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Beig M, Moradkasani S, Goodarzi F, Sholeh M. Prevalence of Brucella melitensis and Brucella abortus Fluoroquinolones Resistant Isolates: A Systematic Review and Meta-Analysis. Vector Borne Zoonotic Dis 2024; 24:1-9. [PMID: 37862228 DOI: 10.1089/vbz.2023.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Background: Brucellosis impact both animals and humans worldwide. However, using antibiotics for brucellosis remains controversial despite decades of research. Relapse can complicate treatment in this area. Since the mid-1980s, microbiologists, and physicians have studied fluoroquinolones' use for treating human brucellosis. The principal advantages of fluoroquinolones are their intracellular antimicrobial activity, low nephrotoxicity, good pharmacokinetics, and the lack of drug-level monitoring. Fluoroquinolones inhibit disease recurrence. In vitro and clinical data were used to study the prevalence of Brucella melitensis and Brucella abortus fluoroquinolone-resistant isolates. Methods: The PubMed, Scopus, Embase, and Web of Science databases were carefully searched until August 6, 2022, for relevant papers. The number of resistant isolates and sample size were used to estimate the proportion of resistant isolates, fitting a model with random effects, and DerSimonian-Laird estimated heterogeneity. Furthermore, meta-regression and subgroup analyses were used to assess the moderators to identify the sources of heterogeneity. Meta-analysis was performed using R software. Results: Forty-seven studies evaluated fluoroquinolone resistance in Brucella spp. Isolates. Fluoroquinolones have shown high in vitro efficacy against Brucella spp. The resistance rates to ofloxacin, sparfloxacin, fleroxacin, pefloxacin, and lomefloxacin were 2%, 1.6%, and 4.6%, respectively. Conclusion: Clinical in vitro tests demonstrated that fluoroquinolones can eradicate Brucella spp. Owing to first-line medication resistance, recurrence, and toxicity, it is essential to standardize the Brucella antimicrobial susceptibility test method for a more precise screening of resistance status. Fluoroquinolones are less resistant to fluoroquinolone-based treatments in modern clinical practice as alternatives to standard therapy for patients with brucellosis relapse after treatment with another regimen and in patients who have developed toxicity from older agents.
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Affiliation(s)
- Masoumeh Beig
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | | | - Forough Goodarzi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Sholeh
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
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Rezaei Shahrabi A, Moradkasani S, Goodarzi F, Beig M, Sholeh M. Prevalence of Brucella melitensis and Brucella abortus tetracyclines resistance: A systematic review and meta-analysis. Microb Pathog 2023; 183:106321. [PMID: 37673354 DOI: 10.1016/j.micpath.2023.106321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Brucellosis is a zoonotic disease that can be transmitted from animals to humans. Brucellosis is caused by bacteria of the genus Brucella, which are typically transmitted through contact with infected animals, unpasteurized dairy products, or airborne pathogens. Tetracyclines (tetracycline and doxycycline) are antibiotics commonly used to treat brucellosis; however, antibiotic resistance has become a major concern. This study assessed the worldwide prevalence of tetracycline-resistant Brucella isolates. METHODS A systematic search was conducted in Scopus, PubMed, Web of Science, and EMBASE using relevant keywords and Medical Subject Headings (MeSH) terms until August 13, 2022, to identify relevant studies for meta-analysis. A random effects model was used to estimate the proportion of resistance. Meta-regression analysis, subgroup analysis, and examination of outliers and influential studies were also performed. RESULTS The prevalence rates of resistance to tetracycline and doxycycline were estimated to be 0.017 (95% confidence interval [CI], 0.009-0.035) and 0.017 (95%CI, 0.011-0.026), respectively, based on 51 studies conducted from 1983 to 2020. Both drugs showed increasing resistance over time (tetracycline: r = 0.077, P = 0.012; doxycycline: r = 0.059, P = 0.026). CONCLUSION The prevalence of tetracycline and doxycycline resistance in Brucella was low (1.7%) but increased over time. This increase in tetracycline and doxycycline resistance highlights the need for further research to understand resistance mechanisms and develop more effective treatments.
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Affiliation(s)
| | | | - Forough Goodarzi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Masoumeh Beig
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Sholeh
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran.
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Wareth G, Dadar M, Ali H, Hamdy MER, Al-Talhy AM, Elkharsawi AR, Tawab AAAE, Neubauer H. The perspective of antibiotic therapeutic challenges of brucellosis in the Middle East and North African (MENA) countries: Current situation and therapeutic management. Transbound Emerg Dis 2022; 69:e1253-e1268. [PMID: 35244335 DOI: 10.1111/tbed.14502] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/14/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
Brucellosis is among the most prevalent zoonotic infections in Middle Eastern and North African (MENA) countries, critically impacting human and animal health. A comprehensive review of studies on antibiotic susceptibility and therapeutic regimes for brucellosis in ruminants and humans in the MENA region was conducted to evaluate the current therapeutic management in this region. Different scientific databases were searched for peer-reviewed original English articles published from January 1989 to February 2021. Reports from research organizations and health authorities have been taken into consideration. Brucella melitensis and Brucella abortus have been reported from the majority of MENA countries, suggesting a massive prevalence particularly of B. melitensis across these countries. Several sporadic cases of brucellosis relapse, therapeutic failure, and antibiotic resistance of animal and human isolates have been reported from the MENA region. However, several studies proved that brucellae are still in-vitro susceptible to the majority of antibiotic compounds and combinations in current recommended WHO treatment regimens, e.g. levofloxacin, tetracyclines, doxycycline, streptomycin, ciprofloxacin, chloramphenicol, gentamicin, tigecycline, and trimethoprim/sulfamethoxazole. The current review presents an overview on resistance development of brucellae and highlights the current knowledge on effective antibiotics regimens for treating human brucellosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gamal Wareth
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, Jena, 07743, Germany.,Department of Bacteriology, Immunology, and Mycology, Faculty of Veterinary Medicine, Benha University, Moshtohor, 13736, Egypt
| | - Maryam Dadar
- Department of Brucellosis, Razi Vaccine and Serum Research Institute, Agricultural Research, Education, and Extension Organization, Karaj, Iran
| | - Haytham Ali
- Department of Animal and Veterinary Sciences, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Oman.,Department of Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud E R Hamdy
- Animal Health Research Institute, Agricultural Research Center, P.O. Box 264-Giza, Cairo, 12618, Egypt
| | | | - Ahmed R Elkharsawi
- Jena University Hospital, Department of Gastroenterology, Hepatology and Infectious diseases, Am Klinikum 1, Jena, 07747, Germany
| | - Ashraf A Abd El Tawab
- Department of Bacteriology, Immunology, and Mycology, Faculty of Veterinary Medicine, Benha University, Moshtohor, 13736, Egypt
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, Jena, 07743, Germany
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Arapović J, Kompes G, Dedić K, Teskeredžić S, Ostojić M, Travar M, Tihić N, Delić J, Skočibušić S, Zekiri-Sivro M, Verhaz A, Piljić D, Laura L, Duvnjak S, Zdelar-Tuk M, Arapović M, Šabotić E, Reil I, Nikolić J, Ahmetagić S, Cvetnić Ž, Habrun B, Bosilkovski M, Špičić S. Antimicrobial resistance profiles of human Brucella melitensis isolates in three different microdilution broths: First multicentre study in Bosnia and Herzegovina. J Glob Antimicrob Resist 2022; 29:99-104. [PMID: 35182775 DOI: 10.1016/j.jgar.2022.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Brucellosis is a ubiquitous emergent bacterial zoonotic disease causing significant human morbidity in Bosnia and Herzegovina. So far, a high rate of resistant Brucella has been found worldwide. This study prospectively analysed the rates of resistance among human Brucella melitensis (B. melitensis) strains isolated in Bosnia and Herzegovina. METHODS This study included 108 B. melitensis isolates from 209 patients diagnosed at five medical centres in Bosnia and Herzegovina. The resistance profiles of the B. melitensis isolates for the 13 most commonly used antimicrobials were studied in standard Brucella broth (BB) and cation-adjusted Mueller-Hinton broth (CAMHB) supplemented with 4% lysed horse blood or 5% defibrinated sheep blood. RESULTS Of the 209 patients, B. melitensis blood cultures were positive for 111 (53.1%). Among the 108 isolates investigated, 91 (84.3%) were resistant to trimethoprim-sulfamethoxazole on BB, but not on either CAMHB. Nearly all isolates (>90%) were resistant to azithromycin on BB and both CAMHBs. CONCLUSIONS We observed a high rate of B. melitensis resistance to azithromycin. The high rate of resistance to trimethoprim-sulfamethoxazole that we observed was related to BB, so an alternative broth should be used, such as the enriched CAMHBs in this study, for evaluating resistance to trimethoprim-sulfamethoxazole. Whole-genome sequencing studies are needed to understand the development of antimicrobial resistance in B. melitensis strains isolated from humans.
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Affiliation(s)
- Jurica Arapović
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina.
| | | | - Kanita Dedić
- Cantonal Hospital "Dr. Irfan Ljubijankic", Bihac, Bosnia and Herzegovina
| | | | - Maja Ostojić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Maja Travar
- University Clinical Centre of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Nijaz Tihić
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Jasminka Delić
- Cantonal Hospital "Dr. Irfan Ljubijankic", Bihac, Bosnia and Herzegovina
| | - Siniša Skočibušić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | | | - Antonija Verhaz
- University Clinical Centre of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina; Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Dilista Piljić
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Luka Laura
- Veterinary Institute of Herzegovina-Neretva Canton, Mostar, Bosnia and Herzegovina
| | | | | | - Maja Arapović
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina; Veterinary Institute of Herzegovina-Neretva Canton, Mostar, Bosnia and Herzegovina
| | - Enisa Šabotić
- Cantonal Hospital "Dr. Irfan Ljubijankic", Bihac, Bosnia and Herzegovina
| | - Irena Reil
- Croatian Veterinary Institute, Zagreb, Croatia
| | - Jadranka Nikolić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Sead Ahmetagić
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | | | | | - Mile Bosilkovski
- Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, University Clinic for Infectious Diseases, Skopje, Republic of North Macedonia
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Rabiei MM, Imanzade F, Hatami F, Hesami H, Irvani SSN, Alavi Darazam I. Brucellosis in transplant recipients: A systematic review. Transpl Infect Dis 2021; 23:e13604. [PMID: 33743545 DOI: 10.1111/tid.13604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/02/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Brucellosis is a bacterial disease caused by Brucella species. The purpose of this study was to evaluate brucellosis in all types of transplant patients. METHODS All the cases of brucellosis in transplant patients with no time and language limitations were searched and retrieved on May 20, 2020, using the following search keywords: (Brucella OR Brucellosis) AND (Transplant OR Transplantation) through the following medical databases: Web of Sciences, Google Scholar, Scopus, PubMed, and regional databases, for example, SID. All clinical features, including the time of transmission (before, during, and after transplantation), treatment protocols and medications, and patients' outcomes were investigated. RESULTS A total of 14 cases reported in 14 studies (out of 777 studies) were retrieved. Kidney (50%), liver (28.5%), and hematopoietic stem cell transplantation (14.2%) were the most reported types of transplantation. The presentation of brucellosis in 42.8% of the patients occurred in the early post-transplantation period, whereas 57.1% of the cases presented with late onset disease. CONCLUSION Brucellosis in transplant recipients seems to be uncommon even in the endemic regions. However, rare cases could be transmitted through bone marrow transplantation and transfusion. Precise screening and meticulous supervision during and after transplantation might lead to a reduction in the frequency of brucellosis.
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Affiliation(s)
- Mohammad M Rabiei
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Imanzade
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Firouze Hatami
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Hesami
- Medical Researcher, Pediatric Gastroenterology, Hepatology and Nutrition Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed S N Irvani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Denk A, Demirdag K, Kalkan A, Ozden M, Cetinkaya B, Kilic SS. In vitro activity of Brucella melitensis isolates to various antimicrobials in Turkey. Infect Dis (Lond) 2015; 47:364-9. [PMID: 25712728 DOI: 10.3109/00365548.2014.988748] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Brucellosis is a systemic infectious disease caused by Brucella bacteria. A successful treatment requires antibiotics that can penetrate into the cell at high concentrations. The aim of this study was to assess the biotype and in vitro activity of 80 Brucella isolates obtained from blood against various antimicrobials for human brucellosis in Turkey. METHODS Identification of the types of the species designated Brucella species was made using the polymerase chain reaction (PCR), with type-specific primers. Serotyping was performed using mono-specific A and M antisera. The minimum inhibitory concentrations (MICs) of antibiotics known to have good intracellular penetration (doxycycline, rifampicin, ofloxacin, levofloxacin, moxifloxacin, clarithromycin, and azithromycin) were determined by the agar dilution method. RESULTS All of the 80 Brucella isolates were determined to be Brucella melitensis: 75 B. melitensis biotype 3 (93.7%) and 5 B. melitensis biotype 1 (6.3%). Doxycycline was the most effective among the tested antibiotics against Brucella species (MIC(50)-MIC(90), 0.25-0.5 μg/ml), and it was followed by levofloxacin (MIC(50)-MIC(90), 0.5-1 μg/ml), moxifloxacin (MIC(50)-MIC(90), 1-1 μg/ml), ofloxacin (MIC(50)-MIC(90), 1-1 μg/ml), rifampicin (MIC(50)-MIC(90), 2-4 μg/ml), azithromycin (MIC(50)-MIC(90), 4-8 μg/ml), and clarithromycin (MIC(50)-MIC(90), 8-32 μg/ml), respectively. CONCLUSIONS The in vitro activity of doxycycline and rifampicin, which are used in the classic treatment of brucellosis, was found to be very good. Quinolones were found to have in vitro activity against Brucella isolates. Among the macrolides, azithromycin had a higher level of activity compared with clarithromycin. A combination of quinolones and azithromycin could be an alternative to doxycycline and rifampicin in the treatment of brucellosis.
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Affiliation(s)
- Affan Denk
- From the Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Firat University , Elazig , Turkey
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Ting IW, Ho MW, Sung YJ, Tien N, Chi CY, Ho HC, Huang CC. Brucellosis in a renal transplant recipient. Transpl Infect Dis 2013; 15:E191-5. [PMID: 24034171 DOI: 10.1111/tid.12125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/19/2013] [Accepted: 05/27/2013] [Indexed: 11/30/2022]
Abstract
Brucellosis is one of the most common systemic zoonotic diseases transmitted by consumption of unpasteurized dairy products or by occupational contact with infected animals. Brucellosis is rare in renal transplant recipients. Only 3 cases have been reported in the literature. We report a case of brucellosis with hematologic and hepatobiliary complications in a patient 3 years after renal transplantation. The mean time from transplantation to the diagnosis of brucellosis in these 4 reported patients was 5.1 years (range 17 months to 13 years). All patients had fever and constitutional symptoms, and all attained clinical cure after combination antibiotic therapy. Given the small number of patients, further study is needed to identify the characteristics of brucellosis in renal transplant recipients. Drug interactions and acute renal failure developed in our patient during antibiotic treatment. Therefore, we should monitor the levels of immunosuppressive agents frequently. Several studies have shown in vitro susceptibilities of Brucella melitensis to tigecycline. In our patient, fever finally subsided after tigecycline administration. The minimum inhibitory concentration of tigecycline using Etest was 0.094 μg/mL. Tigecycline may be a potential option for treatment of brucellosis in the setting of transplantation.
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Affiliation(s)
- I W Ting
- Kidney Institute, China Medical University Hospital, Taichung, Taiwan; School of Medicine China Medical University, Taichung, Taiwan
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Parlak M, Güdücüoğlu H, Bayram Y, Çıkman A, Aypak C, Kılıç S, Berktaş M. Identification and determination of antibiotic susceptibilities of Brucella strains isolated from patients in van, Turkey by conventional and molecular methods. Int J Med Sci 2013; 10:1406-11. [PMID: 23983603 PMCID: PMC3753419 DOI: 10.7150/ijms.6565] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/13/2013] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In this study, we aimed to identify biovars of Brucella strains isolated from clinical specimens taken from brucellosis patients from the Eastern Anatolia region as well determine the susceptibility of these isolates to tigecycline and azithromycin, drugs that may serve as alternatives to the conventional drugs used in the therapy. MATERIALS AND METHODS Seventy-five Brucella spp. isolates were included in the study. All strains were identified by both conventional and molecular methods. Brucella Multiplex PCR kit (FC-Biotech, Code: 0301, Turkey) and B. melitensis biovar typing PCR kit (FC-Biotech, Code: 0302, Turkey) were used for molecular typing. Antimicrobial susceptibilities of all strains were determined by E-tests. RESULTS By conventional biotyping, 73 strains were identified as B. melitensis biovar 3 and two strains as B. abortus biovar 3. Molecular typing results were compatible with conventional methods. The MIC50 and MIC90 values of doxycycline were 0.047 and 0.094; tigecycline 0.094 and 0.125; trimethoprim/sulfamethoxazole 0.064 and 0.19; ciprofloxacin 0.19 for both; streptomycin 0.75 and 1; rifampin 1 and 2 and azithromycin 4 and 8. According to the MIC values, doxycycline was found to be the most effective antibiotic, followed by tigecycline, trimethoprim-sulfamethoxazole and ciprofloxacin. CONCLUSION Currently recommended antibiotics for the treatment of brucellosis such as doxycycline, rifampin, streptomycin, trimethoprim-sulfamethoxazole and ciprofloxacin were found to be still effective. While our results showed that tigecycline can be used an alternative agent in the treatment of brucellosis, azithromycin has not been confirmed as an appropriate agent for the treatment.
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Affiliation(s)
- Mehmet Parlak
- 1. Microbiology Laboratory, Van Education and Training Hospital, Van, Turkey
| | - Hüseyin Güdücüoğlu
- 2. Department of Medical Microbiology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Yasemin Bayram
- 2. Department of Medical Microbiology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Aytekin Çıkman
- 3. Microbiology Laboratory, Mengucek Gazi Education and Training Hospital, Erzincan, Turkey
| | - Cenk Aypak
- 4. Department of Family Medicine, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Selçuk Kılıç
- 5. Bacterial Zoonoses Research Reference Laboratory, Turkey Public Health Agency, Ankara, Turkey
| | - Mustafa Berktaş
- 2. Department of Medical Microbiology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
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Mile B, Valerija K, Krsto G, Ivan V, Ilir D, Nikola L. Doxycycline-rifampin versus doxycycline-rifampin-gentamicin in treatment of human brucellosis. Trop Doct 2012; 42:13-7. [DOI: 10.1258/td.2011.110284] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This prospective, non-randomized trial, compared the efficacy and tolerance of a doxycycline-rifampin regimen, administered for 45 days, versus doxycycline-rifampin given for 45 days plus gentamicin for the first 7–10 days, in the treatment of human brucellosis. Of 238 patients that were initially included in the study, 181 were finally evaluated. Ninety-four were treated with the doxycycline-rifampin and 87 with the doxycycline-rifampin-gentamicin regimens. In the doxycycline-rifampin group: relapses were noted in 13 (13.8%) patients; therapeutic failures in five (5.3%); and mild adverse effects in 28 (29.8%). In the doxycycline-rifampin-gentamicin group: four (4.6%) relapsed; and five (5.7%) therapeutic failures were registered. Mild adverse effects were registered in 29 (33.3%) patients. The doxycycline-rifampin-gentamicin regimen demonstrated a significantly lower relapse rate compared to the doxycycline-rifampin combination ( P = 0.034). We conclude that adding gentamicin for the first 7–10 days to the standard oral doxycycline-rifampin regimen can decrease the rate of relapses.
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Affiliation(s)
- Bosilkovski Mile
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje
| | - Kirova Valerija
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje
| | - Grozdanovski Krsto
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje
| | - Vidinic Ivan
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje
| | - Demiri Ilir
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje
| | - Labacevski Nikola
- Institute for Clinical Pharmacology, Medical Faculty Skopje, Republic of Macedonia
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10
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Sayan M, Kılıc S, Uyanık MH. Epidemiological survey of rifampicin resistance in clinic isolates of Brucella melitensis obtained from all regions of Turkey. J Infect Chemother 2012; 18:41-6. [DOI: 10.1007/s10156-011-0281-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/26/2011] [Indexed: 11/29/2022]
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Multiple-locus variable-number tandem-repeat analysis genotyping of human Brucella isolates from Turkey. J Clin Microbiol 2011; 49:3276-83. [PMID: 21795514 DOI: 10.1128/jcm.02538-10] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A multiple-locus variable-number tandem-repeat analysis (MLVA) was applied to investigate the epidemiological relationship and genetic diversity among 162 human Brucella isolates collected from all geographic regions of Turkey in an 8-year period (2001 to 2008). The isolates were genotyped by using an MLVA assay developed in Orsay, France (MLVA-16(Orsay)) including eight minisatellite (panel 1) and eight microsatellite (panel 2, subdivided into 2A and 2B) markers. Panels 1 and 2A distinguish 14 genotypes; two of these represented 85% of the strains. Panel 2B displayed a very high discriminatory power. Three loci from panel 2B had diversity index values higher than 0.74. MLVA-16(Orsay) yielded 105 genotypes; 73 were represented by a unique isolate, and 32 included two to eight isolates. The isolates from different patients within the same outbreak or from the same patient before first-line therapy and after relapse showed identical genotypes. A number of MLVA genotypes appeared to be partially restricted to some geographic areas and displayed no annual variation, possibly reflecting persistence of genotypes in certain areas for a time span of at least a decade. This study, representing the first molecular typing results of human Brucella isolates from Turkey, indicated that Turkish human Brucella melitensis isolates were most closely related to the neighboring countries' isolates included in the East Mediterranean group.
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12
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Bayram Y, Korkoca H, Aypak C, Parlak M, Cikman A, Kilic S, Berktas M. Antimicrobial susceptibilities of Brucella isolates from various clinical specimens. Int J Med Sci 2011; 8:198-202. [PMID: 21448305 PMCID: PMC3053491 DOI: 10.7150/ijms.8.198] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 02/23/2011] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In the study we claimed to identify Brucella species from clinical samples of patients with active brucellosis from Van region of Eastern Anatolia and to determine in vitro antimicrobial susceptibilities of these strains to commonly used anti-Brucella agents and a possible new alternative tigecycline. MATERIALS AND METHODS A total of 56 Brucella isolates were enrolled the study and the identification of the isolates were based on conventional methods. In vitro activities of antimicrobials were evaluated by the E test method. RESULTS All isolates were identified as B. melitensis. MIC(90) values of doxycycline, streptomycin, rifampin, trimethoprim-sulfamethoxazole and tigecycline were 0.064 mg/L, 1 mg/L, 2 mg/L, 0.125 mg/L and 0.094 mg/L, respectively. Tigecycline had low MIC(50) and MIC(90) values against all B. melitensis strains; the highest MIC observed was 0.25 μg/mL. CONCLUSION Our data suggest that tigecycline can be a therapeutic alternative option for the treatment of brucellosis.
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Affiliation(s)
- Yasemin Bayram
- 1. Van Education and Research Hospital, Department of Microbiology, 65100 Van, Turkey
| | - Hanifi Korkoca
- 2. Muş Alparslan University, School of Health, Department of Nursing, 49100 Muş, Turkey
| | - Cenk Aypak
- 3. Van Gevaş Hospital, Department of Family Medicine, 65110 Van, Turkey
| | - Mehmet Parlak
- 4. Van 100. Yil University, Department of Microbiology, 65100 Van, Turkey
| | - Aytekin Cikman
- 4. Van 100. Yil University, Department of Microbiology, 65100 Van, Turkey
| | - Selcuk Kilic
- 5. Refik Saydam National Hygiene Center, Department of Communicable Diseases Research, 06100 Ankara, Turkey
| | - Mustafa Berktas
- 4. Van 100. Yil University, Department of Microbiology, 65100 Van, Turkey
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Tanyel E, Coban AY, Fisgin NT, Tulek N. The effect of tigecycline and ertapenem against clinical isolates of Brucella melitensis detected by E-test on different media. Indian J Med Microbiol 2010; 28:370-1. [PMID: 20966572 DOI: 10.4103/0255-0857.71822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In this study, in vitro activity of tigecycline (TIG) and ertapenem (ERT) against clinical isolates of Brucella melitensis and the effect of different media on in vitro test results were investigated. The in vitro effects of TIG and ERT to 38 B. melitensis isolates were comparatively investigated in brucella agar and 5% sheep blood agar. MIC value of ERT was 0.032 μg/mL in 23 of 38 and 20 of 38 isolates on blood and brucella agar, respectively. Minimum inhibitory concentration values of TIG were substantially different ranging between 0.064-0.25 μg/mL on blood agar. However, MIC values of TIG were similar on brucella agar with 0.25 μg/mL in 15 of 38 isolates and 0.5 μg/mL in 10 of 38 isolates. In conclusion, although ERT and TIG were effective against B. melitensis isolates in vitro, further studies are needed in order to determine the use of these novel drugs in treatment of brucellosis.
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Affiliation(s)
- E Tanyel
- Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayis University, Medical School, Samsun, Turkey.
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Cocchi S, Bisi L, Codeluppi M, Venturelli C, Di Benedetto F, Ballarin R, Gerunda GE, Rumpianesi F, Esposito R, Guaraldi G. Brucellosis in a patient with end-stage liver disease undergoing liver transplantation: successful treatment with tigecycline. Liver Transpl 2010; 16:1215-6. [PMID: 20589653 DOI: 10.1002/lt.22104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Efficacy of moxifloxacin or gatifloxacin as prophylaxis against experimental murine Brucella melitensis infection. Int J Antimicrob Agents 2009; 34:471-3. [DOI: 10.1016/j.ijantimicag.2009.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 06/12/2009] [Accepted: 06/15/2009] [Indexed: 11/21/2022]
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Aliskan H, Can F, Demirbilek M, Colakoglu S, Kilic S, Arslan H. Determining in vitro synergistic activities of tigecycline with several other antibiotics against Brucella melitensis using checkerboard and time-kill assays. J Chemother 2009; 21:24-30. [PMID: 19297268 DOI: 10.1179/joc.2009.21.1.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Antimicrobial therapy of Brucella spp. infection is difficult because there are relatively few effective treatment regimens, and single-agent therapy has generally been considered inadequate due to unacceptably high relapse rates. tigecycline, the first in a new class of antimicrobials, the glycylcyclines, is a 9-t-butylglycylamido derivate of minocycline. in this study, the in vitro activity of tigecycline in combination with gentamicin, streptomycin, rifampin, co-trimoxazole, levofloxacin, and minocycline was investigated using the checkerboard method to evaluate 16 Brucella melitensis isolates. The time-kill method was used to determine the bactericidal activities of combinations of tigecycline with rifampin, gentamicin, and levofloxacin, which were found (via the checkerboard method) to have a synergistic effect in combinations with tigecycline. Using the checkerboard method, combinations of rifampin, gentamicin, and levofloxacin with tigecycline showed synergistic effects against 5 (31.2%), 3 (18.9%), and 8 (50%) of the isolates. No synergy was observed with tigecycline in combination with minocycline, streptomycin, or co-trimoxazole. tigecycline with gentamicin achieved the earliest complete killing at 4x miC (in 6 h), while complete killing with the other combinations was delayed up to 24 h. the time-kill method showed that the combination of tigecycline and levofloxacin had an antagonistic effect, while the checkerboard method detected synergy and no interaction effects. these data suggest that a combination regimen of tigecycline with gentamicin and rifampin may be a good choice for treating brucellosis.
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Affiliation(s)
- H Aliskan
- Department of Microbiology and Clinical Microbiology, Baskent University Faculty of Medicine, Ankara, Turkey
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