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Santavy P, Kubickova V, Sima M, Urbanek K. Population pharmacokinetics of three alternative prophylactic antibiotics during cardiac surgery with extracorporeal circulation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022. [PMID: 35775358 DOI: 10.5507/bp.2022.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS The aim of this pharmacokinetic study was to describe and quantify population pharmacokinetics of three antibiotics, cefazolin, ampicillin, and ciprofloxacin, used as antibacterial prophylaxis during cardiovascular surgery with the use of extracorporeal circulation (ECC). METHODS Adult patients undergoing cardiac surgery with ECC were enrolled to this prospective, pharmacokinetic study. An intravenous bolus of 2 g of ampicillin, 2 g of cefazolin or 400 mg of ciprofloxacin was administered 60-30 min before surgery. Blood samples were collected at 15, 30, 45, 60, 120 and 180 min after the administration and at the end of the surgery. Plasma concentrations of the antibiotics were measured using HPLC methods. Serum concentration-time profiles were analyzed using nonlinear mixed-effects modeling approach. RESULTS A total of 54 patients were enrolled into the study, 20 with ampicillin, 25 cefazolin and 9 ciprofloxacin. For all antibiotics, population pharmacokinetic models have been successfully developed. CONCLUSION We identified estimated glomerular filtration rate (eGFR) as the main factor determining the achievement of the pharmacokinetic/pharmacodynamic (PK/PD) target in ampicillin or cefazolin and body weight in ciprofloxacin prophylaxis during cardiac surgery with ECC support.
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Affiliation(s)
- Petr Santavy
- Department of Cardiac Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Vendula Kubickova
- Department of Pharmacology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Martin Sima
- Department of Pharmacology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Karel Urbanek
- Department of Pharmacology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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2
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Zhang L, Zhou Z, Gu X, Huang S, Shen X, Ding H. Murine Thigh Microdialysis to Evaluate the Pharmacokinetic/Pharmacodynamic Integration of Cefquinome Against Actinobacillus pleuropneumoniae. Front Vet Sci 2020; 7:448. [PMID: 32851028 PMCID: PMC7419427 DOI: 10.3389/fvets.2020.00448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
This study aimed to explore the application of microdialysis in pharmacokinetic (PK)/pharmacodynamic (PD) integration of cefquinome against Actinobacillus pleuropneumoniae. After the A. pleuropneumoniae population reached 106 CFU/thigh, the mice received 0.04, 0.16, 0.63, 2.5, and 10 mg/kg cefquinome by subcutaneous injection. Plasma samples were collected by retro-orbital puncture for 4 h, and thigh dialysate was obtained by microdialysis at a flow rate of 1.5 μL/min for 6 h for the PK study. For the PD experiment, the infected mice were treated with a 4-fold-increase in the total cefquinome dose, ranging from 0.01 to 10 mg/kg/24 h, divided into one, two, three, four, and eight doses. The number of bacteria was determined and an inhibitory sigmoid maximum effect (Emax) model was used to analyse the relationships between PK/PD parameters and efficacy. The mean penetration of cefquinome from plasma to the thigh was 0.591. The PK data for PK/PD integration were obtained by extrapolation. The fittest PK/PD parameter for efficacy evaluation was %fT>MIC (the percentage of time that free drug concentrations exceed the MIC). The magnitudes of %fT>MIC to achieve net bacterial stasis, 1-log10 CFU reduction, 2-log10 CFU reduction, and 3-log10 CFU reduction were 19.56, 28.65, 41.59, and 67.07 % in plasma and 21.74, 36.11, 52.96, and 82.68% in murine thigh, respectively. Microdialysis was first applied to evaluate the PK/PD integration of cefquinome against A. pleuropneumoniae. These results would provide valuable references when we apply microdialysis to study the PK/PD integration model and use cefquinome to treat animal diseases caused by A. pleuropneumoniae.
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Affiliation(s)
- Longfei Zhang
- College of Animal Science and Veterinary Medicine of Henan Institute of Science and Technology, Xinxiang, China.,Guangdong Provincial Key Laboratory of Veterinary Drugs Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Zichong Zhou
- Guangdong Provincial Key Laboratory of Veterinary Drugs Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Xiaoyan Gu
- Guangdong Provincial Key Laboratory of Veterinary Drugs Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Sixiu Huang
- Guangdong Provincial Key Laboratory of Veterinary Drugs Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Xiangguang Shen
- Guangdong Provincial Key Laboratory of Veterinary Drugs Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Huanzhong Ding
- Guangdong Provincial Key Laboratory of Veterinary Drugs Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
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Děrgel M, Voborník M, Pojar M, Karalko M, Gofus J, Radochová V, Studená Š, Maláková J, Turek Z, Chládek J, Manďák J. Lung Collapse during Mini-Thoracotomy Reduces Penetration of Cefuroxime to the Tissue: Interstitial Microdialysis Study in Animal Models. Surg Infect (Larchmt) 2020; 22:283-291. [PMID: 32633629 DOI: 10.1089/sur.2019.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Single-lung ventilation facilitates surgical exposure during minimally invasive cardiac surgery. However, a deeper knowledge of antibiotic distribution within a collapsed lung is necessary for effective antibiotic prophylaxis of pneumonia. Patients and Methods: The pharmacokinetics/pharmacodynamics (PK/PD) of cefuroxime were compared between the plasma and interstitial fluid (ISF) of collapsed and ventilated lungs in 10 anesthetized pigs, which were ventilated through a double-lumen endotracheal cannula. Cefuroxime (20 mg/kg) was administered in single 30-minute intravenous infusion. Samples of blood and lung microdialysate were collected until six hours post-dose. Ultrafiltration, in vivo retrodialysis, and high-performance liquid chromatography-tandem mass spectrometry were used to determine plasma and ISF concentrations of free drug. The concentrations were examined with non-compartmental analysis and compartmental modeling. Results: The concentration of free cefuroxime in ISF was lower in the non-ventilated lung than the ventilated one, evidenced by a lung penetration factor of 47% versus 63% (p < 0.05), the ratio between maximum concentrations (65%, p < 0.05), and the ratio between the areas under the concentration-time curve (78%, p = 0.12). The time needed to reach a minimum inhibitory concentration (MIC) was 30%-40% longer for a collapsed lung than for a ventilated one. In addition, a delay of 10-40 minutes was observed for lung ISF compared with plasma. The mean residence time values (ISF collapsed lung > ISF ventilated lung > plasma) could explain the absence of practically important differences in the time interval with the concentration of cefuroxime exceeding the MICs of sensitive strains (≤4 mg/L). Conclusion: The concentration of cefuroxime in the ISF of a collapsed porcine lung is lower than in a ventilated one; furthermore, its equilibration with plasma is delayed. Administration of the first cefuroxime dose earlier or at a higher rate may be warranted, as well as dose intensification of the perioperative prophylaxis of pneumonia caused by pathogens with higher MICs.
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Affiliation(s)
- Martin Děrgel
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Martin Voborník
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Marek Pojar
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Mikita Karalko
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jan Gofus
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Věra Radochová
- Animal Research Facility, Faculty of Military Health Sciences, University of Defense, Třebešská, Králové, Czech Republic
| | - Šárka Studená
- Department of Pharmacology, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jana Maláková
- Institute of Clinical Biochemistry and Diagnoses, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Zdeněk Turek
- Department of Anesthesiology, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jaroslav Chládek
- Department of Pharmacology, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jiří Manďák
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
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4
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Bue M, Hanberg P, Tøttrup M, Thomassen MB, Birke-Sørensen H, Thillemann TM, Andersson TL, Søballe K. Vancomycin concentrations in the cervical spine after intravenous administration: results from an experimental pig study. Acta Orthop 2018; 89:683-688. [PMID: 30080983 PMCID: PMC7025694 DOI: 10.1080/17453674.2018.1501548] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Vancomycin may be an important drug for intravenous perioperative antimicrobial prophylaxis in spine surgery. We assessed single-dose vancomycin intervertebral disc, vertebral cancellous bone, and subcutaneous adipose tissue concentrations using microdialysis in a pig model. Material and methods - 8 female pigs received 1,000 mg of vancomycin intravenously as a single dose over 100 minutes. Microdialysis probes were placed in the C3-C4 intervertebral disc, C3 vertebral cancellous bone, and subcutaneous adipose tissue, and vancomycin concentrations were obtained over 8 hours. Venous blood samples were obtained as reference. Results - Ranging from 0.24 to 0.60, vancomycin tissue penetration, expressed as the ratio of tissue to plasma area under the concentration-time curve from 0 to the last measured value, was incomplete for all compartments. The lowest penetration was found in the intervertebral disc. The time to a mean clinically relevant minimal inhibitory concentration (MIC) of 4 µg/mL was 3, 17, 25, and 156 min for plasma, subcutaneous adipose tissue, vertebral cancellous bone, and the intervertebral disc, respectively. In contrast to the other compartments, a mean MIC of 8 µg/mL was not reached in the intervertebral disc. An approximately 3-times longer elimination rate was observed in the intervertebral disc in comparison with all the other compartments (p < 0.001), and the time to peak drug concentration was higher for all tissues compared with plasma Interpretation - Preoperative administration of 1,000 mg of vancomycin may provide adequate vancomycin tissue concentrations with a considerable delay, though tissue penetration was incomplete. However, in order also to achieve adequate intervertebral disc concentrations in all individuals and accommodating a potentially higher MIC target, supplemental application of vancomycin may be necessary.
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Affiliation(s)
- Mats Bue
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens; ,Orthopaedic Research Unit, Aarhus University Hospital, Aarhus; ,Correspondence:
| | - Pelle Hanberg
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens; ,Orthopaedic Research Unit, Aarhus University Hospital, Aarhus;
| | - Mikkel Tøttrup
- Department of Orthopaedic Surgery, Randers Regional Hospital, Randers; ,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus;
| | | | | | - Theis M Thillemann
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus; ,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus;
| | - Torben L Andersson
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus; ,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus;
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5
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Bue M, Hanberg P, Koch J, Jensen LK, Lundorff M, Aalbaek B, Jensen HE, Søballe K, Tøttrup M. Single-dose bone pharmacokinetics of vancomycin in a porcine implant-associated osteomyelitis model. J Orthop Res 2018; 36:1093-1098. [PMID: 29058823 DOI: 10.1002/jor.23776] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/13/2017] [Indexed: 02/04/2023]
Abstract
The increasing incidence of orthopaedic methicillin-resistant Staphylococcus aureus (MRSA) infections represents a significant therapeutic challenge. Being effective against MRSA, the role of vancomycin may become more important in the orthopaedic setting in the years to come. Nonetheless, vancomycin bone and soft tissue penetration during infection remains unclear. In eight pigs, implant-associated osteomyelitis was induced on day 0, using a Staphylococcus aureus strain. Following administration of 1,000 mg of vancomycin on day 5, vancomycin concentrations were obtained with microdialysis for 8 h in the implant bone cavity, in cancellous bone adjacent to the implant cavity, in subcutaneous adipose tissue (SCT) adjacent to the implant cavity, and in healthy cancellous bone and healthy SCT in the contralateral leg. Venous blood samples were also obtained. The extent of infection and inflammation was evaluated by post-mortem computed tomography scans, C-reactive protein serum levels and cultures of blood and swabs. In relation to all the implant cavities, bone destruction was found. Ranging from 0.20 to 0.74, tissue penetration, expressed as the ratio of the area under the concentration-time curve from 0 to the last measured value, was incomplete for all compartments except for healthy SCT. The lowest penetration was found in the implant cavity. In conclusion, Staphylococcus aureus implant-associated osteomyelitis was found to reduce vancomycin bone penetration, especially in the implant cavity. These findings suggest that it may be unsafe to rely solely on vancomycin therapy when treating acute osteomyelitis. Particularly when metaphyseal cavities are present, surgical debridement seems necessary. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1093-1098, 2018.
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Affiliation(s)
- Mats Bue
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Sundvej 30, Horsens, 8700, Denmark.,Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Pelle Hanberg
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Sundvej 30, Horsens, 8700, Denmark.,Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Janne Koch
- Department of Experimental medicine, University of Copenhagen, Denmark
| | | | - Martin Lundorff
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Sundvej 30, Horsens, 8700, Denmark
| | - Bent Aalbaek
- Department of Veterinary Disease Biology, University of Copenhagen, Denmark
| | | | - Kjeld Søballe
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel Tøttrup
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Randers Regional Hospital, Randers, Denmark
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6
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Bue M, Tøttrup M, Hanberg P, Langhoff O, Birke-Sørensen H, Thillemann TM, Andersson TL, Søballe K. Bone and subcutaneous adipose tissue pharmacokinetics of vancomycin in total knee replacement patients. Acta Orthop 2018; 89:95-100. [PMID: 28914105 PMCID: PMC5810840 DOI: 10.1080/17453674.2017.1373497] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - The incidence of orthopedic methicillin-resistant Staphylococcus aureus (MRSA) infections is increasing. Vancomycin may therefore play an increasingly important role in orthopedic perioperative antimicrobial prophylaxis. Studies investigating perioperative bone and soft tissue concentrations of vancomycin are sparse and challenged by a lack of appropriate methods. We assessed single-dose plasma, subcutaneous adipose tissue (SCT) and bone concentrations of vancomycin using microdialysis in male patients undergoing total knee replacement. Methods - 1,000 mg of vancomycin was administered postoperatively intravenously over 100 minutes to 10 male patients undergoing primary total knee replacement. Vancomycin concentrations in plasma, SCT, cancellous, and cortical bone were measured over the following 8 hours. Microdialysis was applied for sampling in solid tissues. Results - For all solid tissues, tissue penetration of vancomycin was significantly impaired. The time to a mean clinically relevant minimal inhibitory concentration (MIC) of 2 mg/L was 3, 36, 27, and 110 min for plasma, SCT, cancellous, and cortical bone, respectively. As opposed to the other compartments, a mean MIC of 4 mg/L could not be reached in cortical bone. The area under the concentration-time curve from 0 to the last measured value and peak drug concentrations (Cmax) for SCT, cancellous, and cortical bone was lower than that of free plasma. The time to Cmax was higher for all tissues compared with free plasma. Interpretation - Postoperative penetration of vancomycin to bone and SCT was impaired and delayed in male patients undergoing total knee replacement surgery. Adequate perioperative vancomycin concentrations may not be reached using standard prophylactic dosage.
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Affiliation(s)
- Mats Bue
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens,Orthopaedic Research Unit, Aarhus University Hospital, Aarhus,Correspondence:
| | - Mikkel Tøttrup
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus,Department of Orthopaedic Surgery, Randers Regional Hospital, Randers,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
| | - Pelle Hanberg
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens,Orthopaedic Research Unit, Aarhus University Hospital, Aarhus
| | - Otto Langhoff
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens
| | | | - Theis M Thillemann
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
| | - Torben L Andersson
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Unit, Aarhus University Hospital, Aarhus,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
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7
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Yang B, Gao JD, Cao XY, Wang QY, Sun GZ, Yang JJ. Lung microdialysis study of florfenicol in pigs after single intramuscular administration. J Vet Pharmacol Ther 2017; 40:530-538. [DOI: 10.1111/jvp.12387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/17/2016] [Indexed: 02/02/2023]
Affiliation(s)
- B. Yang
- Hubei Engineering Research Center of Viral Vector; Wuhan Institute of Bioengineering; Wuhan China
| | - J. D. Gao
- Wuhan Royal Veterinary Hospital; Wuhan China
| | - X. Y. Cao
- Department of Veterinary Pharmacology and Toxicology; College of Veterinary Medicine; China Agricultural University Beijing China
| | | | - G. Z. Sun
- Hubei Engineering Research Center of Viral Vector; Wuhan Institute of Bioengineering; Wuhan China
| | - J. J. Yang
- Hubei Engineering Research Center of Viral Vector; Wuhan Institute of Bioengineering; Wuhan China
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Bottino N, Marino A, Polli F, Savioli M, Tubiolo D, Iapichino GE, Protti A, Gattinoni L. Unexpected left atrial reinfusion through a patent foramen ovale during venovenous extracorporeal life support. Anaesth Intensive Care 2016; 44:637-9. [PMID: 27608350 DOI: 10.1177/0310057x1604400516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Bottino
- Anesthesist/ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - A Marino
- Fellow, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università deg li Studi di Milano, Milan, Italy
| | - F Polli
- Anesthesist / ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - M Savioli
- Anesthesist/ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - D Tubiolo
- Anesthesist/ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - G E Iapichino
- Fellow, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università deg li Studi di Milano, Milan, Italy
| | - A Protti
- Anesthesist / ICU doctor, Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - L Gattinoni
- Professor, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università deg li Studi di, Milan, Italy
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Winstanley C, O'Brien S, Brockhurst MA. Pseudomonas aeruginosa Evolutionary Adaptation and Diversification in Cystic Fibrosis Chronic Lung Infections. Trends Microbiol 2016; 24:327-337. [PMID: 26946977 PMCID: PMC4854172 DOI: 10.1016/j.tim.2016.01.008] [Citation(s) in RCA: 445] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/06/2016] [Accepted: 01/25/2016] [Indexed: 12/02/2022]
Abstract
Pseudomonas aeruginosa populations undergo a characteristic evolutionary adaptation during chronic infection of the cystic fibrosis (CF) lung, including reduced production of virulence factors, transition to a biofilm-associated lifestyle, and evolution of high-level antibiotic resistance. Populations of P. aeruginosa in chronic CF lung infections typically exhibit high phenotypic diversity, including for clinically important traits such as antibiotic resistance and toxin production, and this diversity is dynamic over time, making accurate diagnosis and treatment challenging. Population genomics studies reveal extensive genetic diversity within patients, including for transmissible strains the coexistence of highly divergent lineages acquired by patient-to-patient transmission. The inherent spatial structure and spatial heterogeneity of selection in the CF lung appears to play a key role in driving P. aeruginosa diversification. During chronic lung infections of CF patients common genetic adaptations occur in P. aeruginosa, such as conversion to mucoidy, loss of virulence factors, and resistance to antibiotics. Although pathoadaptive mutations in regulatory proteins are common, the actual regulators affected vary between populations. P. aeruginosa populations in CF lungs exhibit high levels of phenotypic diversity. Fine-scale population genomics approaches reveal that divergent sublineages can coexist, with evidence for regional isolation in the spatially structured and heterogeneous lung environment. Experimental evolution is beginning to provide insights into the selective drivers of evolution in P. aeruginosa infection, including the role of social interactions.
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Affiliation(s)
- Craig Winstanley
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, Ronald Ross Building, University of Liverpool, 8 West Derby Street, Liverpool, L69 7BE, UK.
| | - Siobhan O'Brien
- Department of Biology, University of York, Wentworth Way, York, YO10 5DD, UK
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10
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Tøttrup M, Bue M, Koch J, Jensen LK, Hanberg P, Aalbæk B, Fuursted K, Jensen HE, Søballe K. Effects of Implant-Associated Osteomyelitis on Cefuroxime Bone Pharmacokinetics: Assessment in a Porcine Model. J Bone Joint Surg Am 2016; 98:363-9. [PMID: 26935458 DOI: 10.2106/jbjs.o.00550] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prolonged antibiotic therapy that is often needed for successful management of osteomyelitis may be related to incomplete penetration of antibiotics into the target site. The objective of this study was to assess the effects of implant-associated osteomyelitis on cefuroxime penetration into bone. METHODS Implant-associated osteomyelitis using a Staphylococcus aureus strain was induced in the right tibia in ten pigs. After five days and following administration of 1500 mg of cefuroxime, measurements of cefuroxime were obtained using microdialysis for eight hours in the implant-related bone cavity, in the adjacent infected cancellous bone and infected subcutaneous tissue, and in healthy cancellous bone and subcutaneous tissue in the contralateral leg. Measurements of the corresponding free plasma concentrations were also obtained. The extent of the infection was assessed by postmortem computed tomography (CT) scans and cultures of blood, swabs, and bone specimens. RESULTS Bone destruction was found in the implant cavities. No structural bone changes in the adjacent infected cancellous bone were visible on CT scans. S. aureus was grown on culture of specimens from all implant cavities and from eight of ten swabs and seven of ten bone samples from the infected bone. The areas under the concentration-time curves for the different tissues differed significantly, with the lowest area under the curve found in the implant cavity (analysis of variance; p < 0.001). Although not as notable as for the implant cavity, cefuroxime penetration into infected cancellous bone was incomplete but comparable with that in healthy bone. Despite poorer tissue penetration, slightly increased time with concentrations above the minimal inhibitory concentration (MIC) was achieved in the implant cavity up to MICs of 2 mg/L compared with the other tissues, but the time was shorter for higher MICs. CONCLUSIONS Cefuroxime penetration into infected cancellous bone was incomplete but comparable with that in healthy bone. The destructive bone processes associated with acute osteomyelitis reduced cefuroxime penetration further. CLINICAL RELEVANCE These findings support the general clinical perception that fast diagnosis and early initiation of antibiotics before the development of implant-associated cavities is important in nonsurgical management of acute osteomyelitis.
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Affiliation(s)
- Mikkel Tøttrup
- Department of Orthopaedic Surgery (M.T. and K.S.) and Orthopaedic Research Unit (M.T., M.B., P.H., and K.S.), Aarhus University Hospital, Aarhus, Denmark Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Mats Bue
- Department of Orthopaedic Surgery (M.T. and K.S.) and Orthopaedic Research Unit (M.T., M.B., P.H., and K.S.), Aarhus University Hospital, Aarhus, Denmark Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Janne Koch
- Departments of Experimental Medicine (J.K.) and Veterinary Disease Biology (L.K.J., B.A., and H.E.J.), University of Copenhagen, Copenhagen, Denmark
| | - Louise Kruse Jensen
- Departments of Experimental Medicine (J.K.) and Veterinary Disease Biology (L.K.J., B.A., and H.E.J.), University of Copenhagen, Copenhagen, Denmark
| | - Pelle Hanberg
- Department of Orthopaedic Surgery (M.T. and K.S.) and Orthopaedic Research Unit (M.T., M.B., P.H., and K.S.), Aarhus University Hospital, Aarhus, Denmark
| | - Bent Aalbæk
- Departments of Experimental Medicine (J.K.) and Veterinary Disease Biology (L.K.J., B.A., and H.E.J.), University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Elvang Jensen
- Departments of Experimental Medicine (J.K.) and Veterinary Disease Biology (L.K.J., B.A., and H.E.J.), University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery (M.T. and K.S.) and Orthopaedic Research Unit (M.T., M.B., P.H., and K.S.), Aarhus University Hospital, Aarhus, Denmark
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Jorth P, Staudinger BJ, Wu X, Hisert KB, Hayden H, Garudathri J, Harding CL, Radey MC, Rezayat A, Bautista G, Berrington WR, Goddard AF, Zheng C, Angermeyer A, Brittnacher MJ, Kitzman J, Shendure J, Fligner CL, Mittler J, Aitken ML, Manoil C, Bruce JE, Yahr TL, Singh PK. Regional Isolation Drives Bacterial Diversification within Cystic Fibrosis Lungs. Cell Host Microbe 2015; 18:307-19. [PMID: 26299432 PMCID: PMC4589543 DOI: 10.1016/j.chom.2015.07.006] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/25/2015] [Accepted: 07/16/2015] [Indexed: 12/22/2022]
Abstract
Bacterial lineages that chronically infect cystic fibrosis (CF) patients genetically diversify during infection. However, the mechanisms driving diversification are unknown. By dissecting ten CF lung pairs and studying ∼12,000 regional isolates, we were able to investigate whether clonally related Pseudomonas aeruginosa inhabiting different lung regions evolve independently and differ functionally. Phylogenetic analysis of genome sequences showed that regional isolation of P. aeruginosa drives divergent evolution. We investigated the consequences of regional evolution by studying isolates from mildly and severely diseased lung regions and found evolved differences in bacterial nutritional requirements, host defense and antibiotic resistance, and virulence due to hyperactivity of the type 3 secretion system. These findings suggest that bacterial intermixing is limited in CF lungs and that regional selective pressures may markedly differ. The findings also may explain how specialized bacterial variants arise during infection and raise the possibility that pathogen diversification occurs in other chronic infections characterized by spatially heterogeneous conditions.
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Affiliation(s)
- Peter Jorth
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Benjamin J Staudinger
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Xia Wu
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Katherine B Hisert
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Hillary Hayden
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jayanthi Garudathri
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Christopher L Harding
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Matthew C Radey
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Amir Rezayat
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Gilbert Bautista
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - William R Berrington
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Amanda F Goddard
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Chunxiang Zheng
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Angus Angermeyer
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Mitchell J Brittnacher
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jacob Kitzman
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Corinne L Fligner
- Departments of Pathology and Laboratory Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - John Mittler
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Moira L Aitken
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Colin Manoil
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - James E Bruce
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Timothy L Yahr
- Department of Microbiology, University of Iowa School of Medicine, Iowa City, IA 52240, USA
| | - Pradeep K Singh
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA 98195, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Continuous versus short-term infusion of cefuroxime: assessment of concept based on plasma, subcutaneous tissue, and bone pharmacokinetics in an animal model. Antimicrob Agents Chemother 2014; 59:67-75. [PMID: 25313214 DOI: 10.1128/aac.03857-14] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The relatively short half-lives of most β-lactams suggest that continuous infusion of these time-dependent antimicrobials may be favorable compared to short-term infusion. Nevertheless, only limited solid-tissue pharmacokinetic data are available to support this theory. In this study, we randomly assigned 12 pigs to receive cefuroxime as either a short-term or continuous infusion. Measurements of cefuroxime were obtained every 30 min in plasma, subcutaneous tissue, and bone. For the measurements in solid tissues, microdialysis was applied. A two-compartment population model was fitted separately to the drug concentration data for the different tissues using a nonlinear mixed-effects regression model. Estimates of the pharmacokinetic parameters and time with concentrations above the MIC were derived using Monte Carlo simulations. Except for subcutaneous tissue in the short-term infusion group, the tissue penetration was incomplete for all tissues. For short-term infusion, the tissue penetration ratios were 0.97 (95% confidence interval [CI], 0.67 to 1.39), 0.61 (95% CI, 0.51 to 0.73), and 0.45 (95% CI, 0.36 to 0.56) for subcutaneous tissue, cancellous bone, and cortical bone, respectively. For continuous infusion, they were 0.53 (95% CI, 0.33 to 0.84), 0.38 (95% CI, 0.23 to 0.57), and 0.27 (95% CI, 0.13 to 0.48) for the same tissues, respectively. The absolute areas under the concentration-time curve were also lower in the continuous infusion group. Nevertheless, a significantly longer time with concentrations above the MIC was found for continuous infusion up until MICs of 4, 2, 2, and 0.5 μg/ml for plasma and the same three tissues mentioned above, respectively. For drugs with a short half-life, like cefuroxime, continuous infusion seems to be favorable compared to short-term infusion; however, incomplete tissue penetration and high MIC strains may jeopardize the continuous infusion approach.
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