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Tsai MH, Chen CL, Chang HJ, Chuang TC, Chiu CH. Antimicrobial activity of eravacycline and other comparative agents on aerobic and anaerobic bacterial pathogens in Taiwan: A clinical microbiological study. J Glob Antimicrob Resist 2024; 37:93-99. [PMID: 38552878 DOI: 10.1016/j.jgar.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Eravacycline, a new tetracycline derivative, exhibits broad-spectrum antimicrobial susceptibility. This study aimed to comprehensively investigate in vitro activities of eravacycline, tigecycline, and ertapenem against various Gram-positive, Gram-negative, and anaerobic bacteria. METHODS Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method. The following bacterial species were collected: vancomycin-sensitive (VS) Enterococci species, vancomycin-resistant Enterococci species (VRE), Staphylococcus aureus, Streptococcus anginosus, Bacteroides species, Clostridioides difficile, Clostridium innocuum, Clostridium perfringens, Parabacteroides distasonis, and Stenotrophomonas maltophilia. RESULTS We found that eravacycline exhibited superior in vitro activity compared to tigecycline and ertapenem. Notably, it exhibited the lowest MIC90 for several bacterial species, including VS E. faecalis (0.12 µg/mL), VS E. faecium (0.12 µg/mL), and others. Besides, VRE was susceptible to eravacycline (MIC90:0.12 µg/mL) and tigecycline (MIC90:0.12 µg/mL), but was all resistant to ertapenem (MIC90 > 64 µg/mL). S. aureus was also susceptible to eravacycline (MIC90:0.5 µg/mL) as well as tigecycline (MIC90:1.0 µg/mL). Furthermore, S. anginosus showed higher susceptibility to eravacycline (MIC90:2.0 µg/mL) and tigecycline (MIC90:4.0 µg/mL), but lower to ertapenem (MIC90:32.0 µg/mL). Eravacycline and tigecycline also demonstrated good susceptibility to anaerobes, including Bacteroides species (susceptibility rate: 100%), P. distasonis (100%), C. difficile (94.1‒100%), C. innocuum (94.1‒96.1%), and C. perfringens (88.9‒96.3%). For S. maltophilia, both tigecycline and eravacycline showed an MIC90 of 2 µg/mL. A moderate-to-strong correlation (rho = 0.608-0.804, P < 0.001) was noted between the MIC values of eravacycline and tigecycline against various bacterial species. CONCLUSIONS Our study highlights the potential of eravacycline as an effective treatment option for multidrug-resistant bacterial infections.
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Affiliation(s)
- Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Microbiology and Immunology, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Department of Microbiology and Immunology, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Ju Chang
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chun Chuang
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Department of Microbiology and Immunology, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
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Alternatives Therapeutic Approaches to Conventional Antibiotics: Advantages, Limitations and Potential Application in Medicine. Antibiotics (Basel) 2022; 11:antibiotics11121826. [PMID: 36551487 PMCID: PMC9774722 DOI: 10.3390/antibiotics11121826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022] Open
Abstract
Resistance to antimicrobials and particularly multidrug resistance is one of the greatest challenges in the health system nowadays. The continual increase in the rates of antimicrobial resistance worldwide boosted by the ongoing COVID-19 pandemic poses a major public health threat. Different approaches have been employed to minimize the effect of resistance and control this threat, but the question still lingers as to their safety and efficiency. In this context, new anti-infectious approaches against multidrug resistance are being examined. Use of new antibiotics and their combination with new β-lactamase inhibitors, phage therapy, antimicrobial peptides, nanoparticles, and antisense antimicrobial therapeutics are considered as one such promising approach for overcoming bacterial resistance. In this review, we provide insights into these emerging alternative therapies that are currently being evaluated and which may be developed in the future to break the progression of antimicrobial resistance. We focus on their advantages and limitations and potential application in medicine. We further highlight the importance of the combination therapy approach, wherein two or more therapies are used in combination in order to more effectively combat infectious disease and increasing access to quality healthcare. These advances could give an alternate solution to overcome antimicrobial drug resistance. We eventually hope to provide useful information for clinicians who are seeking solutions to the problems caused by antimicrobial resistance.
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Carlson TJ, Gonzales-Luna AJ, Garey KW. Fulminant Clostridioides difficile Infection: A Review of Treatment Options for a Life-Threatening Infection. Semin Respir Crit Care Med 2022; 43:28-38. [PMID: 35172356 DOI: 10.1055/s-0041-1740973] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Fulminant Clostridioides difficile infection (FCDI) encompasses 3 to 5% of all CDI cases with associated mortality rates between 30 and 40%. Major treatment modalities include surgery and medical management with antibiotic and nonantibiotic therapies. However, identification of patients with CDI that will progress to FCDI is difficult and makes it challenging to direct medical management and identify those who may benefit from surgery. Furthermore, since it is difficult to study such a critically ill population, data investigating treatment options are limited. Surgical management with diverting loop ileostomy (LI) instead of a total abdominal colectomy (TAC) with end ileostomy has several appealing advantages, and studies have not consistently demonstrated a clinical benefit with this less-invasive strategy, so both LI and TAC remain acceptable surgical options. Successful medical management of FCDI is complicated by pharmacokinetic changes that occur in critically ill patients, and there is an absence of high-quality studies that included patients with FCDI. Recommendations accordingly include a combination of antibiotics administered via multiple routes to ensure adequate drug concentrations in the colon: intravenous metronidazole, high-dose oral vancomycin, and rectal vancomycin. Although fidaxomicin is now recommended as first-line therapy for non-FCDI, there are limited clinical data to support its use in FCDI. Several nonantibiotic therapies, including fecal microbiota transplantation and intravenous immunoglobulin, have shown success as adjunctive therapies, but they are unlikely to be effective alone. In this review, we aim to summarize diagnosis and treatment options for FCDI.
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Affiliation(s)
- Travis J Carlson
- Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, North Carolina
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
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Bottalico L, Charitos IA, Potenza MA, Montagnani M, Santacroce L. The war against bacteria, from the past to present and beyond. Expert Rev Anti Infect Ther 2021; 20:681-706. [PMID: 34874223 DOI: 10.1080/14787210.2022.2013809] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The human defense against microorganisms dates back to the ancient civilizations, with attempts to use substances from vegetal, animal, or inorganic origin to fight infections. Today, the emerging threat of multidrug-resistant bacteria highlights the consequences of antibiotics inappropriate use, and the urgent need for novel effective molecules. METHODS AND MATERIALS We extensively researched on more recent data within PubMed, Medline, Web of Science, Elsevier's EMBASE, Cochrane Review for the modern pharmacology in between 1987 - 2021. The historical evolution included a detailed analysis of past studies on the significance of medical applications in the ancient therapeutic field. AREAS COVERED We examined the history of antibiotics development and discovery, the most relevant biochemical aspects of their mode of action, and the biomolecular mechanisms conferring bacterial resistance to antibiotics. EXPERT OPINION The list of pathogens showing low sensitivity or full resistance to most currently available antibiotics is growing worldwide. Long after the 'golden age' of antibiotic discovery, the most novel molecules should be carefully reserved to treat serious bacterial infections of susceptible bacteria. A correct diagnostic and therapeutic procedure can slow down the spreading of nosocomial and community infections sustained by multidrug-resistant bacterial strains.
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Affiliation(s)
- Lucrezia Bottalico
- Interdepartmental Research Center for Pre-Latin, Latin and Oriental Rights and Culture Studies (Cediclo), University of Bari, Bari, Italy
| | - Ioannis Alexandros Charitos
- Interdepartmental Research Center for Pre-Latin, Latin and Oriental Rights and Culture Studies (Cediclo), University of Bari, Bari, Italy.,Emergency/Urgent Department, National Poisoning Center, Riuniti University Hospital of Foggia, Foggia, Italy
| | - Maria Assunta Potenza
- Department of Biomedical Sciences and Human Oncology - Section of Pharmacology, School of Medicine, University of Bari "Aldo Moro," Policlinico University Hospital of Bari, Bari, Italy
| | - Monica Montagnani
- Department of Biomedical Sciences and Human Oncology - Section of Pharmacology, School of Medicine, University of Bari "Aldo Moro," Policlinico University Hospital of Bari, Bari, Italy
| | - Luigi Santacroce
- Department of Interdisciplinary Medicine, Microbiology and Virology Unit, School of Medicine,University of Bari "Aldo Moro", Bari, Italy
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In Vitro Evaluation of the Activity of Aztreonam-Avibactam against 341 Recent Clinical Isolates of Anaerobes. Microbiol Spectr 2021; 9:e0190821. [PMID: 34908432 PMCID: PMC8672875 DOI: 10.1128/spectrum.01908-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aztreonam-avibactam is under clinical development for multidrug-resistant Gram-negative infections. We evaluated in vitro activity against 341 recent clinical isolates. The addition of avibactam to aztreonam had no effect on the anaerobic activity of aztreonam. IMPORTANCE This work shows that aztreonam-avibactam lacks activity against anaerobic organisms.
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Wang H, Nguyen N, Cruz C. Eravacycline for the treatment of complicated intra‐abdominal infections. ADVANCES IN DIGESTIVE MEDICINE 2021. [DOI: 10.1002/aid2.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hongmei Wang
- Department of Pharmacy Practice Texas Southern University Houston TX USA
| | - Namphi Nguyen
- Department of Pharmacy Practice Texas Southern University Houston TX USA
| | - Christopher Cruz
- Department of Pharmacy Practice Texas Southern University Houston TX USA
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Guérin F, Dejoies L, Degand N, Guet-Revillet H, Janvier F, Corvec S, Barraud O, Guillard T, Walewski V, Gallois E, Cattoir V. In Vitro Antimicrobial Susceptibility Profiles of Gram-Positive Anaerobic Cocci Responsible for Human Invasive Infections. Microorganisms 2021; 9:microorganisms9081665. [PMID: 34442745 PMCID: PMC8398781 DOI: 10.3390/microorganisms9081665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/14/2022] Open
Abstract
The aim of this multicentre study was to determine the in vitro susceptibility to anti-anaerobic antibiotics of Gram-positive anaerobic cocci (GPAC) isolates responsible for invasive infections in humans. A total of 133 GPAC isolates were collected in nine French hospitals from 2016 to 2020. All strains were identified to the species level (MALDI-TOF mass spectrometry, 16S rRNA sequencing). Minimum inhibitory concentrations (MICs) of amoxicillin, piperacillin, cefotaxime, imipenem, clindamycin, vancomycin, linezolid, moxifloxacin, rifampicin, and metronidazole were determined by the reference agar dilution method. Main erm-like genes were detected by PCR. The 133 GPAC isolates were identified as follows: 10 Anaerococcus spp., 49 Finegoldia magna, 33 Parvimonas micra, 30 Peptoniphilus spp., and 11 Peptostreptococcus anaerobius. All isolates were susceptible to imipenem, vancomycin (except 3 P. micra), linezolid and metronidazole. All isolates were susceptible to amoxicillin and piperacillin, except for P. anaerobius (54% and 45% susceptibility only, respectively). MICs of cefotaxime widely varied while activity of rifampicin, and moxifloxacin was also variable. Concerning clindamycin, 31 were categorized as resistant (22 erm(A) subclass erm(TR), 7 erm(B), 1 both genes and 1 negative for tested erm genes) with MICs from 8 to >32 mg/L. Although GPACs are usually susceptible to drugs commonly used for the treatment of anaerobic infections, antimicrobial susceptibility should be evaluated in vitro.
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Affiliation(s)
- François Guérin
- Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, F-35033 Rennes, France; (F.G.); (L.D.)
| | - Loren Dejoies
- Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, F-35033 Rennes, France; (F.G.); (L.D.)
| | - Nicolas Degand
- Laboratoire de Bactériologie, CHU de Nice, F-06202 Nice, France;
| | | | - Frédéric Janvier
- Service de Microbiologie et Hygiène Hospitalière, Hôpital d’Instruction des Armées Saint-Anne, F-83800 Toulon, France;
| | - Stéphane Corvec
- Service de Bactériologie et des Contrôles Microbiologiques, CHU de Nantes, F-44093 Nantes, France;
| | - Olivier Barraud
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Dupuytren, F-87042 Limoges, France;
| | - Thomas Guillard
- Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré-CHU de Reims, F-51090 Reims, France;
| | - Violaine Walewski
- Service de Microbiologie, Hôpitaux Universitaires de Paris Seine Denis (HUPSSD), Site Avicenne, AP-HP, F-93000 Bobigny, France;
| | | | - Vincent Cattoir
- Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, F-35033 Rennes, France; (F.G.); (L.D.)
- Correspondence: ; Tel.: +33-2-99-28-42-76; Fax: +33-2-99-28-41-59
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Terreni M, Taccani M, Pregnolato M. New Antibiotics for Multidrug-Resistant Bacterial Strains: Latest Research Developments and Future Perspectives. Molecules 2021; 26:2671. [PMID: 34063264 PMCID: PMC8125338 DOI: 10.3390/molecules26092671] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/18/2022] Open
Abstract
The present work aims to examine the worrying problem of antibiotic resistance and the emergence of multidrug-resistant bacterial strains, which have now become really common in hospitals and risk hindering the global control of infectious diseases. After a careful examination of these phenomena and multiple mechanisms that make certain bacteria resistant to specific antibiotics that were originally effective in the treatment of infections caused by the same pathogens, possible strategies to stem antibiotic resistance are analyzed. This paper, therefore, focuses on the most promising new chemical compounds in the current pipeline active against multidrug-resistant organisms that are innovative compared to traditional antibiotics: Firstly, the main antibacterial agents in clinical development (Phase III) from 2017 to 2020 are listed (with special attention on the treatment of infections caused by the pathogens Neisseria gonorrhoeae, including multidrug-resistant isolates, and Clostridium difficile), and then the paper moves on to the new agents of pharmacological interest that have been approved during the same period. They include tetracycline derivatives (eravacycline), fourth generation fluoroquinolones (delafloxacin), new combinations between one β-lactam and one β-lactamase inhibitor (meropenem and vaborbactam), siderophore cephalosporins (cefiderocol), new aminoglycosides (plazomicin), and agents in development for treating drug-resistant TB (pretomanid). It concludes with the advantages that can result from the use of these compounds, also mentioning other approaches, still poorly developed, for combating antibiotic resistance: Nanoparticles delivery systems for antibiotics.
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Affiliation(s)
| | | | - Massimo Pregnolato
- Department of Drug Science, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy; (M.T.); (M.T.)
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Rong SMM, Rodloff AC, Stingu CS. Diversity of antimicrobial resistance genes in Bacteroides and Parabacteroides strains isolated in Germany. J Glob Antimicrob Resist 2021; 24:328-334. [PMID: 33508481 DOI: 10.1016/j.jgar.2021.01.007] [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] [Received: 09/02/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Bacteroides spp. are normal constituents of the human intestinal microflora, but they are also able to cause severe diseases. The aim of this study was to determine the diversity of antibiotic resistance genes found in phenotypically resistant Bacteroides and Parabacteroides strains. METHODS A total of 71 phenotypically resistant Bacteroides spp. from human clinical specimens were screened for the antibiotic resistance genes cfiA, tetQ, tetM, tet36, cepA, cfxA, nim, ermG, ermF, bexA, blaVIM, blaNDM, blaKPC, blaOXA-48 and blaGES. The presence of these genes was compared with phenotypic resistance to ampicillin/sulbactam, cefoxitin, ceftolozane/tazobactam, piperacillin/tazobactam, imipenem, meropenem, meropenem/vaborbactam, clindamycin, moxifloxacin, tigecycline, eravacycline and metronidazole. RESULTS tetQ was the most frequently detected gene, followed by cfiA, ermF, cfxA, ermG, cepA, nim and bexA. None of the strains were positive for tetM, tet36, blaVIM, blaNDM, blaKPC, blaOXA-48 or blaGES. Resistance to the tested β-lactams was mainly linked to the presence of the cfiA gene. Clindamycin resistance correlated with the presence of the genes ermG and ermF. The bexA gene was found in six strains, but only two of them were resistant to moxifloxacin. Tigecycline and eravacycline showed good activities despite the frequent occurrence of tetQ. The nim gene was detected in six isolates, five of which were resistant to metronidazole. CONCLUSION The findings of our study support the general belief that antimicrobial resistance within Bacteroides should be taken into consideration. This underlines the necessity of reliable routine antimicrobial susceptibility test methods for anaerobic bacteria and the implementation of antimicrobial surveillance programmes worldwide.
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Affiliation(s)
- Sebastian Martin Michael Rong
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital of Leipzig, Liebigstraße 21, 04103 Leipzig, Germany.
| | - Arne Christian Rodloff
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital of Leipzig, Liebigstraße 21, 04103 Leipzig, Germany
| | - Catalina-Suzana Stingu
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital of Leipzig, Liebigstraße 21, 04103 Leipzig, Germany
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Felice VGD, Efimova E, Izmailyan S, Napolitano LM, Chopra T. Efficacy and Tolerability of Eravacycline in Bacteremic Patients with Complicated Intra-Abdominal Infection: A Pooled Analysis from the IGNITE1 and IGNITE4 Studies. Surg Infect (Larchmt) 2020; 22:556-561. [PMID: 33201771 DOI: 10.1089/sur.2020.241] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Eravacycline is a novel, fully synthetic fluorocycline antibiotic that was evaluated for the treatment of complicated intra-abdominal infections (cIAI) in two phase 3 clinical trials. The objective of this analysis was to evaluate the clinical cure and microbiologic response at the test-of-cure (TOC) visit and the safety of eravacycline in patients with cIAI and baseline bacteremia who received eravacycline versus comparators. Patients and Methods: Pooled data of patients with bacteremia from the Investigating Gram-Negative Infections Treated with Eravacycline (IGNITE) 1 and IGNITE4 studies were analyzed. All patients were randomly assigned in a one-to-one ratio to receive eravacycline 1 mg/kg intravenously every 12 hours, ertapenem 1 g intravensouly every 24 hours (IGNITE1), or meropenem 1 g intravenously every eight hours (IGNITE4) for four to 14 days. Blood and intra-abdominal samples were collected from all patients at baseline. Clinical outcome and microbiologic eradiation at the TOC visit (28 days after randomization) and safety in the microbiologic-intent-to-treat population (micro-ITT) were assessed. Results: Of 415 patients treated with eravacycline and 431 treated with carbapenem comparators, concurrent bacteremia was identified in 32 (7.7%) and 31 (7.2%) patients, respectively. Demographic and baseline characteristics were similar among treatment groups. In the micro-ITT population, the pooled clinical response at the TOC visit for eravacycline was 28 of 32 (87.5%) and was 24 of 31 (77.0%) for comparators among the subgroup with baseline bacteremia (treatment difference 5.9; 95% confidence interval [CI], -6.5 to 17.4). At TOC, microbiologic eradication of pathogens isolated from blood specimens occurred for 34 of 35 (97.1%) pathogens with eravacycline and 35 of 36 (97.2%) pathogens with comparators. The incidence of adverse events was comparable between treated groups and similar to that observed in the non-bacteremic population. Conclusion: Eravacycline demonstrated a similar clinical outcome and microbiologic eradication rate as comparator carbapenems in patients with cIAI and associated secondary bacteremia. Future clinical trials of cIAI should report outcomes of this important clinical cohort (cIAI with concurrent bacteremia) given their high risk for adverse outcomes.
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Affiliation(s)
| | | | | | | | - Teena Chopra
- Wayne State University School of Medicine, Detroit, Michigan, USA
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Boukthir S, Dejoies L, Zouari A, Collet A, Potrel S, Auger G, Cattoir V. In vitro activity of eravacycline and mechanisms of resistance in enterococci. Int J Antimicrob Agents 2020; 56:106215. [PMID: 33122095 DOI: 10.1016/j.ijantimicag.2020.106215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/25/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
Eravacycline (ERC), the first fluorocycline, is a new tetracycline with superior activity to tigecycline (TGC) against many bacterial species. This work aimed to determine the in vitro activity of ERC compared with other tetracyclines against enterococcal clinical isolates and to analyse corresponding resistance mechanisms. A collection of 60 enterococcal strains was studied: 54 epidemiologically unrelated clinical isolates (46 Enterococcus faecium and 8 Enterococcus faecalis) including 42 vancomycin-resistant enterococci (VRE) (33 vanA and 9 vanB), 3 in vitro TGC-resistant mutants (E. faecium AusTig, HMtig1 and HMtig2) and 3 reference wild-type strains (E. faecium Aus0004 and HM1070, E. faecalis ATCC 29212). In vitro susceptibility was determined using Etest strips (for ERC) or by broth microdilution (for TGC, doxycycline, minocycline and tetracycline). Resistance genes [tet(M), tet(L), tet(O) and tet(S)] were screened by PCR for TGC- and/or ERC-resistant strains as well as sequencing of the rpsJ gene (encoding ribosomal protein S10). MIC50/90 values were 0.016/0.08, ≤0.03/0.5, 4/32, 8/16 and 32/>32 mg/L for ERC, TGC, doxycycline, minocycline and tetracycline, respectively. According to EUCAST guidelines, nine strains were categorised as resistant to TGC (MIC, 0.5-8 mg/L), including four E. faecium vanA(+) strains also resistant to ERC (MIC, 0.19-1.5 mg/L). These four strains all possessed at least one mutation in rpsJ and two tet determinants: tet(M) + tet(L) (n = 2); and tet(M) + tet(S) (n = 2). Although ERC has excellent in vitro activity against enterococci (including VRE), emergence of resistance is possible due to combined mechanisms (rpsJ mutations + tet genes).
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Affiliation(s)
- Sarrah Boukthir
- CHU de Rennes, Service de Bactériologie-Hygiène hospitalière, Rennes, France
| | - Loren Dejoies
- CHU de Rennes, Service de Bactériologie-Hygiène hospitalière, Rennes, France; Université de Rennes 1, Unité Inserm U1230, Rennes, France
| | - Asma Zouari
- CNR Résistance aux antibiotiques (Laboratoire associé 'Entérocoques'), Rennes, France
| | - Anaïs Collet
- CHU de Rennes, Service de Bactériologie-Hygiène hospitalière, Rennes, France; CNR Résistance aux antibiotiques (Laboratoire associé 'Entérocoques'), Rennes, France
| | - Sophie Potrel
- CHU de Rennes, Service de Bactériologie-Hygiène hospitalière, Rennes, France; CNR Résistance aux antibiotiques (Laboratoire associé 'Entérocoques'), Rennes, France
| | - Gabriel Auger
- CHU de Rennes, Service de Bactériologie-Hygiène hospitalière, Rennes, France; CNR Résistance aux antibiotiques (Laboratoire associé 'Entérocoques'), Rennes, France
| | - Vincent Cattoir
- CHU de Rennes, Service de Bactériologie-Hygiène hospitalière, Rennes, France; Université de Rennes 1, Unité Inserm U1230, Rennes, France; CNR Résistance aux antibiotiques (Laboratoire associé 'Entérocoques'), Rennes, France.
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Bassères E, Begum K, Lancaster C, Gonzales-Luna AJ, Carlson TJ, Miranda J, Rashid T, Alam MJ, Eyre DW, Wilcox MH, Garey KW. In vitro activity of eravacycline against common ribotypes of Clostridioides difficile. J Antimicrob Chemother 2020; 75:2879-2884. [PMID: 32719870 PMCID: PMC7678891 DOI: 10.1093/jac/dkaa289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background Eravacycline is a novel synthetic fluorocycline antibacterial approved for complicated intra-abdominal infections. Objectives The purpose of this study was to assess the in vitro activities of eravacycline and comparator antibiotics against contemporary clinical isolates of Clostridioides difficile representing common ribotypes, including isolates with decreased susceptibility to metronidazole and vancomycin. Methods Clinical C. difficile strains from six common or emerging ribotypes were used to test the in vitro activities of eravacycline and comparator antibiotics (fidaxomicin, vancomycin and metronidazole) by broth microdilution. In addition, MBC experiments, time–kill kinetic studies and WGS experiments were performed. Results A total of 234 isolates were tested, including ribotypes RT001 (n = 37), RT002 (n = 41), RT014-020 (n = 39), RT027 (n = 42), RT106 (n = 38) and RT255 (n = 37). MIC50/90 values were lowest for eravacycline (≤0.0078/0.016 mg/L), followed by fidaxomicin (0.016/0.063 mg/L), metronidazole (0.25/1.0 mg/L) and vancomycin (2.0/4.0 mg/L). MBCs were lower for eravacycline compared with vancomycin for all ribotypes tested. Both vancomycin and eravacycline demonstrated bactericidal killing, including for epidemic RT027. The presence of the tetM or tetW resistance genes did not affect the MIC of eravacycline. Conclusions This study demonstrated potent in vitro activity of eravacycline against a large collection of clinical C. difficile strains that was not affected by ribotype, susceptibility to vancomycin or the presence of certain tet resistance genes. Further development of eravacycline as an antibiotic to be used in patients with Clostridioides difficile infection is warranted.
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Affiliation(s)
| | | | | | | | - Travis J Carlson
- Fred Wilson School of Pharmacy, High Point University, High Point, NC, USA
| | - Julie Miranda
- University of Houston College of Pharmacy, Houston, TX, USA
| | - Tasnuva Rashid
- University of Houston College of Pharmacy, Houston, TX, USA
| | | | - David W Eyre
- Big Data Institute, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Mark H Wilcox
- Healthcare Associated Infections Research Group, Leeds Institute for Medical Research, University of Leeds, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX, UK.,Microbiology, Leeds Teaching Hospitals NHS Trust, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, TX, USA
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13
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Li P, Wei Y, Li G, Cheng H, Xu Z, Yu Z, Deng Q, Shi Y. Comparison of antimicrobial efficacy of eravacycline and tigecycline against clinical isolates of Streptococcus agalactiae in China: In vitro activity, heteroresistance, and cross-resistance. Microb Pathog 2020; 149:104502. [PMID: 32947016 DOI: 10.1016/j.micpath.2020.104502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
AIMS The aims of this study were to compare the antimicrobial efficacy of Eravacycline (Erava) versus tigecycline (Tig) in vitro against clinical isolates of S. agalactiae from China and further to evaluate the heteroresistance risk and resistance mechanisms of Erava. METHODS 162 clinical isolates of S. agalactiae were collected retrospectively and the minimal inhibitory concentrations (MICs) of Erava and Tig were determined by agar dilution. Moreover, Tetracycline (Tet) specific resistance genes, genetic mutations in Tet target sites, and sequence types (ST) profiles of clinical isolates of S. agalactiae were investigated with polymerase chain reaction (PCR) experiments. The heteroresistance frequency of Erava and Tig in S. agalactiae was analyzed by population analysis profiling. Furthermore, the resistance mechanisms of both Erava and Tig were investigated in antibiotic-induced resistant S. agalactiae isolates in vitro. RESULTS The MIC values of Erava and Tig were shown with ≤0.25 mg/L and ≤0.5 mg/L, respectively, against clinical S. agalactiae isolates, including that harboring the Tet-specific resistance genes tet(K), tet(M), or tet(O). The heteroresistance frequency of Tig among the clinical isolates of S. agalactiae was 1.84% (3/162), whereas no positive Erava heteroresistance was found. The enhanced MIC values of both Erava and Tig in the heteroresistance-derivative S. agalactiae clones could be reversed by the efflux pump inhibition experiments. Genetic mutations affecting 30S ribosome units (16SrRNA copies or 30S ribosome protein S10) could result in the cross resistance toward Erava and Tig in the antibiotic-induced resistant S. agalactiae isolates in vitro. CONCLUSIONS Erava MIC values were nearly half of that of Tig against the clinical isolates of S. agalactiae from China and genetic mutations in the 30S ribosome units of Tet target sites (16SrRNA copies or 30S ribosome protein S10) participated in the resistance evolution of both Erava and Tig under the antibiotic pressure.
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Affiliation(s)
- Peiyu Li
- Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital of Guangdong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China; Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Ying Wei
- Heilongjiang Medical Service Management Evaluation Center, Harbin, Heilongjiang, 150031, China
| | - Guiqiu Li
- Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital of Guangdong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China; Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China; The Clinical Microbiology Lab of the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150031, China
| | - Hang Cheng
- Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital of Guangdong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China; Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Zhichao Xu
- Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital of Guangdong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China; Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Zhijian Yu
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Qiwen Deng
- Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital of Guangdong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China; Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.
| | - Yiyi Shi
- Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital of Guangdong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China; Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.
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14
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De Oliveira DMP, Forde BM, Kidd TJ, Harris PNA, Schembri MA, Beatson SA, Paterson DL, Walker MJ. Antimicrobial Resistance in ESKAPE Pathogens. Clin Microbiol Rev 2020; 23:788-99. [PMID: 32404435 DOI: 10.1111/imb.12124] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Antimicrobial-resistant ESKAPE ( Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens represent a global threat to human health. The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the treatment options for serious infections, increased the burden of disease, and increased death rates due to treatment failure and requires a coordinated global response for antimicrobial resistance surveillance. This looming health threat has restimulated interest in the development of new antimicrobial therapies, has demanded the need for better patient care, and has facilitated heightened governance over stewardship practices.
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Affiliation(s)
- David M P De Oliveira
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Brian M Forde
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Timothy J Kidd
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Patrick N A Harris
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - David L Paterson
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
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15
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Antibiotic Treatment Pipeline for Clostridioides difficile Infection (CDI): A Wide Array of Narrow-Spectrum Agents. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00730-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Bassetti M, Russo A, Carnelutti A, Wilcox M. Emerging drugs for treating methicillin-resistant Staphylococcus aureus. Expert Opin Emerg Drugs 2020; 24:191-204. [PMID: 31590576 DOI: 10.1080/14728214.2019.1677607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: In clinical practice, methicillin-resistant Staphylococcus aureus (MRSA) represents a major threat and has been associated with high rates of inadequate antibiotic treatment and significant increases in morbidity, mortality, and overall healthcare costs. The association between the prescription of an inappropriate or delayed antibiotic and impaired clinical outcomes has been widely described. Areas covered: To address the threat of MRSA, many new therapeutic options with a peculiar activity against MRSA have been recently developed and approved. New agents are characterized by specific issues in terms of spectrum of activity, pharmacokinetics, risk of drug-drug interactions, and toxicity, with potential advantages that should be considered in everyday clinical practice. Expert opinion: The most attractive characteristic of new drugs is represented by the broad spectrum of activity against multidrug-resistant pathogens; moreover, new compounds in most cases are characterized by favorable toxicity profiles compared with old drugs currently used in clinical practice. Some of the new antimicrobials will be also available as oral formulations, with the potential for oral switch, even in infections due to resistant pathogens. In particular conditions/populations (e.g. liver failure, renal disease, pregnancy, diabetic, children, and elderly), novel antibiotics with reduced toxicity could be an important option, including after hospital discharge.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa and Hospital Policlinico San Martino - IRCCS , Genoa , Italy
| | - Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine University of Udine, Sanitaria Universitaria Integrata di Udine , Udine , Italy
| | - Alessia Carnelutti
- Infectious Diseases Clinic, Department of Medicine University of Udine, Sanitaria Universitaria Integrata di Udine , Udine , Italy
| | - Mark Wilcox
- Leeds Teaching Hospitals NHS Trust & University of Leeds , Leeds , UK
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17
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Abstract
Antimicrobial-resistant ESKAPE ( Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens represent a global threat to human health. The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the treatment options for serious infections, increased the burden of disease, and increased death rates due to treatment failure and requires a coordinated global response for antimicrobial resistance surveillance. This looming health threat has restimulated interest in the development of new antimicrobial therapies, has demanded the need for better patient care, and has facilitated heightened governance over stewardship practices.
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18
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Alosaimy S, Abdul-Mutakabbir JC, Kebriaei R, Jorgensen SCJ, Rybak MJ. Evaluation of Eravacycline: A Novel Fluorocycline. Pharmacotherapy 2020; 40:221-238. [PMID: 31944332 DOI: 10.1002/phar.2366] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Eravacycline (ERV), formerly known as TP-434, is a novel tetracycline (TET) antibiotic that exhibits in vitro activity against various gram-positive, gram-negative aerobic and anaerobic pathogens, including those exhibiting TET-specific acquired resistance mechanisms. Similar to other TETs, it inhibits protein synthesis through binding to the 30S ribosomal subunit. Eravacycline was approved by the United States Food and Drug Administration (FDA) in August 2018 for the treatment of complicated intraabdominal infections (cIAIs) in adults following the Investigating Gram-Negative Infections Treated with Eravacycline (IGNITE)1 and IGNITE4 phase III trials. In these two, double-blind, multicenter clinical trials, ERV was proven noninferior in terms of clinical response in comparison to ertapenem and meropenem, respectively. Eravacycline was well tolerated with nausea, vomiting, and infusion site reactions being the most commonly reported adverse reactions. Clinicians now have ERV as a novel therapeutic option for the treatment of adults with intraabdominal infections, allergies to β-lactam agents, Clostridioides difficile-associated diarrhea, or if tolerability to other agents is a concern.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Jacinda C Abdul-Mutakabbir
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Razie Kebriaei
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Sarah C J Jorgensen
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan.,Department of Pharmacy, Detroit Medical Center, Detroit, Michigan.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan
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19
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Montravers P, Zappella N, Tran-Dinh A. Eravacycline for the treatment of complicated intra-abdominal infections. Expert Rev Anti Infect Ther 2019; 17:851-863. [PMID: 31622119 DOI: 10.1080/14787210.2019.1681975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Complicated intra-abdominal infections (cIAIs) are among the most frequent infections, contributing to significant morbidity and healthcare costs. Several medical needs remain unmet, related to the pharmacokinetic capacities of the available drugs and their limited spectrum of activity for targeting multidrug-resistant Gram-negative and Gram-positive bacteria. Eravacycline, a new synthetic fluorocycline, could have useful properties in cIAIs.Areas covered: The antimicrobial activity of eravacycline against the microorganisms most frequently cultured in cIAIs has been confirmed in worldwide panels of clinical isolates, including enterococci, ESBL-producing Enterobacteriaceae, Acinetobacter baumannii and anaerobes. Pharmacokinetic data demonstrate interesting characteristics with good tissue concentrations including biliary tract and digestive tissues. At a conventional dosage of 1 mg/kg q12h, no adjustment is required on the basis of race or gender, or in elderly (≥ 65 years old) patients, patients with renal impairment or patients undergoing hemodialysis. Phase 2 and 3 trials assessing the clinical efficacy and safety of eravacycline demonstrated non-inferiority versus carbapenems and a good safety profile.Expert opinion: Eravacycline may be particularly suitable for the treatment of cIAIs. Results from clinical trials and real-world data are now expected in specific subgroups of patients to confirm the safety profile and efficacy observed in registration trials.
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Affiliation(s)
- Philippe Montravers
- INSERM UMR 1152, Université de Paris, Paris, France.,Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Nathalie Zappella
- Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Alexy Tran-Dinh
- Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.,INSERM UMR 1148, Université de Paris, Paris, France
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20
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Abstract
Eravacycline (Xerava™), a novel fully synthetic fluorocycline, consists of the tetracyclic core scaffold with unique modifications in the tetracyclic D ring; consequently, it exhibits potent in vitro activity against Gram-positive and -negative bacterial strains expressing certain common tetracycline-specific acquired resistance mechanisms. In vitro, eravacycline exhibits potent activity against a broad spectrum of clinically relevant Gram-positive and -negative aerobic and anaerobic bacteria. Intravenous eravacycline is approved in several countries for the treatment of complicated intra-abdominal infections (cIAIs) in adult patients. In two pivotal double-blind, multinational trials in this patient population, eravacycline (infusion ≈ 1 h) was noninferior to intravenous ertapenem or meropenem at the test-of-cure visit in terms of clinical response rates in all prespecified populations. Eravacycline had an acceptable tolerability profile, with infusion site reactions, nausea, vomiting and diarrhoea the most commonly reported adverse reactions, most of which were of mild to moderate severity. Given its broad spectrum of activity against common clinically relevant pathogens (including those expressing certain tetracycline- and other antibacterial-specific acquired resistance mechanisms) and its more potent in vitro activity and better tolerability profile than tigecycline, eravacycline provides a novel emerging option for the treatment of adult patients with cIAIs, especially as empirical therapy when coverage of resistant pathogens is required.
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21
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Solomkin JS, Sway A, Lawrence K, Olesky M, Izmailyan S, Tsai L. Eravacycline: a new treatment option for complicated intra-abdominal infections in the age of multidrug resistance. Future Microbiol 2019; 14:1293-1308. [DOI: 10.2217/fmb-2019-0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: Recently approved for use in complicated intra-abdominal infection, eravacycline is a novel fluorocycline with broad spectrum of activity against resistant Gram-negative pathogens. This manuscript is a pooled analysis of two Phase III trials. Clinical efficacy: Clinical cure rates were 86.8% for eravacycline versus 87.6% for ertapenem, and 90.8% for eravacycline versus 91.2% for meropenem in the Intent to Treat (micro-ITT) populations, and 87.0% for eravacycline versus 88.8% ertapenem, and 92.4 versus 91.6% for meropenem in the Modified Intent to Treat (MITT) populations. Safety: Eravacycline is well tolerated, with lower rates of nausea, vomiting and diarrhea than other tetracyclines. Conclusion: Eravacycline is an effective new option for use in complicated intra-abdominal infections, and in particular, for the treatment of extended-spectrum β-lactamase- and carbapenem-resistant Enterobacteriaceae-expressing organisms.
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Affiliation(s)
- Joseph S Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, 6005 Given Road Cincinnati, OH 45243, USA
| | - Angie Sway
- Medical Writing, World Surgical Infection Society, Cincinnati, OH 45243, USA
| | - Kenneth Lawrence
- Medical Affairs, Tetraphase Pharmaceuticals, Watertown, MA 02472, USA
| | - Melanie Olesky
- Medical Affairs, Tetraphase Pharmaceuticals, Watertown, MA 02472, USA
| | - Sergey Izmailyan
- Medical Affairs, Tetraphase Pharmaceuticals, Watertown, MA 02472, USA
| | - Larry Tsai
- Medical Affairs, Tetraphase Pharmaceuticals, Watertown, MA 02472, USA
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22
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23
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Avery LM, Chen IH, Reyes S, Nicolau DP, Kuti JL. Assessment of the Physical Compatibility of Eravacycline and Common Parenteral Drugs During Simulated Y-site Administration. Clin Ther 2019; 41:2162-2170. [PMID: 31506218 DOI: 10.1016/j.clinthera.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/17/2019] [Accepted: 08/08/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Eravacycline is a broad-spectrum, intravenous fluorocycline antibiotic approved for the treatment of complicated intra-abdominal infections in adults. A 60-minute infusion is recommended for each infused dose. Compatibility data that may allow convenient Y-site administration of eravacycline with other parenteral medications are unavailable. We aimed to determine the physical compatibility of eravacycline with other intravenous medications by simulated Y-site administration. METHODS Eravacycline was reconstituted according to published prescribing information and diluted with 0.9% sodium chloride to a concentration of 0.6 mg/mL. Simulated Y-site administration was performed by mixing 5 mL of eravacycline with an equal volume of 51 other intravenous medications, including crystalloid and carbohydrate hydration fluids and 20 antimicrobials. Secondary medications were assessed at the upper range of concentrations considered standard for intravenous infusion. Mixtures underwent visual inspection and turbidity measurement immediately on mixture and at 3 subsequent time points (30, 60, and 120 minutes after admixture), and pH was measured at 60 minutes for comparison with the baseline value of the secondary medication. FINDINGS Eravacycline was physically compatible with 41 parenteral drugs (80%) by simulated Y-site administration. Incompatibility was observed with albumin, amiodarone hydrochloride, ceftaroline fosamil, colistimethate sodium, furosemide, meropenem, meropenem/vaborbactam, micafungin sodium, propofol, and sodium bicarbonate. IMPLICATIONS Eravacycline for injection was physically compatible with most parenteral medications assessed. Pharmacists and nurses should be knowledgeable of the observed incompatibilities with eravacycline to prevent the unintentional mixing of incompatible intravenous medications.
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Affiliation(s)
- Lindsay M Avery
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - Iris H Chen
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - Sergio Reyes
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA; Department of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
| | - Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA.
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Abstract
Multidrug resistance (MDR) in anaerobes is not a well-known topic. Bacteroides fragilis group isolates have numerous resistance determinants such as multidrug efflux pumps, cfiA and nimB genes and activating insertion sequences, and some isolates exhibited extensive drug-resistant patterns. MDR rates in B. fragilis group were from 1.5 to >18% and up to >71% in cfiA and nimB positive isolates carrying insertion sequences. MDR was present in >1/2 of Clostridioides difficile isolates, most often in epidemic/hypervirulent strains and unusually high metronidazole or vancomycin resistance has been reported in single studies. MDR was found in Prevotella spp. (in ≤10% of isolates), Finegoldia magna, Veillonella spp. and Cutibacterium acnes. Resistance in the anaerobes tends to be less predictable and anaerobic microbiology is required in more laboratories. New hopes may be new antibiotics such as eravacycline, cadazolid, surotomycin, ridinilazol or C. difficile toxoid vaccines; however, more efforts are needed to track the MDR in anaerobes.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Sofia 1431, Bulgaria
| | - Rumyana Markovska
- Department of Medical Microbiology, Medical University of Sofia, Sofia 1431, Bulgaria
| | - Ivan Mitov
- Department of Medical Microbiology, Medical University of Sofia, Sofia 1431, Bulgaria
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Petrosillo N, Taglietti F, Granata G. Treatment Options for Colistin Resistant Klebsiella pneumoniae: Present and Future. J Clin Med 2019; 8:E934. [PMID: 31261755 PMCID: PMC6678465 DOI: 10.3390/jcm8070934] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/01/2019] [Accepted: 06/25/2019] [Indexed: 01/17/2023] Open
Abstract
Multidrug-resistant (MDR) Klebsiella pneumoniae represents an increasing threat to human health, causing difficult-to-treat infections with a high mortality rate. Since colistin is one of the few treatment options for carbapenem-resistant K. pneumoniae infections, colistin resistance represents a challenge due to the limited range of potentially available effective antimicrobials, including tigecycline, gentamicin, fosfomycin and ceftazidime/avibactam. Moreover, the choice of these antimicrobials depends on their pharmacokinetics/pharmacodynamics properties, the site of infection and the susceptibility profile of the isolated strain, and is sometimes hampered by side effects. This review describes the features of colistin resistance in K. pneumoniae and the characteristics of the currently available antimicrobials for colistin-resistant MDR K. pneumoniae, as well as the characteristics of novel antimicrobial options, such as the soon-to-be commercially available plazomicin and cefiderocol. Finally, we consider the future use of innovative therapeutic strategies in development, including bacteriophages therapy and monoclonal antibodies.
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Affiliation(s)
- Nicola Petrosillo
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS-Via Portuense, 292 00149 Rome, Italy.
| | - Fabrizio Taglietti
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS-Via Portuense, 292 00149 Rome, Italy.
| | - Guido Granata
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS-Via Portuense, 292 00149 Rome, Italy.
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The Efficacy and Safety of Eravacycline in the Treatment of Complicated Intra-Abdominal Infections: A Systemic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2019; 8:jcm8060866. [PMID: 31212991 PMCID: PMC6617347 DOI: 10.3390/jcm8060866] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/24/2022] Open
Abstract
This study aims to assess the clinical efficacy and safety of eravacycline for treating complicated intra-abdominal infection (cIAI) in adult patients. The PubMed, Web of Science, EBSCO, Cochrane databases, Ovid Medline, Embase, and ClinicalTrials.gov were searched up to May 2019. Only randomized controlled trials (RCTs) that evaluated eravacycline and other comparators for the treatment of cIAI were included. The primary outcome was the clinical cure rate at the test-of-cure visit based on modified intent-to-treat population, microbiological intent-to-treat population, clinically evaluable population, and microbiological evaluable population, and the secondary outcomes were clinical failure rate and the risk of adverse event. Three RCTs were included. Overall, eravacycline had a clinical cure rate (88.7%, 559/630) at test-of-cure in modified intent-to-treat population similar to comparators (90.1%, 492/546) in the treatment of cIAIs (risk ratio (RR), 0.99; 95% confidence interval (CI), 0.95–1.03; I2 = 0%, Figure 3). In the microbiological intent-to-treat, clinically evaluable, and microbiological evaluable populations, no difference was found between eravacycline and comparators in terms of clinical cure rate at test-of-cure (microbiological intent-to-treat population, RR, 0.99; 95% CI, 0.95–1.04; I2 = 0%, clinically evaluable population, RR, 1.00; 95% CI, 0.97–1.03; I2 = 0%, microbiological evaluable population, RR, 0.98; 95% CI, 0.95–1.02; I2 = 0%). In addition, eravacycline had clinical failure rate similar to comparators at test-of-cure in modified intent-to-treat population (RR, 1.01; 95% CI, 0.61–0.69; I2 = 0%), microbiological intent-to-treat population (RR, 1.34; 95% CI, 0.77–2.31; I2 = 16%), clinically evaluable population (RR, 1.03; 95% CI, 0.61–1.76; I2 = 0%), and microbiological evaluable population (RR, 1.32; 95% CI, 0.75–2.32; I2 = 10%). Although eravacycline was associated with higher risk of treatment-emergent adverse event than comparators (RR, 1.34; 95% CI, 1.13–1.58; I2 = 0%), no significant differences were found between eravacycline and comparators for the risk of serious adverse event (RR, 1.04; 95% CI, 0.65–1.65; I2 = 0%), discontinuation of study drug because of adverse event (RR, 0.68; 95% CI, 0.23–1.99; I2 = 13%), and all-cause mortality (RR, 1.09; 95% CI, 0.41–2.9; I2 = 28%). In conclusion, the clinical efficacy of eravacycline is as high as that of the comparator drugs in the treatment of cIAIs and this antibiotic is as well tolerated as the comparators.
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Abstract
Delayed antimicrobial prescriptions and inappropriate treatment can lead to poor outcomes in pneumonia. In nosocomial infections, especially in countries reporting high rates of antimicrobial resistance, the presence of multidrug-resistant gram-negative and gam-positive bacteria can limit options for adequate antimicrobial treatment. New antibiotics, belonging to known classes of antimicrobials or characterized by novel mechanisms of actions, have recently been approved or are under development. Advantages of the new compounds include enhanced spectrum of activity against resistant bacteria, high lung penetration, good tolerability, and possibility for intravenous to oral sequential therapy. This article reviews characteristics of newly approved and investigational compounds.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Colugna Street, Udine 33100, Italy.
| | - Elda Righi
- Infectious Diseases Clinic, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Colugna Street, Udine 33100, Italy
| | - Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Colugna Street, Udine 33100, Italy
| | - Alessia Carnelutti
- Infectious Diseases Clinic, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Colugna Street, Udine 33100, Italy
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Voulgaris GL, Voulgari ML, Falagas ME. Developments on antibiotics for multidrug resistant bacterial Gram-negative infections. Expert Rev Anti Infect Ther 2019; 17:387-401. [PMID: 31006284 DOI: 10.1080/14787210.2019.1610392] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The constantly increasing spread of severe infections due to multidrug-resistant (MDR) Gram-negative bacteria (GNB) is a critical threat to the global medical community. After a long period of antibiotic pipeline pause, new antibiotic compounds are commercially available or are at late stages of clinical evaluation, promising to augment the therapeutic armamentarium of clinicians against deadly pathogens. Areas covered: This review summarizes available data regarding agents with potent activity against critical MDR Gram-negative pathogens, which urgently require new efficient antibiotics. Recently approved antibiotic formulations; and agents in advanced stages of development, including combinations of β-lactam/β-lactamase inhibitor, novel cephalosporins (cefiderocol), tetracyclines (eravacycline), aminoglycosides (plazomicin), quinolones (delafloxacin and finafloxacin) and pleuromutilins (lefamulin) are discussed in this review. Expert opinion: The recent introduction of new antibiotics into clinical practice is an encouraging step after a long period of pipeline stagnation. New formulations will be a useful option for clinicians to treat serious infections caused by several MDR Gram-negative pathogens. However, most of the new compounds are based on modifications of traditional antibiotic structures challenging their longevity as therapeutic options. More investment is needed for the discovery and clinical development of truly innovative and effective antibiotics without cross-resistance to currently used antibiotics.
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Affiliation(s)
- Georgios L Voulgaris
- a Alfa Institute of Biomedical Sciences , Athens , Greece.,b Laboratory of Pharmacokinetics and Toxicology , Department of Pharmacy, 401 General Military Hospital , Athens , Greece
| | - Maria L Voulgari
- a Alfa Institute of Biomedical Sciences , Athens , Greece.,c Department of Internal Medicine , Hospital Neuwittelsbach of the Sisters of Mercy , Munich , Germany
| | - Matthew E Falagas
- a Alfa Institute of Biomedical Sciences , Athens , Greece.,d Department of Medicine , Henry Dunant Hospital Center , Athens , Greece.,e Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
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Heaney M, Mahoney MV, Gallagher JC. Eravacycline: The Tetracyclines Strike Back. Ann Pharmacother 2019; 53:1124-1135. [DOI: 10.1177/1060028019850173] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective: To review the pharmacology, pharmacokinetics, efficacy, safety, and place in therapy of eravacycline, a novel fluorocycline antibiotic from the tetracycline family. Data Sources: A PubMed search was conducted for data between 1946 and March 2019 using MeSH terms eravacycline and TP-434. An internet search was conducted for unpublished clinical research. Study Selection and Data Extraction: The literature search was limited to English-language studies that described clinical efficacy, safety, and pharmacokinetics in humans and animals. Abstracts featuring prepublished data were also evaluated for inclusion. Data Synthesis: Eravacycline has in vitro activity against multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus, extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacteriaceae, and Acinetobacter. It was approved for the treatment of complicated intra-abdominal infections (cIAIs) in adults following favorable results of 2 phase III trials, IGNITE 1 and IGNITE 4, compared with ertapenem and meropenem, respectively. The most common adverse drug events associated with eravacycline were infusion site reactions (7.7%), nausea (6.5%), vomiting (3.7%), and diarrhea (2.3%). Relevance to Patient Care and Clinical Practice: Eravacycline will likely be most useful for resistant infections when lack of tolerability, resistant phenotypes, or allergies prevent the use of β-lactams. Conclusions: Eravacycline is a new tetracycline antibiotic with a broad spectrum of activity that has demonstrated efficacy in the treatment of cIAIs. Although it has activity against multidrug-resistant organisms, data are limited for other indications.
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Zhang F, Bai B, Xu GJ, Lin ZW, Li GQ, Chen Z, Cheng H, Sun X, Wang HY, Chen YW, Zheng JX, Deng QW, Yu ZJ. Eravacycline activity against clinical S. aureus isolates from China: in vitro activity, MLST profiles and heteroresistance. BMC Microbiol 2018; 18:211. [PMID: 30545293 PMCID: PMC6293590 DOI: 10.1186/s12866-018-1349-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Mortality rates for patients with Staphylococcus aureus (S. aureus) infections have improved only modestly in recent decades and S. aureus infections remain a major clinical challenge This study investigated the in vitro antimicrobial activity of erevacycline (erava) against clinical S. aureus isolates from China, as well as the heteroresistance frequency of erava and sequence types (STs) represented in the sample. Results A sample of 328 non-duplicate clinical S. aureus isolates, including 138 methecillin-resistant (MRSA) and 190 methecillin-sensitive (MSSA) isolates, were collected retrospectively in China. Erava exhibited excellent in vitro activity (MIC50 ≤ 0.25 mg/L) against MRSA and MSSA, including isolates harboring Tet specific resistance genes. The frequency of erava heteroresistance in MSSA with erava MICs = 0.5 mg/L was 13.79% (4/29); no MRSA with erava MICs ≤0.5 mg/L exhibited heteroresistance. Heteroresistance- derived clones had no 30S ribosome subunit mutations, but their erava MICs (range, 1–4 mg/L) were suppressed dramatically in the presence of efflux protein inhibitors. Conclusions Conclusively, erava exhibited excellent in vitro activity against S. aureus, however hints of erava heteroresistance risk and MIC creep were detected, particularly among MSSA with MICs of 0.5 mg/L. Electronic supplementary material The online version of this article (10.1186/s12866-018-1349-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fan Zhang
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Department of Tuberculosis, Shenzhen Nanshan Center for Chronic Disease Control, No 7, Huaming Road, Nanshan District, Shenzhen, 518054, China
| | - Bing Bai
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Guang-Jian Xu
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Zhi-Wei Lin
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, 200032, China
| | - Gui-Qiu Li
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Zhong Chen
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, 200032, China
| | - Hang Cheng
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Xiang Sun
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Hong-Yan Wang
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Yan-Wei Chen
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China
| | - Jin-Xin Zheng
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.,Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, 200032, China
| | - Qi-Wen Deng
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China. .,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.
| | - Zhi-Jian Yu
- Department of Infectious Diseases and Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen Nanshan People's Hospital, Guang Dong Medical University, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China. .,Shenzhen key laboratory for endogenous infections, Shenzhen Nanshan People's Hospital, Shenzhen University school of medicine, No 89, Taoyuan Road, Nanshan District, Shenzhen, 518052, China.
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Poulakou G, Lagou S, Karageorgopoulos DE, Dimopoulos G. New treatments of multidrug-resistant Gram-negative ventilator-associated pneumonia. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:423. [PMID: 30581831 PMCID: PMC6275416 DOI: 10.21037/atm.2018.10.29] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/25/2018] [Indexed: 01/10/2023]
Abstract
Ventilator-associated pneumonia (VAP) remains an important clinical problem globally, being associated with significant morbidity and mortality. As management of VAP requires adequate and timely antibiotic administration, global emergence of antimicrobial resistance poses serious challenges over our ability to maintain this axiom. Development of antimicrobials against MDR Gram-negative pathogens has therefore emerged as a priority and some new antibiotics have been marketed or approach late stage of development. The aim of this review is to analyse new therapeutic options from the point view of potential treatment of VAP. Among recently developed antimicrobials presented herein, it is obvious that we will have promising therapeutic options against VAP caused by Enterobacteriaceae excluding those producing metallo-β-lactamases, against which only cefiderocol and aztreonam/avibactam are expected to be active. Against infections caused by carbapenem non-susceptible Pseudomonas aeruginosa, ceftolozane/tazobactam and to a lesser extend ceftazidime/avibactam may cover a proportion of current medical needs, but there still remain a considerable proportion of strains which harbor other resistance mechanisms. Murepavadin and cefiderocol hold promise against this particularly notorious pathogen. Finally, Acinetobacter baummannii remains a treatment-challenge. Eravacycline, cefiderocol and probably plazomicin seem to be the most promising agents against this difficult-to treat pathogen, but we have still a long road ahead, to see their position in clinical practice and particularly in VAP. In summary, despite persisting and increasing unmet medical needs, several newly approved and forthcoming agents hold promise for the treatment of VAP and hopefully will enrich our antimicrobial arsenal in the next few years. Targeted pharmacokinetic and clinical studies in real-life scenario of VAP are important to position these new agents in clinical practice, whereas vigilant use will ensure their longevity in our armamentarium.
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Affiliation(s)
- Garyphallia Poulakou
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria General Hospital, Athens, Greece
| | - Styliani Lagou
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria General Hospital, Athens, Greece
| | - Drosos E. Karageorgopoulos
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, Athens, Greece
| | - George Dimopoulos
- Department of Critical Care, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, Athens, Greece
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Bassetti M, Righi E, Carnelutti A, Graziano E, Russo A. Multidrug-resistantKlebsiella pneumoniae: challenges for treatment, prevention and infection control. Expert Rev Anti Infect Ther 2018; 16:749-761. [DOI: 10.1080/14787210.2018.1522249] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Matteo Bassetti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elda Righi
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessia Carnelutti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elena Graziano
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessandro Russo
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
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Abstract
Tetracyclines possess many properties considered ideal for antibiotic drugs, including activity against Gram-positive and -negative pathogens, proven clinical safety, acceptable tolerability, and the availability of intravenous (IV) and oral formulations for most members of the class. As with all antibiotic classes, the antimicrobial activities of tetracyclines are subject to both class-specific and intrinsic antibiotic-resistance mechanisms. Since the discovery of the first tetracyclines more than 60 years ago, ongoing optimization of the core scaffold has produced tetracyclines in clinical use and development that are capable of thwarting many of these resistance mechanisms. New chemistry approaches have enabled the creation of synthetic derivatives with improved in vitro potency and in vivo efficacy, ensuring that the full potential of the class can be explored for use against current and emerging multidrug-resistant (MDR) pathogens, including carbapenem-resistant Enterobacteriaceae, MDR Acinetobacter species, and Pseudomonas aeruginosa.
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