Impact of antimicrobial agents and chemotherapy from 1972 to 1998

Oxygen tension during biofilm growth influences the efficacy antimicrobial agents

Abstract Objective To compare the antimicrobial efficacy of a 0.12% chlorhexidine (CHX) and herbal green tea (Camellia sinensis) solution on established biofilms formed at different oxygen tensions in an in situ model. Method Twenty-five dental students were eligible for the study. In situ devices with standardized enamel specimens (ES) facing the palatal and buccal sides were inserted in the mouths of volunteers for a 7 day period. No agent was applied during the first four days. From the fifth day onward, both agents were applied to the test ES group and no agent was applied to the control ES group. After 7 days the ES fragments were removed from the devices, sonicated, plated on agar, and incubated for 24 h at 37 °C to determine and quantify the colony forming units (CFUs). Result CHX had significantly higher efficacy compared to green tea on the buccal (1330 vs. 2170 CFU/µL) and palatal (2250 vs. 2520 CFU/µL) ES. In addition, intragroup comparisons showed significantly higher efficacy in buccal ES over palatal ES (1330 vs. 2250 CFU/µL for CHX and 2170 vs, 2520 CFU/µL for CV) for both solutions. Analysis of the ES controls showed significantly higher biofilm formation in palatal ES compared to buccal ES. Conclusion CHX has higher efficacy than green tea on 4-day biofilms. The efficacy of both agents was reduced for biofilms grown in a low oxygen tension environment. Therefore, the oxygen tension environment seems to influence the efficacy of the tested agents.

Risk factors for hospital-acquired bacteremia due to carbapenem-resistant Pseudomonas aeruginosa in a Colombian hospital

INTRODUCTION

Bacteremia due to Pseudomonas aeruginosa resistant to carbapenems is a public health problem due to the limitations it places on therapeutic options, as well as the increased time patients must spend in hospital, costs and the risk of mortality. 

OBJECTIVE

To evaluate the risk factors for presentation of bacteremia due to carbapenem-resistant P. aeruginosa acquired in the Hospital Universitario San Ignacio between January 2008 and June 2014. 

MATERIALS AND METHODS

This was a case control study in which the case patients presented bacteremia due to P. aeruginosa resistant to carbapenems and the control group included patients with P. aeruginosa susceptible to this group of antibiotics. Variables such as the previous use of meropenem and ertapenem, immunosuppression and neoplasia were measured. Mortality and duration of hospital were also described. 

RESULTS

In all, 168 patients were evaluated, of which 42 were cases and 126 controls. Using a multivariate model, the risk factors related to bacteremia due to carbapenem-resistant P. aeruginosa acquired in hospital were the following: use of parenteral nutrition (OR=8.28; 95% CI: 2.56-26.79; p=0); use of meropenem (OR=1.15; 95% CI: 1.03-1.28; p=0.01); and use of ciprofloxacin (OR=81.99; 95% CI: 1.14-5884; p=0.043). 

CONCLUSION

In order to prevent the emergence of carbapenem-resistant P. aeruginosa, antimicrobial control programs should be strengthened by promoting the prudent administration of carbapenems and quinolones. The correct use of parenteral nutrition should also be monitored.

Antibacterial cyclic D,L-alpha-glycopeptides

We report the design, synthesis, membrane activity, biophysical characterization, and in vitro antibacterial activities of cationic cyclic D,L-alpha-glycopeptides bearing d-glucosamine (GlcNH(2)), D-galactose (Gal), or D-mannose (Man) glycosyl side chains.

The resumption of consumption -- a review on tuberculosis

Among all infectious diseases that afflict humans, tuberculosis (TB) remains the deadliest. At present, epidemiologists estimate that one-third of the world population is infected with tubercle bacilli, which is responsible for 8 to 10 million new cases of TB and 3 million deaths annually throughout the world. Approximately 95% of new cases and 98% of deaths occur in developing nations, generally due to the few resources available to ensure proper treatment and where human immunodeficiency virus (HIV) infections are common. In 1882, Dr Robert Koch identified an acid-fast bacterium, Mycobacterium tuberculosis, as the causative agent of TB. Thirty-nine years later, BCG vaccine was introduced for human use, and became the most widely used prophylactic strategy to fight TB in the world. The discovery of the properties of first-line antimycobacterial drugs in the past century yielded effective chemotherapies, which considerably decreased TB mortality rates worldwide. The later introduction of some additional drugs to the arsenal used to treat TB seemed to provide an adequate number of effective antimicrobial agents. The modern, standard short-course therapy for TB recommended by the World Health Organization is based on a four-drug regimen that must be strictly followed to prevent drug resistance acquisition, and relies on direct observation of patient compliance to ensure effective treatment. Mycobacteria show a high degree of intrinsic resistance to most antibiotics and chemotherapeutic agents due to the low permeability of its cell wall. Nevertheless, the cell wall barrier alone cannot produce significant levels of drug resistance. M. tuberculosis mutants resistant to any single drug are naturally present in any large bacterial population, irrespective of exposure to drugs. The frequency of mutants resistant to rifampicin and isoniazid, the two principal antimycobacterial drugs currently in use, is relatively high and, therefore, the large extra-cellular population of actively metabolizing and rapidly growing tubercle bacilli in cavitary lesions will contain organisms which are resistant to a single drug. Consequently, monotherapy or improperly administered two-drug therapies will select for drug-resistant mutants that may lead to drug resistance in the entire bacterial population. Thereby, despite the availability of effective chemotherapy and the moderately protective vaccine, new anti-TB agents are urgently needed to decrease the global incidence of TB. The resumption of TB, mainly caused by the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains and HIV epidemics, led to an increased need to understand the molecular mechanisms of drug action and drug resistance, which should provide significant insight into the development of newer compounds. The latter should be effective to combat both drug-susceptible and MDR/XDR-TB.

Ubiquity and diversity of multidrug resistance genes inLactococcus lactisstrains isolated between 1936 and 1995

The presence and the nucleotide sequence of four multidrug resistance genes, lmrA, lmrP, lmrC, and lmrD, were investigated in 13 strains of Lactococcus lactis ssp. lactis, four strains of Lactococcus lactis ssp. cremoris, two strains of Lactococcus plantarum, and two strains of Lactococcus raffinolactis. Multidrug resistance genes were present in all L. lactis isolates tested. However, none of them could be detected in the strains belonging to the species L. raffinolactis and L. plantarum, suggesting a different set of multidrug resistance genes in these species. The analysis of the four deduced amino acid sequences established two different variants depending on the subspecies of L. lactis. Either lmrA, or lmrP, or both were found naturally disrupted in five strains, while full-length lmrD was present in all strains.

Novel concentration-killing curve method for estimation of bactericidal potency of antibiotics in an in vitro dynamic model

The bactericidal pharmacodynamics of antibiotics against Escherichia coli were analyzed by a concentration-killing curve (CKC) approach, and the novel parameters median bactericidal concentration (BC(50)) and bactericidal intensity (r) for bactericidal potency were proposed. By using the agar plate method, about 500 E. coli cells were inoculated onto Luria-Bertani plates containing a series of antibiotic concentrations, and after 24 h of incubation at 37 degrees C, all the viable colonies were enumerated. This resulted in a sigmoidal CKC that could be perfectly fitted (R(2) > 0.9) with the function N = N(0)/[1 + e(r(x - BC(50)))], where N is number of colonies surviving on each plate with an x series of concentrations of an antibiotic, and N(0) represents the meaningful inoculum size. Construction of the CKC method was based on the bactericidal effect of each antibiotic against the bacterial strain versus the concentration in two dimensions and may be a more valid, accurate, and reproducible method for estimating the bactericidal effect than the endpoint minimum bactericidal concentration (MBC) method. Mathematically, the CKC approach was point symmetrical toward its inflexion (BC(50), N(0)/2); thus, 2BC(50) could replace MBC. The parameter BC(1) can be defined as BC(50) + [ln(N(0) - 1)/r], which is the drug concentration at which only one colony survived and which is the least critical value of MBC in the CKC. The variate r, which determined the tangent slope on inflexion when N(0) was limited, could estimate the bactericidal intensity of an antibiotic. This verified that the CKC approach may be useful in studies with other classes of antibiotics and has considerable value as a tool for the accurate and proper administration of antibiotics.

A new test of non-inferiority for anti-infective trials

This paper describes a new statistical test of non-inferiority in clinical trials of anti-infective medications. The test allows the inferiority limit, delta, to vary with the underlying success rates. The test is a simple modification of the standard fixed-delta test, and its parameters can be adjusted to yield the fixed-delta test, a test similar to the FDA's Points-to-Consider procedure, or a test with nearly constant power values over a range of success rates. The test satisfies the size and power criteria for a valid statistical test. The effects on the test of lowering success rates through stringent criteria or through error are discussed.

Clinical resistance encountered in the respiratory surveillance program (RESP) study: a review of the implications for the treatment of community-acquired respiratory tract infections

The Respiratory Surveillance Program (RESP) is a large-scale surveillance study of potential bacterial pathogens from respiratory tract infections that was performed over a 10-month period (July to April) during the 1999-2000 respiratory infection season. It is also the first study of its kind to derive its information entirely from community-based medical practices. This study, therefore, provides insight into the identity, frequency, and susceptibility of the possible pathogens isolated from patients encountered by primary care physicians. Reduction of antibiotic susceptibility in various bacterial pathogens may be of academic interest. However, it is only the emergence of clinical resistance (strains exhibiting minimum inhibitory concentrations above the resistance breakpoint) to commonly used antibacterial agents in the most prevalent species that has significant impact on empiric therapy choices. A review of data from RESP indicated that the most prevalent species were Moraxella catarrhalis, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae. As expected, the prevalence of these bacterial isolates varied by disease state. The prevalence of clinical resistance to various antibiotics ranged, within these 4 species, between 0% and 92%. Resistance to the greatest number of drugs was expressed by S pneumoniae, followed by S aureus, H influenzae, and M catarrhalis. The prevalence of antibiotic resistance found among these community-isolated pathogens was surprisingly similar to that reported in hospital-based studies, suggesting that resistance is as important an issue in the community as it is in hospitals. With few exceptions, the prevalence of resistance was fairly uniform across disease states. The antibiotics most likely to encounter clinically resistant isolates during the treatment of community-acquired respiratory tract infections were penicillins, macrolides, and trimethoprim/sulfamethoxazole. The antibiotics least likely to encounter resistance were quinolones, followed by ceftriaxone and amoxicillin/clavulanate.