective antibacterial activity. This dual-functional PEEK material has great application potential in clinical bone tissue repair.
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Affiliation(s)
- Wei-Hong Yin
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China
| | - Chang-Hai Zhou
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China
| | - Xiao-Jie Ju
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China.
| | - Yi Deng
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China
| | - Lu Zhang
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Rui Xie
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Wei Wang
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Zhuang Liu
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | - Liang-Yin Chu
- School of Chemical Engineering, Sichuan University, Chengdu 610065, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
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4
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Workman CD, Hopkins S, Pant J, Goudie M, Handa H. Covalently Bound S-Nitroso- N-Acetylpenicillamine to Electrospun Polyacrylonitrile Nanofibers for Multifunctional Tissue Engineering Applications. ACS Biomater Sci Eng 2021; 7:5279-5287. [PMID: 34695358 DOI: 10.1021/acsbiomaterials.1c00907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Attachment of a nitric oxide (NO) donor to an electrospun polymer has the potential to improve its proliferative and antimicrobial capabilities. This study presents the novel, covalent attachment of S-nitroso-N-acetylpenicillamine (SNAP) to polyacrylonitrile (PAN) fibers. By attaching the NO donor to the polymer, rather than blending it, leaching is reduced to maintain a NO flux within the physiologically relevant range for a longer duration, while limiting any cytotoxic effects. The synthesized fibers were characterized using a variety of techniques such as scanning electron microscopy, 1H NMR, and drop shape analysis. Due to the antimicrobial activity of NO, the SNAP-PAN fibers demonstrated a 2-log reduction of S. aureus adhesion. Furthermore, the extended zone of inhibition of S. aureus by SNAP-PAN demonstrates the ability of NO to impact the environment surrounding the material, in addition to the environment in direct contact with it. The combination of NO release, hydrophilicity of PAN, and the fibrous network led to increased fibroblast proliferation and attachment, potentially expanding the fibers as an improved cell scaffolding platform. The results from this study demonstrate a novel preparation and design of NO-releasing fibers to provide multiple benefits for a variety of biomedical applications.
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Affiliation(s)
- Christina D Workman
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Sean Hopkins
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Jitendra Pant
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Marcus Goudie
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States.,Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
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5
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Zhang T, Zhu X, Guo J, Gu AZ, Li D, Chen J. Toxicity Assessment of Nano-ZnO Exposure on the Human Intestinal Microbiome, Metabolic Functions, and Resistome Using an In Vitro Colon Simulator. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:6884-6896. [PMID: 33969685 DOI: 10.1021/acs.est.1c00573] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Nano-ZnO, as a commonly used nanomaterial, has been found in drinking water, food, and medicine; therefore, it poses potential health risks via the digestion system. However, little is known about the toxicity of nano-ZnO on the human intestinal microbiome, which plays critical roles in human health. This study comprehensively investigated the impact of nano-ZnO on the human gut microbiome, metabolic functions, and resistome using an in vitro colon simulator. Nano-ZnO induced concentration-dependent decreases in the production of short-chain fatty acids (SCFAs). Metagenomic analysis revealed that nano-ZnO not only led to dose-dependent shifts in the composition and diversity of the gut microbiota but also changed the key functional pathways of the gut microbiome. Although the diversity of the gut microbiota basically recovered after stopping exposure to nano-ZnO, SCFAs still showed a concentration-dependent decrease. Furthermore, although a medium concentration of nano-ZnO (2.5 mg/L) reduced the abundance of many antibiotic resistance genes (ARGs) by inhibiting the growth of related host bacteria, a low concentration of nano-ZnO (0.1 mg/L) greatly enriched the abundance of tetracycline resistance genes. Our findings provide evidence that nano-ZnO can impact the diversity, metabolism, and functional pathways of the human gut microbiome, as well as the gut resistome, highlighting the potential health effects of nanoparticles.
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Affiliation(s)
- Tingting Zhang
- Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan Tyndall Centre, Department of Environmental Science and Engineering, Fudan University, Shanghai 200433, China
| | - Xuan Zhu
- School of Food Science and Bioengineering, Zhejiang Gongshang University, Hangzhou 310018, China
| | - Jianhua Guo
- Advanced Water Management Centre (AWMC), The University of Queensland, St. Lucia, Brisbane, QLD 4072, Australia
| | - April Z Gu
- School of Civil and Environmental Engineering, Cornell University, Ithaca, New York 14850, United States
| | - Dan Li
- Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan Tyndall Centre, Department of Environmental Science and Engineering, Fudan University, Shanghai 200433, China
| | - Jianmin Chen
- Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan Tyndall Centre, Department of Environmental Science and Engineering, Fudan University, Shanghai 200433, China
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6
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Guleng SR, Wu RH, Guo XB. Vancomycin-induced thrombocytopenia in endocarditis: A case report and review of literature. World J Clin Cases 2021; 9:1696-1704. [PMID: 33728314 PMCID: PMC7942037 DOI: 10.12998/wjcc.v9.i7.1696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/28/2020] [Accepted: 01/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thrombocytopenia is a serious complication in the medical practice of numerous drugs. Vancomycin is frequently used for the prophylaxis and treatment of suspected or identified methicillin-resistant positive infections. Several cases with vancomycin-induced thrombocytopenia (VIT) have been reported. However, these have rarely been extensively reviewed. The present report describes a case of VIT in endocarditis, and reviews all VIT cases reported in the literature.
CASE SUMMARY A 26-year-old male diagnosed with infective endocarditis was admitted. The patient was treated with multiple drugs, including vancomycin, which was initially intravenously given at 1000 mg every 12 h and subsequently at 500 mg every 8 h on day 3. On day 11, the platelet count decreased to 51 × 109/L, vancomycin was switched to 500 mg every 12 h, and platelet transfusion was given. On day 17, the platelet count dropped to 27 × 109/L, and platelet transfusion was administered again. On day 23, vancomycin was adjusted to 500 mg every 8 h as the trough concentration dropped to the minimum effective concentration. On day 33, the platelet count declined to approximately 40 × 109/L. After platelet transfusion, the platelet count rebounded to 90 × 109/L on day 35 but dropped again to 42 × 109/L on day 43. Based on the time-to-platelet count curve and Naranjo’s Adverse Drug Reaction Probability Scale score, VIT was suspected. After vancomycin discontinuation and platelet transfusion, the platelet count gradually normalized.
CONCLUSION The diagnosis of VIT can be achieved through the time-to-platelet count curve and Naranjo’s Adverse Drug Reaction Probability Scale score. The platelet count cannot be normalized simply by platelet transfusion alone, and vancomycin discontinuation is essential.
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Affiliation(s)
- Si-Ri Guleng
- Department of Pharmacy, Inner Mongolia Autonomous Region People's Hospital, Hohhot 010010, Inner Mongolia Autonomous, China
| | - Ri-Han Wu
- Department of Pharmacy, Inner Mongolia Autonomous Region People's Hospital, Hohhot 010010, Inner Mongolia Autonomous, China
| | - Xiao-Bin Guo
- Department of Pharmacy, Inner Mongolia Autonomous Region People's Hospital, Hohhot 010010, Inner Mongolia Autonomous, China
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7
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Glycopeptide Hypersensitivity and Adverse Reactions. PHARMACY 2020; 8:pharmacy8020070. [PMID: 32326261 PMCID: PMC7357119 DOI: 10.3390/pharmacy8020070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/23/2020] [Accepted: 04/18/2020] [Indexed: 12/27/2022] Open
Abstract
Glycopeptides, such as vancomycin and teicoplanin, are primarily used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, such as cellulitis, endocarditis, meningitis, pneumonia, and septicemia, and are some of the most commonly prescribed parenteral antimicrobials. Parenteral glycopeptides are first-line therapy for severe MRSA infections; however, oral vancomycin is used as a first-line treatment of Clostridioides difficile infections. Also, we currently have the longer-acting lipoglycopeptides, such as dalbavancin, oritavancin, and telavancin to our armamentarium for the treatment of MRSA infections. Lastly, vancomycin is often used as an alternative treatment for patients with β-lactam hypersensitivity. Common adverse effects associated with glycopeptide use include nephrotoxicity, ototoxicity, and Redman Syndrome (RMS). The RMS is often mistaken for a true allergy; however, it is a histamine-related infusion reaction rather than a true immunoglobulin E (IgE)-mediated allergic reaction. Although hypersensitivity to glycopeptides is rare, both immune-mediated and delayed reactions have been reported in the literature. We describe the various types of glycopeptide hypersensitivity reactions associated with glycopeptides and lipoglycopeptides, including IgE-mediated reactions, RMS, and linear immunoglobulin A bullous dermatosis, as well as describe cross-reactivity with other glycopeptides.
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8
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Moravej H, Moravej Z, Yazdanparast M, Heiat M, Mirhosseini A, Moosazadeh Moghaddam M, Mirnejad R. Antimicrobial Peptides: Features, Action, and Their Resistance Mechanisms in Bacteria. Microb Drug Resist 2018; 24:747-767. [PMID: 29957118 DOI: 10.1089/mdr.2017.0392] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In recent years, because of increased resistance to conventional antimicrobials, many researchers have started to study the synthesis of new antibiotics to control the disease-causing effects of infectious pathogens. Antimicrobial peptides (AMPs) are among the newest antibiotics; these peptides are integral compounds in all kinds of organisms and play a significant role in microbial ecology, and critically contribute to the innate immunity of organisms by destroying invading microorganisms. Moreover, AMPs may encourage cells to produce chemokines, stimulate angiogenesis, accelerate wound healing, and influence programmed cell death in multicellular organisms. Bacteria differ in their inherent susceptibility and resistance mechanisms to these peptides when responding to the antimicrobial effects of AMPs. Generally, the development of AMP resistance mechanisms is driven by direct competition between bacterial species, and host and pathogen interactions. Several studies have shown diverse mechanisms of bacterial resistance to AMPs, for example, some bacteria produce proteases and trapping proteins; some modify cell surface charge, change membrane fluidity, and activate efflux pumps; and some species make use of biofilms and exopolymers, and develop sensing systems by selective gene expression. A closer understanding of bacterial resistance mechanisms may help in developing novel therapeutic approaches for the treatment of infections caused by pathogenic organisms that are successful in developing extensive resistance to AMPs. Based on these observations, this review discusses the properties of AMPs, their targeting mechanisms, and bacterial resistance mechanisms against AMPs.
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Affiliation(s)
- Hoda Moravej
- 1 Molecular Biology Research Center, Systems Biology and Poisoning Institute, Baqiyatallah University of Medical Sciences , Tehran, Iran
| | - Zahra Moravej
- 2 Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
| | - Maryam Yazdanparast
- 3 Department of Pharmacology, Experimental Medicine Research Center, School of Medicine, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohammad Heiat
- 4 Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences , Tehran, Iran
| | - Ali Mirhosseini
- 5 Applied Microbiology Research Center, Systems Biology and Poisoning Institute, Baqiyatallah University of Medical Sciences , Tehran, Iran
| | | | - Reza Mirnejad
- 1 Molecular Biology Research Center, Systems Biology and Poisoning Institute, Baqiyatallah University of Medical Sciences , Tehran, Iran
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9
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Mohammadi M, Jahangard-Rafsanjani Z, Sarayani A, Hadjibabaei M, Taghizadeh-Ghehi M. Vancomycin-Induced Thrombocytopenia: A Narrative Review. Drug Saf 2017; 40:49-59. [PMID: 27848200 DOI: 10.1007/s40264-016-0469-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Thrombocytopenia has been reported as an adverse reaction of numerous drugs. Vancomycin is often overlooked as a culprit but has been associated with several cases of thrombocytopenia that were not well described in the literature. A literature search was conducted to find reports of thrombocytopenia induced by vancomycin. Biomedical databases including 'PubMed', 'Scopus', and 'Web of Science' were searched using terms 'vancomycin', 'platelet', 'pancytopenia', 'thrombocytopenia', and 'bleeding'. English language articles published before July 2015 were included. Thirty-nine papers including 29 case reports (30 cases), five observational studies, two clinical trials, two letters, and one case series remained for final analysis. The main route of administration was intravenous infusion. This adverse reaction seems to be duration dependent with the mean time to platelet nadir count of 8 days in reported cases. The interval may be significantly shorter in re-exposure to the drug. Platelet nadir counts ranged from 2000 to 100,000/mL in patients who experienced bleeding. Vancomycin-specific antibodies were detected in 13 of 17 patients who were tested in the case reports. Based on the Naranjo Adverse Drug Reaction Probability Scale, reaction was 'definite', 'probable', and 'possible' in 1, 15, and 14 patients, respectively. Among 30 cases, vancomycin was discontinued in 29 patients and platelets returned to normal counts within 5-6 days in 17 of them; in one patient, vancomycin was not discontinued, but platelet count recovered 11 days after the nadir time. Transfusion might be recommended if severe thrombocytopenia and bleeding occurs. Intravenous immunoglobulins, corticosteroids, rituximab, and plasma exchange should be reserved for patients with resistant thrombocytopenia and severe bleeding as mentioned in a number of reports.
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Affiliation(s)
- Mehdi Mohammadi
- Faculty of Pharmacy, Tehran University of Medical Sciences, Pour Sina St, District 6, Tehran, Iran
| | | | - Amir Sarayani
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, 4th Floor, No. 92, Karimkhan Zand Avenue, Hafte Tir Square, Tehran, Iran
| | - Molouk Hadjibabaei
- Faculty of Pharmacy, Tehran University of Medical Sciences, Pour Sina St, District 6, Tehran, Iran.,Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, 4th Floor, No. 92, Karimkhan Zand Avenue, Hafte Tir Square, Tehran, Iran
| | - Maryam Taghizadeh-Ghehi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, 4th Floor, No. 92, Karimkhan Zand Avenue, Hafte Tir Square, Tehran, Iran.
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10
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Zhu L, Qian X, Chen D, Ge M. Role of two 5-aminolevulinic acid biosynthetic pathways in heme and secondary metabolite biosynthesis in Amycolatopsis orientalis. J Basic Microbiol 2017; 58:198-205. [PMID: 29164655 DOI: 10.1002/jobm.201600758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 07/25/2017] [Accepted: 09/23/2017] [Indexed: 11/09/2022]
Abstract
Analysis of the Amycolatopsis orientalis genome revealed that two genes, hemA1 and hemA2, belonging to divergent pathways, were involved in the biosynthesis of 5-aminolevulinic acid. The roles of hemA1 and hemA2 were elucidated via genetic manipulation and metabolite analysis. The disruption of hemA1, encoding the glutamyl-tRNAGlu reductase of the C5 pathway, was essential for cell growth and is used for heme synthesis. Overexpression of hemA1 resulted in elevated vancomycin and ECO-0501 production in Amycolatopsis orientalis, and it was also effective in increasing the production of daptomycin and natamycin in other Streptomycetes. The disruption of hemA2 indicated that it encodes the 5-aminolevulinic acid synthase of the Shemin pathway, serving as a key enzyme for the synthesis of the precursor aminohydroxycyclopentenone unit of ECO-0501. However, hemA2 disruption could not be complemented by the addition of 5-aminolevulinic acid or by the expression of hemA2 outside of the ECO-0501 gene cluster. The synthesis of ECO-0501 was only restored by the insertion of hemA2 at its original locus. The hemA2 gene could partly complement the hemA1 deficiency. Overexpression of hemA1, a key gene from the heme biosynthetic pathway, is proposed here as a new approach to improve the production of secondary metabolites in bacteria, whereas hemA2 plays different roles depending on its pattern of expression.
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Affiliation(s)
- Li Zhu
- School of Pharmacy, Shanghai Jiaotong University, Shanghai, China.,Shanghai Laiyi Center for Biopharmaceutical R&D, Shanghai, China
| | - Xiuping Qian
- School of Pharmacy, Shanghai Jiaotong University, Shanghai, China
| | - Daijie Chen
- School of Pharmacy, Shanghai Jiaotong University, Shanghai, China
| | - Mei Ge
- Shanghai Laiyi Center for Biopharmaceutical R&D, Shanghai, China
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11
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Genetic engineering of a temperate phage-based delivery system for CRISPR/Cas9 antimicrobials against Staphylococcus aureus. Sci Rep 2017; 7:44929. [PMID: 28322317 PMCID: PMC5359561 DOI: 10.1038/srep44929] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/16/2017] [Indexed: 12/29/2022] Open
Abstract
Discovery of clustered, regularly interspaced, short palindromic repeats and the Cas9 RNA-guided nuclease (CRISPR/Cas9) system provides a new opportunity to create programmable gene-specific antimicrobials that are far less likely to drive resistance than conventional antibiotics. However, the practical therapeutic use of CRISPR/Cas9 is still questionable due to current shortcomings in phage-based delivery systems such as inefficient delivery, narrow host range, and potential transfer of virulence genes by generalized transduction. In this study, we demonstrate genetic engineering strategies to overcome these shortcomings by integrating CRISPR/Cas9 system into a temperate phage genome, removing major virulence genes from the host chromosome, and expanding host specificity of the phage by complementing tail fiber protein. This significantly improved the efficacy and safety of CRISPR/Cas9 antimicrobials to therapeutic levels in both in vitro and in vivo assays. The genetic engineering tools and resources established in this study are expected to provide an efficacious and safe CRISPR/Cas9 antimicrobial, broadly applicable to Staphylococcus aureus.
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12
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Bioavailability of gentamicin and vancomycin released from an antibiotic containing bone cement in patients undergoing a septic one-stage total hip arthroplasty (THA) revision: a monocentric open clinical trial. Hip Int 2017; 26:90-6. [PMID: 26449335 DOI: 10.5301/hipint.5000307] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this clinical investigation was to evaluate the systemic bioavailability of antibiotics from bone cement after implantation. This was done by determining the concentrations of gentamicin and vancomycin in plasma and urine of patients receiving a novel bone cement during one-stage revision in periprosthetic hip infections. The local concentrations of both antibiotic agents in wound exudate as well as the efficacy and tolerability were assessed as a secondary objective. METHODS In a prospective open clinical trial, 20 patients (mean age 62.5 years) with an implanted hip prosthesis requiring revision due to periprosthetic infection were treated with this antibiotic loaded bone cement (ALBC) between 2009 and 2011. The concentrations of gentamicin and vancomycin in plasma, urine and wound exudate were determined with quantitative liquid chromatography analysis (LC-MS-MS). RESULTS The mean postoperative maximum gentamicin plasma concentration at 5.85 hours was 209.65 ng/mL. For vancomycin, a mean postoperative maximum plasma concentration of 134.64 ng/mL was determined at 20.03 hours. Small amounts of both antibiotics were excreted via the urine within the first 10 days after surgery. No reinfection was observed at the end of the hospital stay or during the follow-up period up to 7 months post surgery. CONCLUSIONS Slow absorption of both antibiotics after release from the cement resulted in plasma concentrations well below toxic levels and did not result in a critical systemic concentration potientially inducing bacterial resistance. The treatment with this novel bone cement was assessed as efficacious and was very well tolerated by all patients.
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Triple prophylaxis for the prevention of surgical site infections in total joint arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wales SM, Hammer KA, Somphol K, Kemker I, Schröder DC, Tague AJ, Brkic Z, King AM, Lyras D, Riley TV, Bremner JB, Keller PA, Pyne SG. Synthesis and antimicrobial activity of binaphthyl-based, functionalized oxazole and thiazole peptidomimetics. Org Biomol Chem 2015; 13:10813-24. [PMID: 26349598 DOI: 10.1039/c5ob01638j] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Thirty two new binaphthyl-based, functionalized oxazole and thiazole peptidomimetics and over thirty five novel leucine-containing intermediate oxazoles and thiazoles were prepared in this study. This includes the first examples of the direct C-5 arylation of an amino acid dipeptide-derived oxazole. Moderate to excellent antibacterial activity was observed for all new compounds across Gram positive isolates with MICs ranging from 1-16 μg mL(-1). Results for Gram negative E. coli and A. baumannii were more variable, but MICs as low as 4 μg mL(-1) were returned for two examples. Significantly, the in vitro results with a fluoromethyl-oxazole derivative collectively represent the best obtained to date for a member of our binaphthyl peptide antimicrobials.
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Affiliation(s)
- Steven M Wales
- School of Chemistry, University of Wollongong, Wollongong, NSW 2522, Australia.
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Glycopeptides Versus β-Lactams for the Prevention of Surgical Site Infections in Cardiovascular and Orthopedic Surgery. Ann Surg 2015; 261:72-80. [DOI: 10.1097/sla.0000000000000704] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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16
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Jennepalli S, Hammer KA, Riley TV, Pyne SG, Keller PA. Synthesis of Mono and Bis[60]fullerene-Based Dicationic Peptoids. European J Org Chem 2014. [DOI: 10.1002/ejoc.201403046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Synergistic Effect between Cryptotanshinone and Antibiotics against Clinic Methicillin and Vancomycin-Resistant Staphylococcus aureus. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:450572. [PMID: 24782909 PMCID: PMC3982256 DOI: 10.1155/2014/450572] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/06/2014] [Accepted: 02/18/2014] [Indexed: 11/18/2022]
Abstract
Cryptotanshinone (CT), a major tanshinone of medicinal plant Salvia miltiorrhiza Bunge, demonstrated strong antibacterial activity against clinic isolated methicillin and vancomycin-resistant Staphylococcus aureus (MRSA and VRSA) in this experiment. The CT was determined against clinic isolated MRSA 1–16 with MIC and MBC values ranging from 4 to 32 and 8 to 128 μg/mL; for MSSA 1-2 from 16 to 32 μg/mL and 64 to 128 μg/mL; for VRSA 1-2 from 2 to 4 μg/mL and 4 to 16 μg/mL, respectively. The range of MIC50 and MIC90 of CT was 0.5–8 μg/mL and 4–64 μg/mL, respectively. The combination effects of CT with antibiotics were synergistic (FIC index <0.5) against most of tested clinic isolated MRSA, MSSA, and VRSA except additive, MRSA 4 and 16 in oxacillin, MRSA 6, 12, and 15 in ampicillin, and MRSA 6, 11, and 15 in vancomycin (FIC index < 0.75–1.0). Furthermore, a time-kill study showed that the growth of the tested bacteria was completely attenuated after 2–6 h of treatment with the 1/2 MIC of CT, regardless of whether it was administered alone or with ampicillin, oxacillin, or vancomycin. The results suggest that CT could be employed as a natural antibacterial agent against multidrug-resistant pathogens infection.
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Kullar R, Rybak MJ, Kaye KS. Comparative epidemiology of bacteremia due to methicillin-resistant Staphylococcus aureus between older and younger adults: a propensity score analysis. Infect Control Hosp Epidemiol 2013; 34:400-6. [PMID: 23466914 DOI: 10.1086/669868] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We evaluated the clinical and molecular epidemiology of bloodstream infections (BSIs) due to methicillin-resistant Staphylococcus aureus (MRSA) in older versus younger patients treated with vancomycin, determining the independent effect of increased age on outcomes. DESIGN Observational retrospective cohort study. SETTING Detroit Medical Center, level I trauma center. PATIENTS Adult older (65 years and older) and younger (younger than 65 years) patients with documented BSIs due to MRSA treated with vancomycin (2005-2010). METHODS Collected demographics, comorbidities, microbiology, treatment, outcomes. Multivariable model used to generate propensity score for each patient on the basis of the probability of being 65 years of age or older. RESULTS Three hundred twenty patients were eligible (69 patients 65 years and older; 251 patients younger than 65 years). Catheter-related infections and endocarditis were the most common sites of infection for older (20.3%) and younger (19.1%) adults, respectively. Median first total 24-hour vancomycin dose (1,000 vs 2,000 mg; [Formula: see text]) and initial trough (13.1 vs 15.0 mg/L; [Formula: see text]) was significantly lower in older versus younger patients. Vancomycin treatment failure rates were similar among older and younger patients (49.3% vs 53.4%; [Formula: see text]). In multivariable analysis of outcomes, after controlling for predictors of older age, there was no difference in clinical outcomes between older and younger adults. CONCLUSIONS After accounting for confounders associated with increased age, failure rate of patients with BSIs due to MRSA treated with vancomycin was similar between older and younger patients. Older adults were less likely to have optimal vancomycin dosing and initial trough levels than younger patients. Efforts should be made to optimize dosing of medications such as vancomycin in older adults.
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Affiliation(s)
- Ravina Kullar
- College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR 97239, USA.
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Grüger T, Schmidt T, Schnitzler N, Nidermajer S, Brandenburg K, Zündorf J. Negative impact of linezolid on human neutrophil functions in vitro. Chemotherapy 2012; 58:206-11. [PMID: 22759803 DOI: 10.1159/000338390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS In a recent phase III clinical trial on linezolid, more patients in the linezolid treatment arm acquired Gram-negative catheter-related bloodstream infections despite the adequate therapy of infections caused by Gram-negative bacteria. We tested our hypothesis that linezolid impairs phagocytosis and the killing of Gram-negative bacteria by polymorphonuclear leukocytes (PMN). METHODS The influence of clinically relevant concentrations (5, 20 and 50 mg/l) of linezolid on granulocyte function in vitro was tested. Phagocytosis was determined by flow cytometry, and killing of bacteria was evaluated by plate counting. Chemotaxis was examined by an under-agarose cell migration assay. Gram-positive and Gram-negative bacteria were used. RESULTS Linezolid significantly impaired phagocytosis of a specific Escherichia coli strain in a concentration-dependent manner, whereas the effect on Pseudomonas aeruginosa was less prominent. No such effects were observed with a different E. coli strain or Staphylococcus aureus. Neither killing nor the chemotactic behaviour of PMN was significantly affected by linezolid. CONCLUSIONS The observed concentration-dependent impairment of the phagocytic function might contribute to the higher frequency of catheter-related Gram-negative bloodstream infections in patients treated with linezolid. Individual patient risk may also depend on the causative Gram-negative strain.
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Affiliation(s)
- Thomas Grüger
- Federal Institute for Drugs and Medical Devices, Biosafety Laboratory, Bonn, Germany
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Synergistic activity of ceftobiprole and vancomycin in a rat model of infective endocarditis caused by methicillin-resistant and glycopeptide-intermediate Staphylococcus aureus. Antimicrob Agents Chemother 2012; 56:1476-84. [PMID: 22232278 DOI: 10.1128/aac.06057-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The therapeutic activity of ceftobiprole medocaril, the prodrug of ceftobiprole, was compared to that of vancomycin, daptomycin, and the combination of a subtherapeutic dose of ceftobiprole and vancomycin in a rat model of infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) (ATCC 43300) or glycopeptide-intermediate Staphylococcus aureus (GISA) (NRS4 and HIP 5836) strains. The minimum bactericidal concentrations of ceftobiprole, vancomycin, and daptomycin at bacterial cell densities similar to those encountered in the cardiac vegetation in the rat endocarditis model were 2, >64, and 8 μg/ml, respectively, for MRSA ATCC 43300 and 4, >64, and 8 μg/ml, respectively, for the GISA strain. Ceftobiprole medocaril administered in doses of 100 mg/kg of body weight given intravenously (i.v.) twice a day (BID) every 8 h (q8h) (equivalent to a human therapeutic dose of ceftobiprole [500 mg given three times a day [TID]) was the most effective monotherapy, eradicating nearly 5 log(10) CFU/g MRSA or 6 log(10) CFU/g GISA organisms from the cardiac vegetation and had the highest incidence of sterile vegetation compared to the other monotherapies in the endocarditis model. In in vitro time-kill studies, synergistic effects were observed with ceftobiprole and vancomycin on MRSA and GISA strains, and in vivo synergy was noted with combinations of subtherapeutic doses of these agents for the same strains. Additionally, sterile vegetations were achieved in 33 and 60%, respectively, of the animals infected with MRSA ATCC 43300 or GISA NRS4 receiving ceftobiprole-vancomycin combination therapy. In summary, ceftobiprole was efficacious both as monotherapy and in combination with vancomycin in treating MRSA and GISA infections in a rat infective endocarditis model and warrants further evaluation.
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Robertson M, Bremner JB, Coates J, Deadman J, Keller PA, Pyne SG, Somphol K, Rhodes DI. Synthesis and antibacterial activity of C2-symmetric binaphthyl scaffolded amino acid derivatives. Eur J Med Chem 2011; 46:4201-11. [DOI: 10.1016/j.ejmech.2011.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 05/07/2011] [Accepted: 06/18/2011] [Indexed: 10/18/2022]
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Coghlan DR, Bremner JB, Keller PA, Pyne SG, David DM, Somphol K, Baylis D, Coates J, Deadman J, Rhodes DI, Robertson AD. Synthesis and antibacterial activity of some binaphthyl-supported macrocycles containing a cationic amino acid. Bioorg Med Chem 2011; 19:3549-57. [DOI: 10.1016/j.bmc.2011.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 04/02/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
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Antibiotische Infektionsprophylaxe in der Primär- und Revisionsendoprothetik der Hüfte. DER ORTHOPADE 2011; 40:520-7. [DOI: 10.1007/s00132-011-1755-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Yang Y, McBride MV, Rodvold KA, Tverdek F, Trese AM, Hennenfent J, Schiff G, Lambert BL, Schumock GT. Hospital policies and practices on prevention and treatment of infections caused by methicillin-resistantStaphylococcus aureus. Am J Health Syst Pharm 2010; 67:1017-24. [DOI: 10.2146/ajhp090563] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Yoojung Yang
- Center for Pharmacoeconomic Research, University of Illinois at Chicago (UIC), Chicago
| | - Martin V. McBride
- Pharmacy Services, Operations Department, Broadlane Inc., Dallas, TX
| | | | - Frank Tverdek
- Department of Pharmacy Services, Tenet–Saint Louis University Hospital, St. Louis, MO
| | - Anne Marie Trese
- Infectious Disease, Forest Research Institute, Jersey City, NJ; when this article was written, she was Director, The Preference Group, Broadlane Inc
| | | | - Gordon Schiff
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School, Boston, MA
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Bouza E. New therapeutic choices for infections caused by methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2010; 15 Suppl 7:44-52. [PMID: 19951334 DOI: 10.1111/j.1469-0691.2009.03091.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In recent years, a marked increase in the incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has occurred in many countries. This review addresses the effectiveness and limitations of drugs classically used for the treatment of MRSA, e.g. vancomycin, and also newer anti-MRSA antimicrobials, e.g. second-generation glycolipopeptides, tigecycline, and beta-lactams.
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Affiliation(s)
- E Bouza
- Servicio de Microbiología Clínica y E. Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutenste, Madrid, and Ciber de Enfermedades Respiratories (CIBERES), Spain.
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Bremner J, Keller P, Pyne S, Boyle T, Brkic Z, David D, Garas A, Morgan J, Robertson M, Somphol K, Miller M, Howe A, Ambrose P, Bhavnani S, Fritsche T, Biedenbach D, Jones R, Buckheit R, Watson K, Baylis D, Coates J, Deadman J, Jeevarajah D, McCracken A, Rhodes D. Binaphthyl-Based Dicationic Peptoids with Therapeutic Potential. Angew Chem Int Ed Engl 2010. [DOI: 10.1002/ange.200904392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bremner J, Keller P, Pyne S, Boyle T, Brkic Z, David D, Garas A, Morgan J, Robertson M, Somphol K, Miller M, Howe A, Ambrose P, Bhavnani S, Fritsche T, Biedenbach D, Jones R, Buckheit R, Watson K, Baylis D, Coates J, Deadman J, Jeevarajah D, McCracken A, Rhodes D. Binaphthyl-Based Dicationic Peptoids with Therapeutic Potential. Angew Chem Int Ed Engl 2009; 49:537-40. [DOI: 10.1002/anie.200904392] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vidaillac C, Leonard SN, Rybak MJ. In vitro activity of ceftaroline against methicillin-resistant Staphylococcus aureus and heterogeneous vancomycin-intermediate S. aureus in a hollow fiber model. Antimicrob Agents Chemother 2009; 53:4712-7. [PMID: 19738009 PMCID: PMC2772315 DOI: 10.1128/aac.00636-09] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 08/03/2009] [Accepted: 08/28/2009] [Indexed: 11/20/2022] Open
Abstract
Ceftaroline is a broad-spectrum injectable cephalosporin exhibiting bactericidal activity against a variety of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Using a two-compartment in vitro pharmacokinetic/pharmacodynamic (PK/PD) model, we evaluated the activity of ceftaroline at 600 mg every 8 h (q8h) and q12h in comparison with that of vancomycin at 1,000 mg q12h over a 72-h time period against six clinical MRSA isolates, including two heterogeneous vancomycin-intermediate S. aureus (hVISA) isolates. The MIC and minimum bactericidal concentration ranged between 0.125 to 2 and 0.5 to 2 microg/ml for ceftaroline and vancomycin, respectively. In the PK/PD model, ceftaroline was superior to vancomycin against all isolates (P < 0.05), except one to which it was equivalent. No difference in activity was observed between both q8 and q12h dosing regimens of ceftaroline. Bacterial regrowth was observed after 32 h for two isolates treated with ceftaroline. This regrowth was uncorrelated to resistance, instability of the drug, or tolerance. However, subpopulations with higher MICs to ceftaroline were found by population analysis for these two isolates. Finally, and in contrast to ceftaroline, MIC elevations up to 8 to 12 microg/ml were observed with vancomycin for the hVISA isolates. In conclusion, in addition to a lower potential to select resistant mutants, ceftaroline demonstrated activity equal to or greater than vancomycin against MRSA isolates. Although further in vitro and in vivo investigations are warranted, ceftaroline appears to be a promising alternative for the treatment of MRSA infections.
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Affiliation(s)
- Céline Vidaillac
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan 48201, Detroit Receiving Hospital, Detroit, Michigan 48201
| | - Steve N. Leonard
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan 48201, Detroit Receiving Hospital, Detroit, Michigan 48201
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan 48201, Detroit Receiving Hospital, Detroit, Michigan 48201
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Abstract
Prophylactic parenteral antibiotics have contributed to the present low rate of surgical site infections following hip and knee arthroplasty. Over the past decade, there has been a change in the pattern of methicillin-resistant Staphylococcus aureus infections from hospital-acquired to community-acquired. The findings of recent studies on screening programs to identify carriers of methicillin-resistant Staphylococcus aureus have been equivocal, with some studies showing that such programs reduce the rate of infections and others showing no effect on infection rates. Hospitals with antibiogram data that reveal high Staphylococcus resistance should consider use of vancomycin as a prophylactic antibiotic.
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Affiliation(s)
- John Meehan
- Department of Orthopaedic Surgery, University of California at Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
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Moise PA, Hershberger E, Amodio-Groton MI, Lamp KC. Safety and Clinical Outcomes when Utilizing High-Dose (≥8 mg/kg) Daptomycin Therapy. Ann Pharmacother 2009; 43:1211-9. [DOI: 10.1345/aph.1m085] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Daptomycin is approved for the treatment of skin and skin-structure infections (4 mg/kg) and Staphylococcus aureus bacteremia, including right-sided endocarditis (β mg/kg). In vitro and animal studies have reported increased activity with increased daptomycin doses. There are limited clinical data on use of daptomycin at doses greater than 6 mg/kg. Objective: To evaluate the safety and efficacy of higher doses (≥8 mg/kg) of daptomycin when administered for a variety of gram-positive infections. Methods: Data were collected retrospectively as part of an ongoing registry (the Cubicin Outcomes Registry and Experience database) for the 2005–2007 program years. For the purpose of this study, the safety and efficacy of daptomycin were evaluated in patients who received doses of 8 m/kg or higher. Results: Ninety-four (2.6%) of 3617 patients received daptomycin doses of 6 mg/kg or higher; 18 (19%) of those patients received doses of 10 mg/kg or higher. The most common infections were bacteremia (30/94), skin and skin-structure infections (22/94), and endocarditis (15/94). The most common pathogens were Enterococcus spp. (37/94; 57% vancomycin-resistant) and S. aureus (28/94; 68% methicllin-resistant). Fifty-one percent of the patients were male. 39% were aged 66 years or older, 27% had an initial creatinine clearance less than 30 mL/min, and 17% were on dialysis. The median duration of daptomycin therapy was 15 days (minimum 1, maximum 90). Six (6.4%) of the 94 patients experienced 1 or more adverse events or abnormal laboratory value changes possibly related to daptomycin; in 2 (2.1%) of the 94 patients, daptomycin was discontinued due to treatment-related adverse events. Seventy-four (79%) patients were considered evaluable for efficacy. The overall clinical success rate was 89% (bacteremia, 91 %; skm and skin-structure infections. 88%: endocarditis. 67%) Conclusions: Daptomycin was well tolerated and effective at doses of 8 mg/kg or higher in patients with gram-positive infections. Further prospective and comparative studies of daptomycin at doses greater than 6 mg/kg are warranted.
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Abstract
PURPOSE OF REVIEW Immunosuppressive states and therapies are becoming common in clinical practice. Recent advances and trends in bacterial, fungal, viral and parasitic pulmonary infections in immunosuppressed patients are described. RECENT FINDINGS Pulmonary infections can jeopardize the prognosis of immunosuppressed patients. The number of patients infected with multidrug-resistant bacteria or opportunistic pathogens like rapid-growing environmental mycobacteria, Strongyloides stercoralis or Rhodococcus equi is increasing with the increased numbers of immunosuppressed patients due to HIV/AIDS and the potent immunosuppressive therapies used in solid-organ and haematopoietic transplantations, cancer and systemic illnesses. The slow development of more effective antibiotics underlines the necessity of preventive measures, development of rapid detection tests for pathogens and appropriate treatment regimens to avoid development of further resistance. SUMMARY Adequate prophylaxis, clinical suspicion, microbiological and molecular investigations, drug susceptibility-based antibiotic treatment and new drug development are strategies required to face up to the challenge of pulmonary infections in immunodepressed patients.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:66-73. [PMID: 19225308 DOI: 10.1097/moo.0b013e32832406ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Laddis D, Khine H, Goldman DL. Fever and Rash: A Changing Landscape in the 21st Century. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2008; 9:244-249. [PMID: 32288649 PMCID: PMC7106328 DOI: 10.1016/j.cpem.2008.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Although “fever and rash” is a common complaint in the pediatric emergency department, most causes are benign. Of the more severe causes, several have been greatly reduced by vaccination programs. In addition, new vaccines such as those for invasive meningococcal disease hold promise for an even brighter future. Although meningococcemia remains an important concern when evaluating a child with fever and a rash, the resurgence of measles, the emergence of invasive group A streptococcal disease and antibiotic-resistant Staphylococcus aureus, as well as the fear of agents of bioterrorism (anthrax, smallpox) have changed the landscape of fever and rash in the 21st century. The purpose of this article is not to offer a comprehensive differential of febrile exanthema, but rather to highlight some new concerns related to the evaluation of fever and rash in today's emergency department.
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The Rise and Fall of Vancomycin. South Med J 2008; 101:231-2. [DOI: 10.1097/smj.0b013e3181646c8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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