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Fuochi V, Furnari S, Trovato L, Calvo M, Furneri PM. Therapies in preclinical and in early clinical development for the treatment of urinary tract infections: from pathogens to therapies. Expert Opin Investig Drugs 2024; 33:677-698. [PMID: 38700945 DOI: 10.1080/13543784.2024.2351509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/01/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Urinary tract infections (UTIs) are a prevalent health challenge characterized by the invasion and multiplication of microorganisms in the urinary system. The continuous exploration of novel therapeutic interventions is imperative. Advances in research offer hope for revolutionizing the management of UTIs and improving the overall health outcomes for individuals affected by these infections. AREAS COVERED This review aimed to provide an overview of existing treatments for UTIs, highlighting their strengths and limitations. Moreover, we explored and analyzed the latest therapeutic modalities under clinical development. Finally, the review offered a picture into the potential implications of these therapies on the future landscape of UTIs treatment, discussing possible advancements and challenges for further research. EXPERT OPINION Comprehensions into the pathogenesis of UTIs have been gleaned from foundational basic science studies, laying the groundwork for the exploration of novel therapeutic interventions. The primary source of evidence originates predominantly from animal studies conducted on murine models. Nevertheless, the lack of clinical trials interferes the acquisition of robust evidence in humans. The challenges presented by the heterogeneity and virulence of uropathogens add an additional layer of complexity, posing an obstacle that scientists and clinicians are actively grappling with in their pursuit of effective solutions.
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Affiliation(s)
- Virginia Fuochi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Salvatore Furnari
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Laura Trovato
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Maddalena Calvo
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Pio Maria Furneri
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Rizvi M, Malhotra S, Agarwal J, Siddiqui AH, Devi S, Poojary A, Thakuria B, Princess I, Sami H, Gupta A, Sultan A, Jitendranath A, Mohan B, Banashankari GS, Khan F, Kalita JB, Jain M, Singh NP, Gur R, Mohapatra S, Farooq S, Purwar S, Jankhwala MS, Yamunadevi VR, Masters K, Goyal N, Sen M, Zadjali RA, Jaju S, Rugma R, Meena S, Dutta S, Langford B, Brown KA, Dougherty KM, Kanungo R, Jabri ZA, Singh S, Singh S, Taneja N, John KHS, Sardana R, Kapoor P, Jardani AA, Soman R, Balkhair A, Livermore DM. Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: Findings of a multicentric study highlighting the importance of local antibiograms. IJID REGIONS 2024; 11:100370. [PMID: 38812702 PMCID: PMC11134879 DOI: 10.1016/j.ijregi.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
Objectives Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (https://dashuti.com/) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers. Methods These centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed. Results Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices. Conclusions Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.
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Affiliation(s)
- Meher Rizvi
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Shalini Malhotra
- Department of Microbiology, ABVIMS and Dr RML Hospital, New Delhi, India
| | - Jyotsna Agarwal
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | | | - Sheela Devi
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Aruna Poojary
- Department of Pathology & Microbiology, Breach Candy Hospital Trust, Mumbai, India
| | - Bhaskar Thakuria
- Department of Microbiology, All India Institute of Medical Sciences Patna, Patna, India
| | | | - Hiba Sami
- Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India
| | - Aarti Gupta
- Agilus Diagnostics Limited, Fortis Memorial Research Institute, Gurugram, India
| | - Asfia Sultan
- Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India
| | - Ashish Jitendranath
- Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, India
| | - Balvinder Mohan
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Fatima Khan
- Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India
| | | | - Mannu Jain
- Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
| | - Narendra Pal Singh
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Renu Gur
- Department of Microbiology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, India
| | - Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shaika Farooq
- Department of Microbiology, GMC Srinagar, Srinagar, India
| | - Shashank Purwar
- Department of Microbiology, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Mohmed Soeb Jankhwala
- Department of Microbiology, Nootan Medical College and Research Centre, Sankalchand Patel University, Visnagar, India
| | | | - Ken Masters
- Medical Education and Informatics Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Nisha Goyal
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Manodeep Sen
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Razan Al Zadjali
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjay Jaju
- Family Medicine & Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Rajendradas Rugma
- Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Kerala, India
| | - Suneeta Meena
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sudip Dutta
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Reba Kanungo
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Zaaima Al Jabri
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjeev Singh
- Department of Medicine- Infection Diseases and Epidemiology, Amrita Institute of Medical Sciences, Faridabad, India
| | - Sarman Singh
- All India Institute of Medical Sciences, Bhopal, India
| | - Neelam Taneja
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Raman Sardana
- Clinical Microbiology and Infection Control, Indraprastha Apollo Hospitals, New Delhi, India
- The IFIC, Oxford, UK
- Hospital Infection Society-India, New Delhi, India
| | - Pawan Kapoor
- National Accreditation Board for Hospitals and Healthcare Providers, New Delhi, India
| | - Amina Al Jardani
- Central Public Health Laboratories, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | | | - Abdullah Balkhair
- Infectious Diseases Unit, Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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Nasrollahian S, Graham JP, Halaji M. A review of the mechanisms that confer antibiotic resistance in pathotypes of E. coli. Front Cell Infect Microbiol 2024; 14:1387497. [PMID: 38638826 PMCID: PMC11024256 DOI: 10.3389/fcimb.2024.1387497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
The dissemination of antibiotic resistance in Escherichia coli poses a significant threat to public health worldwide. This review provides a comprehensive update on the diverse mechanisms employed by E. coli in developing resistance to antibiotics. We primarily focus on pathotypes of E. coli (e.g., uropathogenic E. coli) and investigate the genetic determinants and molecular pathways that confer resistance, shedding light on both well-characterized and recently discovered mechanisms. The most prevalent mechanism continues to be the acquisition of resistance genes through horizontal gene transfer, facilitated by mobile genetic elements such as plasmids and transposons. We discuss the role of extended-spectrum β-lactamases (ESBLs) and carbapenemases in conferring resistance to β-lactam antibiotics, which remain vital in clinical practice. The review covers the key resistant mechanisms, including: 1) Efflux pumps and porin mutations that mediate resistance to a broad spectrum of antibiotics, including fluoroquinolones and aminoglycosides; 2) adaptive strategies employed by E. coli, including biofilm formation, persister cell formation, and the activation of stress response systems, to withstand antibiotic pressure; and 3) the role of regulatory systems in coordinating resistance mechanisms, providing insights into potential targets for therapeutic interventions. Understanding the intricate network of antibiotic resistance mechanisms in E. coli is crucial for the development of effective strategies to combat this growing public health crisis. By clarifying these mechanisms, we aim to pave the way for the design of innovative therapeutic approaches and the implementation of prudent antibiotic stewardship practices to preserve the efficacy of current antibiotics and ensure a sustainable future for healthcare.
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Affiliation(s)
- Sina Nasrollahian
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jay P. Graham
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, CA, United States
| | - Mehrdad Halaji
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Medical Microbiology and Biotechnology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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Ribeiro VST, Bail L, Ito CAS, de Andrade AP, Arend LNVS, Suss PH, Nogueira KDS, Walflor HSM, Faoro H, Kuczera LCSDM, Vicenzi FJ, Tuon FF. In vitro susceptibility to fosfomycin in clinical and environmental extended-spectrum beta-lactamase producing and/or ciprofloxacin-non-susceptible Escherichia coli isolates. Rev Inst Med Trop Sao Paulo 2024; 66:e5. [PMID: 38324871 PMCID: PMC10846478 DOI: 10.1590/s1678-9946202466005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/06/2023] [Indexed: 02/09/2024] Open
Abstract
Extended-spectrum beta-lactamase producing and ciprofloxacin-non-susceptible Escherichia coli are clinical and environmental issues. We evaluated the susceptibility profile of fosfomycin in non-susceptible E. coli isolated from urine and the environment. We measured the activity of fosfomycin against 319 and 36 E. coli strains from urine and environmental isolates, respectively, collected from rivers. Fosfomycin resistance profiles were investigated using the minimal inhibitory concentration (MIC), according to the Clinical and Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST) guidelines. Antibiotic susceptibility testing revealed that 5% and 6.6% of urine samples were non-susceptible to fosfomycin according to CLSI and EUCAST guidelines, respectively. The fosfomycin MIC50/90 was 0.5/4 mg/L. Of the 36 E. coli isolates from river water, 11.1% and 13,8% were non-susceptible to fosfomycin according to CLSI and EUCAST, respectively (range ≤0.25 ≥512 mg/L). All the isolates with MIC ≥512 mg/L for fosfomycin showed the fosA3 gene. Fosfomycin resistance was more frequent in the environment than in clinical samples.
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Affiliation(s)
- Victoria Stadler Tasca Ribeiro
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas Emergentes, Curitiba, Paraná, Brazil
| | - Larissa Bail
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas Emergentes, Curitiba, Paraná, Brazil
- Universidade Estadual de Ponta Grossa do Paraná, Divisão de Microbiologia, Ponta Grossa, Paraná, Brazil
| | - Carmen Antonia Sanches Ito
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas Emergentes, Curitiba, Paraná, Brazil
- Universidade Estadual de Ponta Grossa do Paraná, Divisão de Microbiologia, Ponta Grossa, Paraná, Brazil
| | - Ana Paula de Andrade
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas Emergentes, Curitiba, Paraná, Brazil
| | - Lavinia Nery Villa Stangler Arend
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas Emergentes, Curitiba, Paraná, Brazil
- Laboratório Central do Estado do Paraná, São José dos Pinhais, Paraná, Brazil
| | - Paula Hansen Suss
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas Emergentes, Curitiba, Paraná, Brazil
| | | | | | - Helisson Faoro
- Fiocruz Paraná, Instituto Carlos Chagas, Laboratório de Biologia Celular, Curitiba, Paraná, Brazil
| | | | | | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas Emergentes, Curitiba, Paraná, Brazil
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