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Durkan K, Tuncel A, Yurt F. In vitro evaluation of 99m Tc-sultamicillin for infection imaging. Biopharm Drug Dispos 2021; 42:285-293. [PMID: 33904176 DOI: 10.1002/bdd.2281] [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] [Received: 12/07/2020] [Revised: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 12/15/2022]
Abstract
Early detection of the site of infection non-invasively with radiolabeled molecules is important for the success of treatment. Technetium-99m labeled antibiotics have the potential to discriminate between bacterial infection and sterile inflammation. Sultamicillin is the tosylate salt of the double ester of sulbactam plus ampicillin. In this study, sultamicillin was labeled with 99m Tc according to the stannous chloride method. Quality control studies of radiolabeled sultamicillin were performed by radiochromatographic methods. In vitro binding assays were performed in live and heat-killed gram-positive Staphylococcus aureus and gram-negative Escherichia coli strains. The radiolabeling yield of 99m Tc-sultamicillin was determined as 97.8% ± 3.1% (n = 5). The maximum bacterial uptake of 99m Tc-sultamicillin was 80.7% ± 11.00% at 4 h for living S. aureus and 93.2% ± 4.40% at 2 h for E. coli. Bacterial uptake study results show that sultamicillin has the potential to be a nuclear imaging agent, especially in infections caused by gram-negative E. coli and gram-positive S. aureus.
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Affiliation(s)
- Kubra Durkan
- Nuclear Applications, Ege University Institute of Nuclear Sciences, Bornova, Izmir, Turkey
| | - Ayca Tuncel
- Nuclear Applications, Ege University Institute of Nuclear Sciences, Bornova, Izmir, Turkey
| | - Fatma Yurt
- Nuclear Applications, Ege University Institute of Nuclear Sciences, Bornova, Izmir, Turkey
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Bhowmick T, Weinstein MP. Microbiology of Meropenem-Vaborbactam: A Novel Carbapenem Beta-Lactamase Inhibitor Combination for Carbapenem-Resistant Enterobacterales Infections. Infect Dis Ther 2020; 9:757-767. [PMID: 33017041 PMCID: PMC7680474 DOI: 10.1007/s40121-020-00350-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/23/2020] [Indexed: 11/20/2022] Open
Abstract
Vaborbactam is a novel boron-based beta-lactamase inhibitor developed to be effective against Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria. This enzyme is a key driver in the global spread of β-lactam resistance among carbapenem-resistant Enterobacterales. Alone, vaborbactam has no antibacterial activity; however, the combination of meropenem-vaborbactam has enhanced activity against gram-negative organisms, particularly Enterobacterales with class A and C carbapenemases. Multiple in vitro studies evaluating isolates from various geographic regions, and over different time periods, have demonstrated the high potency of meropenem-vaborbactam against organisms containing KPC2 and KPC3. However, meropenem-vaborbactam does not have activity against OXA-48 or metallo-beta lactamases. This review covers the in vitro studies of meropenem-vaborbactam performed to date, which evaluated both large cohorts of clinical isolates and engineered isolates, to determine efficacy in various settings, including the presence of porin mutations and efflux pump upregulation. Meropenem-vaborbactam is a new combination antibiotic that was designed specifically for efficacy against bacteria that produce the Klebsiella pneumoniae carbapenemase (KPC) enzyme, which enables resistance to beta-lactam antibiotics. The global spread and increase of difficult-to-treat infections caused by carbapenem-resistant Enterobacterales (CRE) is in part because they produce KPC enzymes. The authors review the in vitro studies of meropenem-vaborbactam activity, which have included isolates from different geographic regions, time periods, and settings, showing that it has high potency against organisms containing KPC enzymes-KPC2 and KPC3. Meropenem-vaborbactam was tested against globally sourced isolates that carried different resistance mechanisms, including carbapenem resistance, multidrug resistant (MDR), and resistance to colistin and/or tigecycline; it inhibited activity of 99.1% Enterobacterales isolates tested at ≤ 1 µg/ml, and at ≤ 8 µg/ml it inhibited 96.5% of MDR isolates and 82% of XDR isolates. Against OXA-48 or metallo-beta lactamase enzymes, meropenem-vaborbactam has limited or no activity, so in the Asia-Pacific region where MLBs are prevalent it was least effective, but and was most effective against US strains where KPC is prevalent. In multiple studies, meropenem-vaborbactam showed strong in vitro activity against E. coli, Enterobacter spp., and K. pneumoniae. Compared to available antibiotics, against both clinical and engineered isolates, as well as engineered E. coli strains with KPC, SHV, and TEM enzymes, meropenem-vaborbactam demonstrated lower MIC values. Overall, in vitro studies of meropenem-vaborbactam have shown enhanced activity against CRE and KPC producers compared to other antibiotics, which is needed in the current CRE environment where KPC is dominant.
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Affiliation(s)
- Tanaya Bhowmick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Melvin P Weinstein
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Rodkey EA, McLeod DC, Bethel CR, Smith KM, Xu Y, Chai W, Che T, Carey PR, Bonomo RA, van den Akker F, Buynak JD. β-Lactamase inhibition by 7-alkylidenecephalosporin sulfones: allylic transposition and formation of an unprecedented stabilized acyl-enzyme. J Am Chem Soc 2013; 135:18358-69. [PMID: 24219313 PMCID: PMC4042847 DOI: 10.1021/ja403598g] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The inhibition of the class A SHV-1 β-lactamase by 7-(tert-butoxycarbonyl)methylidenecephalosporin sulfone was examined kinetically, spectroscopically, and crystallographically. An 1.14 Å X-ray crystal structure shows that the stable acyl-enzyme, which incorporates an eight-membered ring, is a covalent derivative of Ser70 linked to the 7-carboxy group of 2-H-5,8-dihydro-1,1-dioxo-1,5-thiazocine-4,7-dicarboxylic acid. A cephalosporin-derived enzyme complex of this type is unprecedented, and the rearrangement leading to its formation may offer new possibilities for inhibitor design. The observed acyl-enzyme derives its stability from the resonance stabilization conveyed by the β-aminoacrylate (i.e., vinylogous urethane) functionality as there is relatively little interaction of the eight-membered ring with active site residues. Two mechanistic schemes are proposed, differing in whether, subsequent to acylation of the active site serine and opening of the β-lactam, the resultant dihydrothiazine fragments on its own or is assisted by an adjacent nucleophilic atom, in the form of the carbonyl oxygen of the C7 tert-butyloxycarbonyl group. This compound was also found to be a submicromolar inhibitor of the class C ADC-7 and PDC-3 β-lactamases.
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Affiliation(s)
- Elizabeth A. Rodkey
- Department of Biochemistry, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106, United States
| | - David C. McLeod
- Department of Chemistry, Southern Methodist University, 3215 Daniel Ave., Dallas, Texas 75275, United States
| | - Christopher R. Bethel
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106, United States
| | - Kerri M. Smith
- Department of Chemistry, Cleveland State University, 2121 Euclid Ave., Cleveland, Ohio 44115, United States
| | - Yan Xu
- Department of Chemistry, Cleveland State University, 2121 Euclid Ave., Cleveland, Ohio 44115, United States
| | - Weirui Chai
- Department of Chemistry, Southern Methodist University, 3215 Daniel Ave., Dallas, Texas 75275, United States
| | - Tao Che
- Department of Biochemistry, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106, United States
| | - Paul R. Carey
- Department of Biochemistry, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106, United States
| | - Robert A. Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106, United States
| | - Focco van den Akker
- Department of Biochemistry, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106, United States
| | - John D. Buynak
- Department of Chemistry, Southern Methodist University, 3215 Daniel Ave., Dallas, Texas 75275, United States
- Center for Drug Discovery, Design, and Development, Southern Methodist University, Dallas, Texas 75275, United States
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Lee G. Ciprofloxacin Resistance in Enterococcus faecalis Strains Isolated From Male Patients With Complicated Urinary Tract Infection. Korean J Urol 2013; 54:388-93. [PMID: 23789048 PMCID: PMC3685639 DOI: 10.4111/kju.2013.54.6.388] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/01/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Urinary tract infection (UTI) is one of the most prevalent bacterial infections, and fluoroquinolone therapy is a well-known standard regimen for UTI. The prevalence and risk factor analysis of fluoroquinolone resistance in enterococcal UTIs are not well documented. The aim of this study was to evaluate the antimicrobial susceptibility and risk factors for ciprofloxacin resistance in Enterococcus faecalis strains isolated from patients with complicated UTI. MATERIALS AND METHODS We evaluated 81 E. faecalis strains isolated from 81 male patients at a single teaching hospital over 3 years. The Vitek 2 automatic system was used for antimicrobial susceptibility analysis. RESULTS Antimicrobial resistance rates were rare for ampicillin/sulbactam, imipenem, and vancomycin in E. faecalis. Forty-six percent of the E. faecalis strains were resistant to levofloxacin, 47% were resistant to ciprofloxacin, and 58% were resistant to norfloxacin. E. faecalis strains were highly resistant to erythromycin (92%) and ftetracycline (96%). The risk factor analysis revealed that age intervals, the underlying diseases, catheterization, and the number of admissions did not increase the risk of ciprofloxacin resistance, whereas patients with hospital-acquired infection (odds ratio [OR], 18.15; 95% confidence interval [CI], 3.46 to 95.13; p=0.001), patients who were treated in a urological department (OR, 6.15; 95% CI, 1.5 to 25.41; p=0.012), and patients who were transferred from health care centers (OR, 7.393; 95% CI, 1.32 to 41.22; p=0.023) had an increased risk of ciprofloxacin resistance compared with the matched controls. CONCLUSIONS Ciprofloxacin is no longer a recommended therapy for E. faecalis from complicated UTI in men with risk factors. We suggest that ampicillin/sulbactam can be recommended as alternatives for treating ciprofloxacin-resistant E. faecalis strains associated with UTI in Korea.
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Affiliation(s)
- Gilho Lee
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
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Nazik H, Öngen B, Mete B, Aydin S, Yemişen M, Keleşoğlu FM, Ergul Y, Tabak F. Coexistence of blaOXA48 and aac(6′)-Ib-cr Genes in Klebsiella Pneumoniae Isolates from Istanbul, Turkey. J Int Med Res 2011; 39:1932-40. [DOI: 10.1177/147323001103900538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the presence of carbapenem hydrolysing β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 22 Klebsiella pneumoniae isolates collected from the Istanbul Medical Faculty, Turkey, which reduced the susceptibility or resistance to carbapenem. The VITEK® 2 system and E-tests were used to determine the minimum inhibitory concentrations needed to inhibit bacterial growth. Genes were screened by polymerase chain reaction, and gene transferability was evaluated by transconjugation. Strain clonality was investigated by pulsed-field gel electrophoresis (PFGE). All strains were OXA-48 β-lactamase producers and three (13.6%) were also positive for the aac(6′)-Ib-cr gene. Most of the strains harboured other b-lactamase (bla) genes such as blaTEM, blaSHV, blaCTX-M and blaVEB-1. The transconjugants mostly harboured blaOXA-48 and other β-lactamases separately. PFGE revealed eight pulsotypes among the isolates. The coexistence of blaOXA-48 and PMQR in K. pneumoniae isolates may present a significant threat to health, especially in the nosocomial setting.
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Affiliation(s)
- H Nazik
- Department of Microbiology and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - B Öngen
- Department of Microbiology and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - B Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - S Aydin
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M Yemişen
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - FM Keleşoğlu
- Department of Paediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Y Ergul
- Department of Paediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - F Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
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Abeylath SC, Turos E. Drug delivery approaches to overcome bacterial resistance to β-lactam antibiotics. Expert Opin Drug Deliv 2008; 5:931-49. [DOI: 10.1517/17425247.5.9.931] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sampath C Abeylath
- University of South Florida, Center for Molecular Diversity in Drug Design, Discovery, and Delivery, Department of Chemistry, CHE 205, 4202 East Fowler Avenue, Tampa, FL 33620, USA ;
| | - Edward Turos
- University of South Florida, Center for Molecular Diversity in Drug Design, Discovery, and Delivery, Department of Chemistry, CHE 205, 4202 East Fowler Avenue, Tampa, FL 33620, USA ;
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Ferreira JB, Rapoport PB, Sakano E, Kós AODÁ, Piltcher OB, Pignatari SSN, Pinheiro SD, Mocellin M. Eficácia e segurança de Sultamicilina (Ampicilina/Sulbactam) e Amoxacilina/Clavulanato no tratamento das infecções de via aéreas superiores em adultos: um estudo multicêntrico, aberto e randomizado. ACTA ACUST UNITED AC 2006. [DOI: 10.1590/s0034-72992006000100016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As IVAS em crianças e adultos são os motivos mais freqüentes de consulta médica e os que mais demandam o uso de antibióticos. A crescente resistência bacteriana causada pela produção das beta-lactamases constitui um dos mais sérios problemas atuais. A Sultamicilina é uma pró-droga dupla da ampicilina e do sulbactam, um potente inibidor de beta-lactamases que pode fazer frente a estas dificuldades. OBJETIVO: avaliar a eficácia, segurança e tolerabilidade da Ampicilina/Sulbactan comparada à Amoxacilina/Ácido Clavulânico no tratamento de IVAS, em adultos. METODOLOGIA: 102 pacientes com diagnóstico de IVAS foram randomizados em dois grupos recebendo Ampicilina/Sulbactan ou Amoxacilina/Clavulanato por 10 dias. Foram avaliados 10 e 30 dias após para análise da resposta terapêutica. RESULTADOS: Não houve diferença entre os grupos com relação à proporção de pacientes curados ao final do tratamento (visita 2) ou do estudo (visita 3). No grupo que recebeu Amoxacilina/Clavulanato, as proporções de cura foram de 61.7% e 93.2% nas visitas 2 e 3, comparadas a 64.4% e 97.4%, respectivamente, no grupo que recebeu Ampicilina/Sulbactan. A proporção de pacientes que experimentou pelo menos um evento adverso foi semelhante nos dois grupos (p = 0.940). A diarréia foi significativamente mais freqüente no grupo Amoxacilina-Clavulanato (70.6%) do que no grupo Ampicilina/Sulbactan (29.4%), (p=0.0164). CONCLUSÕES: A Ampicilina/Sulbactan é tão segura e eficaz quanto a Amoxacilina/Clavulanato no tratamento empírico de IVAS em adultos. A ocorrência significativamente menor de quadros de diarréia no grupo recebendo Ampicilina/Sulbactan necessita confirmação em estudos posteriores.
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Ferreira JB, Rapoport PB, Sakano E, Kós AODA, Piltcher OB, Pignatari SSN, Pinheiro SD, Mocellin M. Efficacy and safety of Sultamicillin (Ampicillin/Sulbactan) and Amoxicillin/Clavulanic Acid in the treatment of upper respiratory tract infections in adults - an open-label, multicentric, randomized trial. Braz J Otorhinolaryngol 2006; 72:104-11. [PMID: 16917560 PMCID: PMC9445655 DOI: 10.1016/s1808-8694(15)30041-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 05/24/2005] [Indexed: 11/23/2022] Open
Abstract
Upper respiratory tract infections are the most common causes of medical visits in children and adults, demanding massive use of antibiotics. Bacterial resistance caused by beta-lactamase is one of the most serious problems in this matter. Sultamicillin, a double pro-drug of Ampicillin/Sulbactan, is a potent beta-lactamase inhibitor which can face this challenge. Aim evaluate efficacy, safety and tolerability of Ampicillin/Sulbactan compared to Amoxicillin/Clavulanate in upper respiratory tract infections in adults. Methods 102 patients were enrolled and randomized to receive Ampicillin/Sulbactan or Amoxicillin/Clavulanate during 10 days. They were evaluated 10 and 30 days after treatment to learn about the therapeutic response. Results There were no differences between the two groups respecting cure at the end of treatment (visit 2) or at the end of the study (visit 3). Cure ratio was 61.7% and 93.2% (visits 2 and 3) in the Amoxicillin/Clavulanate group compared to 64.4% and 97.4%, respectively, in Ampicillin/Sulbactan group. The adverse events ratio for the two groups was the same (p=0.940). The number of patients with diarrhea was greater in the group of patients receiving Amoxicillin/Clavulanate (70.6%) than in the group receiving Ampicillin/Sulbactan (29.4%) (p=0.0164). Conclusions Ampicillin/Sulbactan is as safe and efficient as Amoxicillin/Clavulanate in the empiric treatment of upper respiratory infections in adults. The low occurrence of diarrhea in the group receiving Ampicillin/Sulbactan needs confirmation in other studies.
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