1
|
Sendra E, Fernández-Muñoz A, Zamorano L, Oliver A, Horcajada JP, Juan C, Gómez-Zorrilla S. Impact of multidrug resistance on the virulence and fitness of Pseudomonas aeruginosa: a microbiological and clinical perspective. Infection 2024:10.1007/s15010-024-02313-x. [PMID: 38954392 DOI: 10.1007/s15010-024-02313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
Pseudomonas aeruginosa is one of the most common nosocomial pathogens and part of the top emergent species associated with antimicrobial resistance that has become one of the greatest threat to public health in the twenty-first century. This bacterium is provided with a wide set of virulence factors that contribute to pathogenesis in acute and chronic infections. This review aims to summarize the impact of multidrug resistance on the virulence and fitness of P. aeruginosa. Although it is generally assumed that acquisition of resistant determinants is associated with a fitness cost, several studies support that resistance mutations may not be associated with a decrease in virulence and/or that certain compensatory mutations may allow multidrug resistance strains to recover their initial fitness. We discuss the interplay between resistance profiles and virulence from a microbiological perspective but also the clinical consequences in outcomes and the economic impact.
Collapse
Affiliation(s)
- Elena Sendra
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
| | - Almudena Fernández-Muñoz
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
| | - Laura Zamorano
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
| | - Antonio Oliver
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Juan
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain.
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain.
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
2
|
Piatti G, De Ferrari L, Schito AM, Riccio AM, Penco S, Cassia S, Bruzzone M, Ceppi M. In Vitro Reduction of Interleukin-8 Response to Enterococcus faecalis by Escherichia coli Strains Isolated from the Same Polymicrobial Urines. Microorganisms 2021; 9:microorganisms9071501. [PMID: 34361936 PMCID: PMC8307267 DOI: 10.3390/microorganisms9071501] [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] [Received: 05/12/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Urinary tract infections are often polymicrobial and are mainly due to uropathogenic Escherichia coli (UPEC). We previously demonstrated a link among clinical fluoroquinolone susceptible E. coli reducing in vitro urothelial interleukin-8 (CXCL8) induced by E. coli K-12, polymicrobial cystitis, and pyuria absence. Here, we evaluated whether fifteen clinical fluoroquinolone susceptible UPEC were able to reduce CXCL8 induced by Enterococcus faecalis that had been isolated from the same mixed urines, other than CXCL8 induced by E. coli K-12. We also evaluated the connection between fluoroquinolone susceptibility and pathogenicity by evaluating the immune modulation of isogenic gyrA, a mutant UPEC resistant to ciprofloxacin. Using the 5637 bladder epithelial cell line, we observed that lower CXCL8 induced the most UPEC isolates than K-12 and the corresponding E. faecalis. During coinfections of UPEC/K-12 and UPEC/E. faecalis, we observed lower CXCL8 than during infections caused by K-12 and E. faecalis alone. UPEC strains showed host–pathogen and pathogen–pathogen interaction, which in part explained their persistence in the human urinary tract and coinfections, respectively. Mutant UPEC showed lower modulating activity with respect to the wildtypes, confirming the connection between acquired fluoroquinolone resistance and the decrease of innate microbial properties.
Collapse
Affiliation(s)
- Gabriella Piatti
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genova, Italy;
- Correspondence: ; Tel.: +39-0105555193
| | - Laura De Ferrari
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy; (L.D.F.); (A.M.R.); (S.C.)
| | - Anna Maria Schito
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genova, Italy;
| | - Anna Maria Riccio
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy; (L.D.F.); (A.M.R.); (S.C.)
| | - Susanna Penco
- Department of Experimental Medicine, University of Genoa, 16132 Genova, Italy;
| | - Sebastiano Cassia
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy; (L.D.F.); (A.M.R.); (S.C.)
| | - Marco Bruzzone
- Unit of Clinical Epidemiology, Ospedale Policlinico San Martino-IRCCS per l’Oncologia, 16132 Genova, Italy; (M.B.); (M.C.)
| | - Marcello Ceppi
- Unit of Clinical Epidemiology, Ospedale Policlinico San Martino-IRCCS per l’Oncologia, 16132 Genova, Italy; (M.B.); (M.C.)
| |
Collapse
|
3
|
Horcajada JP, Montero M, Oliver A, Sorlí L, Luque S, Gómez-Zorrilla S, Benito N, Grau S. Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections. Clin Microbiol Rev 2019; 32:32/4/e00031-19. [PMID: 31462403 PMCID: PMC6730496 DOI: 10.1128/cmr.00031-19] [Citation(s) in RCA: 425] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In recent years, the worldwide spread of the so-called high-risk clones of multidrug-resistant or extensively drug-resistant (MDR/XDR) Pseudomonas aeruginosa has become a public health threat. This article reviews their mechanisms of resistance, epidemiology, and clinical impact and current and upcoming therapeutic options. In vitro and in vivo treatment studies and pharmacokinetic and pharmacodynamic (PK/PD) models are discussed. Polymyxins are reviewed as an important therapeutic option, outlining dosage, pharmacokinetics and pharmacodynamics, and their clinical efficacy against MDR/XDR P. aeruginosa infections. Their narrow therapeutic window and potential for combination therapy are also discussed. Other "old" antimicrobials, such as certain β-lactams, aminoglycosides, and fosfomycin, are reviewed here. New antipseudomonals, as well as those in the pipeline, are also reviewed. Ceftolozane-tazobactam has clinical activity against a significant percentage of MDR/XDR P. aeruginosa strains, and its microbiological and clinical data, as well as recommendations for improving its use against these bacteria, are described, as are those for ceftazidime-avibactam, which has better activity against MDR/XDR P. aeruginosa, especially strains with certain specific mechanisms of resistance. A section is devoted to reviewing upcoming active drugs such as imipenem-relebactam, cefepime-zidebactam, cefiderocol, and murepavadin. Finally, other therapeutic strategies, such as use of vaccines, antibodies, bacteriocins, anti-quorum sensing, and bacteriophages, are described as future options.
Collapse
Affiliation(s)
- Juan P Horcajada
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Milagro Montero
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Antonio Oliver
- Service of Microbiology, Hospital Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Luisa Sorlí
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Sònia Luque
- Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Gómez-Zorrilla
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Santiago Grau
- Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
4
|
Persyn E, Sassi M, Aubry M, Broly M, Delanou S, Asehnoune K, Caroff N, Crémet L. Rapid genetic and phenotypic changes in Pseudomonas aeruginosa clinical strains during ventilator-associated pneumonia. Sci Rep 2019; 9:4720. [PMID: 30886315 PMCID: PMC6423012 DOI: 10.1038/s41598-019-41201-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/27/2019] [Indexed: 11/24/2022] Open
Abstract
Treatment with antibiotics leads to the selection of isolates with increased resistance. We investigated if evolution towards resistance was associated with virulence changes, in the context of P. aeruginosa ventilator-associated pneumonia (VAP). Four patients were selected because they had multiple VAP episodes during short periods (12 days to 5 weeks), with emergence of resistance. We performed whole-genome sequencing of 12 P. aeruginosa from bronchoalveolar lavages or blood culture (3 isolates per patient). Production of quorum sensing-dependent virulence factors, serum resistance, cytotoxicity against A549 cells, biofilm production, and twitching motility were studied. Each patient was infected with a unique strain. For all patients, resistance development was explained by genetic events in ampD, mexR or oprD. Additional variations were detected in virulence- and/or fitness-associated genes (algB, gacA, groEL, lasR, mpl, pilE, pilM, rhlR) depending on the strain. We noticed a convergence towards quorum sensing deficiency, correlated with a decrease of pyocyanin and protease production, survival in serum, twitching motility and cytotoxicity. In one patient, changes in pilM and pilE were related to enhanced twitching. We show that the emergence of resistance in P. aeruginosa is associated with virulence modification, even in acute infections. The consequences of this short-term pathoadaptation need to be explored.
Collapse
Affiliation(s)
- Elise Persyn
- EA3826 Université de Nantes, IRS2 Nantes Biotech, Nantes Cedex 1, F-44100, France. .,CHU Nantes, 9 quai Moncousu, Nantes Cedex 1, F-44093, France.
| | - Mohamed Sassi
- Inserm U835, Université de Rennes, Rennes, F-35000, France
| | - Marc Aubry
- Université de Rennes, CNRS, IGDR [(Institut de génétique et développement de Rennes)] - UMR 6290, F-35000, Rennes, France.,Université de Rennes, Plateforme GEH, CNRS, Inserm, BIOSIT - UMS 3480, US_S 018, F-35000, Rennes, France
| | - Martin Broly
- CHU Nantes, 9 quai Moncousu, Nantes Cedex 1, F-44093, France
| | - Sandie Delanou
- EA3826 Université de Nantes, IRS2 Nantes Biotech, Nantes Cedex 1, F-44100, France
| | - Karim Asehnoune
- EA3826 Université de Nantes, IRS2 Nantes Biotech, Nantes Cedex 1, F-44100, France.,CHU Nantes, 9 quai Moncousu, Nantes Cedex 1, F-44093, France
| | - Nathalie Caroff
- EA3826 Université de Nantes, IRS2 Nantes Biotech, Nantes Cedex 1, F-44100, France
| | - Lise Crémet
- EA3826 Université de Nantes, IRS2 Nantes Biotech, Nantes Cedex 1, F-44100, France.,CHU Nantes, 9 quai Moncousu, Nantes Cedex 1, F-44093, France
| |
Collapse
|
5
|
Silva SSD, Peterson GE, Amantéa SL, Miorelli P, Ulbrich JM, Roesch E, Sanches PR, Fraga JC. Transforming growth factor beta1 (TGF-ß1) levels in a rat model of induced pleural empyema. Acta Cir Bras 2018. [PMID: 29513814 DOI: 10.1590/s0102-865020180020000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the concentration of transforming growth factor beta 1 (TGFB1) levels in a rat pleural effusion obtained by inoculation of intrapleural bacteria or turpentine through thoracentesis. METHODS Thirty-Nine Wistar rats were divided into three groups: Staphylococcus aureus (SA, n = 17); Streptococcus pneumoniae (SP, n = 12); and turpentine (control, n = 10). Pleural fluid was collected through ultrasound-guided thoracentesis 12 h, 24 h, and 36 h after instillation of bacteria or turpentine. Levels of TGFB1 were measured in pleural fluid. RESULTS At 12 h, mean TGFB1concentrations were 5.3450 pg/mL in the SA group, 5.3449 pg/mL in the SP group, and 5.3450 pg/mL in controls. At 24 h, they were 4.6700 pg/mL in the SA group, 4.6700 pg/mL in the SP group, and 4.6700 pg/mL in controls. At 36 h, they were 4.6699 pg/mL in the SA group and in control. No difference was observed among the groups in mean TGFB1concentration (p = 0.12); however, a significant intragroup reduction in mean TGFB1 was observed between 12 and 24 h (p < 0.01). CONCLUSION The transforming growth factor beta 1 concentrations were not useful as a diagnostic tool or an early marker of infected pleural effusion.
Collapse
Affiliation(s)
- Samanta Sarmento da Silva
- Fellow Master degree, Postgraduate Program in Surgical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil. Scientific, intellectual, conception and design of the study; technical procedures; acquisition, analysis and interpretation of data; manuscript preparation; final approval
| | - Guilherme Eckert Peterson
- Fellow Master degree, Postgraduate Program in Surgical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil. Scientific, intellectual, conception and design of the study; technical procedures; acquisition, analysis and interpretation of data; manuscript preparation; final approval
| | - Sérgio Luis Amantéa
- Associate Professor, Pediatric Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil. Scientific, intellectual, conception and design of the study; analysis and interpretation of data; critical revision; final approval
| | - Patrícia Miorelli
- Graduate student, School of Medicine, UFRGS, Porto Alegre-RS, Brazil. Acquisition of data, technical procedures
| | - Jane Maria Ulbrich
- Associate Professor, Department of Pathology, UFRGS, Porto Alegre-RS, Brazil. Histopathological examinations, final approval
| | - Eliane Roesch
- Biochemist, Division of Microbiology and Molecular Biology, Clinical Pathology Service, Hospital de Clínicas de Porto Alegre (HCPA), Brazil. Technical procedures, final approval
| | - Paulo Roberto Sanches
- PhD, Biomedical/Medical Engineering, HCPA, Porto Alegre-RS, Brazil. Scientific and intellectual content of the study, final approval
| | - Jose Carlos Fraga
- Full Professor, and Chairman, Department of Surgery, UFRGS, Porto Alegre-RS, Brazil. Scientific, intellectual, conception and design of the study; analysis and interpretation of data; critical revision; final approval
| |
Collapse
|
6
|
Gómez-Zorrilla S, Calatayud L, Juan C, Cabot G, Tubau F, Oliver A, Dominguez MA, Ariza J, Peña C. Understanding the acute inflammatory response to Pseudomonas aeruginosa infection: differences between susceptible and multidrug-resistant strains in a mouse peritonitis model. Int J Antimicrob Agents 2016; 49:198-203. [PMID: 27939091 DOI: 10.1016/j.ijantimicag.2016.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/23/2016] [Accepted: 10/01/2016] [Indexed: 12/15/2022]
Abstract
The increasing emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains is associated with the spread of a few international epidemic clones called high-risk clones. The existence of a fitness cost associated with multidrug resistance remains unclear, and little is known about the host inflammatory response in acute P. aeruginosa infections. This study aimed to investigate how the inflammatory response occurs in the most relevant high-risk clones and to compare the process with that recorded in clinical susceptible isolates. Nine P. aeruginosa strains were studied, including the most relevant MDR high-risk clones (ST111, ST175 and ST235) circulating worldwide. The inflammatory response in terms of the release of interleukins in serum was investigated in a mouse peritonitis-sepsis model at three time points (4, 8 and 12 h). TNFα and interleukin-10 (IL-10) levels were significantly higher at all time points in mice inoculated with clinical susceptible strains compared with those inoculated with MDR strains. IL-6 levels were significantly higher in the clinical susceptible strain group at 8 h and 12 h (P = 0.036 and P = 0.007, respectively). Bacterial counts (log CFU/mL) in peritoneal fluid were higher in the clinical susceptible strain group compared with the MDR strain group at 8 h [6.00 (4.30-6.90) vs. 4.46 (3.30-5.34); P = 0.005] and 12 h [7.75 (4.00-7.97) vs. 4.04 (2.58-4.94); P = 0.003]. MDR P. aeruginosa strains elicited a weaker inflammatory response than susceptible strains in an experimental mouse model, suggesting the existence of a fitness cost associated with multidrug resistance.
Collapse
Affiliation(s)
- Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Calatayud
- Microbiology Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlos Juan
- Microbiology Service, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdiSPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Gabriel Cabot
- Microbiology Service, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdiSPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Fe Tubau
- Microbiology Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Oliver
- Microbiology Service, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdiSPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Maria Angeles Dominguez
- Microbiology Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Ariza
- Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Peña
- Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, Hospitalet de Llobregat, Barcelona, Spain.
| |
Collapse
|
7
|
Vardakas KZ, Rellos K, Triarides NA, Falagas ME. Colistin loading dose: evaluation of the published pharmacokinetic and clinical data. Int J Antimicrob Agents 2016; 48:475-484. [PMID: 27743779 DOI: 10.1016/j.ijantimicag.2016.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022]
Abstract
Colistin (polymyxin E) has been widely used since the beginning of the century as a last-option antibiotic for the treatment of patients with multidrug-resistant and extensively-drug resistant bacterial infections. However, colistin dosing is troublesome because each batch of the drug contains a mixture of components and because it is administered as the inactive pro-drug colistimethate sodium (CMS), which has different pharmacokinetic (PK) properties from the active drug. Significant inter-individual and intra-individual variability in colistin plasma concentrations have been observed in all available studies. Low plasma concentrations of the drug during the first hours from initiation of administration suggested that a loading dose would be appropriate. However, other PK studies challenge this approach. Clinical data from randomised controlled trials are not available, whilst data from observational studies do not support higher effectiveness of a loading dose. In this review, we summarise the available data regarding the administration of a loading dose and discuss the issues surrounding the potential advantages and disadvantages as well as the context within which such an approach could be beneficial to patients.
Collapse
Affiliation(s)
- Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Department of Internal Medicine-Infectious Diseases, IASO General Hospital, IASO Group, Athens, Greece
| | | | - Nikolaos A Triarides
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Department of Internal Medicine-Infectious Diseases, IASO General Hospital, IASO Group, Athens, Greece
| | - Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Department of Internal Medicine-Infectious Diseases, IASO General Hospital, IASO Group, Athens, Greece; Tufts University School of Medicine, Boston, MA, USA.
| |
Collapse
|
8
|
Gómez-Zorrilla S, Juan C, Cabot G, Camoez M, Tubau F, Oliver A, Dominguez MA, Ariza J, Peña C. Impact of multidrug resistance on the pathogenicity of Pseudomonas aeruginosa: in vitro and in vivo studies. Int J Antimicrob Agents 2016; 47:368-74. [PMID: 27079153 DOI: 10.1016/j.ijantimicag.2016.02.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/18/2016] [Accepted: 02/20/2016] [Indexed: 01/24/2023]
Abstract
The biological cost of multidrug resistance in Pseudomonas aeruginosa (PA) remains unclear. This study aimed to evaluate the relationship between pathogenicity and the resistance profile of different PA strains, including the most common epidemic high-risk clones. Nine PA strains were studied, including two reference strains, PAO1 and PA14 [both susceptible to all antipseudomonals (multiS)], and seven clinical strains comprising three clinical multiS strains, a non-clonal multidrug-resistant (MDR) strain and the high-risk MDR clones ST111, ST235 and ST175. In vitro studies were performed to investigate growth rate, type III secretion system (TTSS) genotype, cytotoxicity and invasiveness. Additionally, a peritonitis/sepsis model was used in C57BL/6 mice. The in vitro bacterial duplication time was shorter in clinical multiS strains than in MDR-PA (0.42±0.08h vs. 0.55±0.14h; P=0.023). Among the clinical strains, exoU(+) genotype was observed only in the epidemic clone ST235. In the animal model, the probability of mortality at 48h was 70% for clinical multiS strains vs. 7.5% for clinical MDR-PA (P<0.001, log-rank). The high-risk clone ST235 was the only MDR strain that was able to cause mortality. Bacterial concentrations in peritoneal fluid were higher in mice inoculated with multiS strains compared with MDR-PA [log CFU/mL, 8.95 (IQR 3.42-9.32) vs. 1.98 (IQR 1.08-2.80); P<0.001]. These data indicate that MDR profiles are associated with a reduction in virulence of PA in a murine model. Further studies are needed to elucidate the clinical implications of these results.
Collapse
Affiliation(s)
- Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carlos Juan
- Microbiology Service, Hospital Universitario son Espases, Instituto de Investigación Sanitaria de Palma (IdiSPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Gabriel Cabot
- Microbiology Service, Hospital Universitario son Espases, Instituto de Investigación Sanitaria de Palma (IdiSPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Mariana Camoez
- Microbiology Service, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fe Tubau
- Microbiology Service, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Oliver
- Microbiology Service, Hospital Universitario son Espases, Instituto de Investigación Sanitaria de Palma (IdiSPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - M Angeles Dominguez
- Microbiology Service, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Ariza
- Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Peña
- Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| |
Collapse
|
9
|
Tsovolou EC, Tzepi IM, Spyridaki A, Tsaganos T, Karagianni V, Menenakos E, Liakou P, Sabracos L, Zografos G, Giamarellos-Bourboulis EJ. Effect of clarithromycin in experimental empyema by multidrug-resistant Pseudomonas aeruginosa. APMIS 2013; 122:68-75. [PMID: 23656439 DOI: 10.1111/apm.12094] [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: 09/14/2012] [Accepted: 03/12/2013] [Indexed: 11/30/2022]
Abstract
Evidence from a recent randomized study of our group suggests that intravenous clarithromycin resulted in earlier resolution of ventilator-associated pneumonia. The need to understand the mechanism of action of clarithromycin guided to the study of a model of experimental empyema by multidrug-resistant Pseudomonas aeruginosa in 40 rabbits. Animals were randomized into controls (group A); treatment with clarithromycin (group B); treatment with piperacillin/tazobactam (group C); and treatment with both agents (group D). Pleural fluid was collected at regular time intervals for quantitative culture, estimation of cell apoptosis and of concentrations of tumour necrosis factor-alpha (TNFα). After 7 days, animals were euthanized for estimation of tissue growth. Bacterial growth in the pleural fluid of group D was significantly decreased compared with the other groups on day 5. Lung growth of group D was lower than group A. That was also the case of cytokine stimulation by pleural fluid samples on U937 monocytes. It is concluded that administration of clarithromycin enhanced the antimicrobial efficacy of piperacillin/tazobactam and decreased bacterial growth in the pleural fluid and in tissues. It also attenuated the pro-inflammatory phenomena induced by the β-lactam.
Collapse
|