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Ngoi ST, Muhamad AN, Teh CSJ, Chong CW, Abdul Jabar K, Chai LC, Leong KC, Tee LH, AbuBakar S. β-Lactam Resistance in Upper Respiratory Tract Pathogens Isolated from a Tertiary Hospital in Malaysia. Pathogens 2021; 10:pathogens10121602. [PMID: 34959557 PMCID: PMC8705930 DOI: 10.3390/pathogens10121602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
The rise of antimicrobial resistance (AMR) among clinically important bacteria, including respiratory pathogens, is a growing concern for public health worldwide. Common causative bacteria for upper respiratory tract infections (URTIs) include Streptococcus pneumoniae and Haemophilus influenzae, and sometimes Staphylococcus aureus. We assessed the β-lactam resistant trends and mechanisms of 150 URTI strains isolated in a tertiary care hospital in Kuala Lumpur Malaysia. High rates of non-susceptibility to penicillin G (38%), amoxicillin-clavulanate (48%), imipenem (60%), and meropenem (56%) were observed in S. pneumoniae. Frequent mutations at STMK and SRNVP motifs in PBP1a (41%), SSNT motif in PBP2b (32%), and STMK and LKSG motifs in PBP2x (41%) were observed in S. pneumoniae. H. influenzae remained highly susceptible to most β-lactams, except for ampicillin. Approximately half of the ampicillin non-susceptible H. influenzae harboured PBP3 mutations (56%) and only blaTEM was detected in the ampicillin-resistant strains (47%). Methicillin-susceptible S. aureus (MSSA) strains were mostly resistant to penicillin G (92%), with at least two-fold higher median minimum inhibitory concentrations (MIC) for all penicillin antibiotics (except ticarcillin) compared to S. pneumoniae and H. influenzae. Almost all URTI strains (88-100%) were susceptible to cefcapene and flomoxef. Overall, β-lactam antibiotics except penicillins remained largely effective against URTI pathogens in this region.
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Affiliation(s)
- Soo Tein Ngoi
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.T.N.); (A.N.M.); (K.A.J.); (S.A.)
| | - Anis Najwa Muhamad
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.T.N.); (A.N.M.); (K.A.J.); (S.A.)
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.T.N.); (A.N.M.); (K.A.J.); (S.A.)
- Correspondence: ; Tel.: +603-79676674
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia;
| | - Kartini Abdul Jabar
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.T.N.); (A.N.M.); (K.A.J.); (S.A.)
| | - Lay Ching Chai
- Faculty of Science, Institute of Biological Sciences, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Kin Chong Leong
- Shionogi Singapore Pte Ltd., Anson Road, #34-14 International Plaza, Singapore 079903, Singapore; (K.C.L.); (L.H.T.)
| | - Loong Hua Tee
- Shionogi Singapore Pte Ltd., Anson Road, #34-14 International Plaza, Singapore 079903, Singapore; (K.C.L.); (L.H.T.)
| | - Sazaly AbuBakar
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (S.T.N.); (A.N.M.); (K.A.J.); (S.A.)
- Tropical Infectious Diseases Research and Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia
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Hughes DL. Patent Review of Manufacturing Routes to Fifth-Generation Cephalosporin Drugs. Part 1, Ceftolozane. Org Process Res Dev 2017. [DOI: 10.1021/acs.oprd.7b00033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David L. Hughes
- Cidara Therapeutics, Inc., 6310 Nancy Ridge Dr., Suite 101, San Diego, California 92121, United States
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Abstract
β-Lactams are the most widely used class of antibiotics. Since the discovery of benzylpenicillin in the 1920s, thousands of new penicillin derivatives and related β-lactam classes of cephalosporins, cephamycins, monobactams, and carbapenems have been discovered. Each new class of β-lactam has been developed either to increase the spectrum of activity to include additional bacterial species or to address specific resistance mechanisms that have arisen in the targeted bacterial population. Resistance to β-lactams is primarily because of bacterially produced β-lactamase enzymes that hydrolyze the β-lactam ring, thereby inactivating the drug. The newest effort to circumvent resistance is the development of novel broad-spectrum β-lactamase inhibitors that work against many problematic β-lactamases, including cephalosporinases and serine-based carbapenemases, which severely limit therapeutic options. This work provides a comprehensive overview of β-lactam antibiotics that are currently in use, as well as a look ahead to several new compounds that are in the development pipeline.
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Affiliation(s)
- Karen Bush
- Molecular and Cellular Biochemistry, Indiana University, Bloomington, Indiana 47405
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Bryskier A. Perfecting the ring and extending the antibacterial spectrum: 'the multiple generations'. Clin Microbiol Infect 2001; 6 Suppl 3:13-21. [PMID: 11449642 DOI: 10.1111/j.1469-0691.2000.tb02035.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Bryskier
- Clinical Pharmacology of Anti-infectives, Hoechst Marion Roussel, 102, route de Noisy, 93235 Romainville, France
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Abstract
The first very effective bactericidal anti-anaerobic drug was metronidazole, introduced in clinical practice in the early 1980s. Sometimes penicillin G and chloramphenicol were used successfully in some anaerobic infections. However, this result was most likely due to Gram-positive anaerobic infections (e.g., Clostridium perfringens). Very rapidly, the anti-anaerobic armamentarium was extended with clindamycin, cefoxitin, imipenem and co-amoxyclav or piperacillin-tazobactam. The resistance rate to metronidazole and imipenem remains low but clindamycin has seen an importance decrease in bacterial susceptibility. New additional drugs could be very helpful to overcome resistance and adverse events. The novelties in this field are fluoroquinolones, which exhibit a good activity against Gram-positive cocci and anaerobes.
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Affiliation(s)
- A Bryskier
- Aventis Pharma, Infectious Disease Group, Clinical Pharmacology, 102, Route de Noisy, 93235, Romainville, Cedex, France.
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Strehl E, Kees F. Pharmacological properties of parenteral cephalosporins: rationale for ambulatory use. Drugs 2000; 59 Suppl 3:9-18; discussion 47-9. [PMID: 10845409 DOI: 10.2165/00003495-200059003-00002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Parenteral cephalosporins are among the most frequently used antibiotics in hospital therapy. They are characterised by an extended spectrum of activity against gram-positive and gram-negative bacteria, and some also have good activity against anaerobes. They kill proliferating bacterial cells rapidly, and generally show only a low tendency to select resistant mutants. However, there are cephalosporin compounds which induce cephalosporinases very rapidly in certain microorganisms. Together with other beta-lactam antibiotics, parenteral cephalosporins interfere with bacterial cell wall synthesis by inhibiting peptidoglycan cross-linkage. Because of this specific target, they are nontoxic to mammalian cells, and have a very favourable adverse effect profile. The chemical stability of parenteral cephalosporins in aqueous solution is good. After intravenous injection, high concentrations of these agents are achieved in serum and tissue. Most cephalosporins are eliminated unchanged via the kidney, with a half-life of 1 to 2 hours. But there are also derivatives with a serum half-life of more than 2 and up to 8 hours, allowing 12- or 24-hour dosage intervals. Because of their reliable efficacy and low risk of adverse effects, the parenteral cephalosporins offer a high degree of tolerability even in the setting of outpatient antibiotic therapy. In particular, the derivatives of the third generation are characterised by unique pharmacological properties.
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Affiliation(s)
- E Strehl
- Clinical Pharmacy, Hospital of the Albert-Ludwigs-University of Freiburg/Br., Freiburg, Germany
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Wolff M. Comparison of strategies using cefpirome and ceftazidime for empiric treatment of pneumonia in intensive care patients. The Cefpirome Pneumonia Study Group. Antimicrob Agents Chemother 1998; 42:28-36. [PMID: 9449256 PMCID: PMC105451 DOI: 10.1128/aac.42.1.28] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/1997] [Accepted: 10/17/1997] [Indexed: 02/05/2023] Open
Abstract
In an international, multicenter, open-label, randomized comparative study, adult patients in intensive care units were enrolled to receive cefpirome intravenously at 2 g twice daily or ceftazidime intravenously at 2 g three times daily for the empiric treatment of pneumonia. Randomization was performed after a double stratification according to the investigator's initial choice of monotherapy or combination therapy and then on the basis of the severity of disease. The primary endpoint was the clinical response at the end of treatment in the intent-to-treat population. Data for all patients were reviewed by a blinded observer. Of the 400 enrolled patients, 201 received cefpirome (monotherapy, 56%) and 199 received ceftazidime (monotherapy, 51%). Pneumonia was hospital acquired for 75% of the patients. Clinical failures rates were 34 versus 36% (odds ratio = 0.922; upper bound of 90% confidence interval = 1.301) in the intent-to-treat analysis for cefpirome and ceftazidime, respectively. For the cefpirome and ceftazidime groups, there were 35 versus 30% clinical failures among monotherapy-stratified patients, respectively, and 34 versus 42% clinical failures among combination therapy-stratified patients, respectively. The rates of clinical failures in the per-protocol analysis were 38 and 42%, respectively. In the population of patients evaluable for bacteriologic efficacy, eradication or presumed eradication was obtained for 71% (172 of 241) and 70% (162 of 230) of the pathogens isolated from the patients receiving cefpirome and ceftazidime, respectively. The mortality rates within 2 weeks after the end of treatment were similar (cefpirome group, 31%; ceftazidime group, 26%), as were the percentages of patients with at least one treatment-related adverse event (17 and 19%, respectively). An empiric treatment strategy with cefpirome at 2 g twice daily is equivalent in terms of efficacy and tolerance to ceftazidime at 2 g three times daily for the treatment of pneumonia in patients in intensive care units.
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Affiliation(s)
- M Wolff
- Hôpital Bichat-Claude Bernard, Paris, France.
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Erwin ME, Varnam D, Jones RN. In vitro antimicrobial activity of RU-59863, a C-7 catechol substituted cephalosporin. Diagn Microbiol Infect Dis 1997; 28:93-100. [PMID: 9239501 DOI: 10.1016/s0732-8893(97)00004-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The in vitro activity of RU-59863, a so-called "fifth generation" catechol cephalosporin, was evaluated against 606 bacterial isolates and compared with the activities of cefotaxime, ceftazidime, cefepime, and cefpirome. RU-59863 demonstrated a broad spectrum of inhibition and superior overall activity than comparators when tested against Enterobacteriaciae (MIC90s, 0.015 to 2 micrograms/ml), Pseudomonas aeruginosa (MIC90, 0.5 microgram/ml), Stenotrophomonas maltophilia (MIC90, 0.25 microgram/ml), Acinetobacter ssp. (MIC90, 4 micrograms/ml), and oxacillin-susceptible Staphylococcus ssp. (MIC90s, 0.5 to 8 micrograms/ml). Potent RU-59863 activity was also observed against beta-haemolytic and viridans gr. streptococci (MIC90s, 0.12-0.5 microgram/ml), Streptococcus pneumoniae (MIC90s, 0.03 to 0.5 microgram/ml), Haemophilus influenzae (MIC90, 0.06 microgram/ml), and Neisseria gonorrhoeae (MIC90, 0.06 micrograms/ml). RU-59863 demonstrated marginal potency against Enterococcus faecalis (MICs 2 to 16 micrograms/ml) and was inactive against Enterococcus faecium (MIC90, > 128 micrograms/ml). Oxacillin-resistant staphylococci were not inhibited by RU-59863 (MIC90s, 32 to 128 micrograms/ml). Among the cephalosporins tested, RU-59863 performed best versus ceftazidime-resistant Bush group 1 isolates and strains producing extended spectrum beta-lactamases. RU-59863 was also effective against many fluoroquinolone-, aminoglycoside-, and imipenem-resistant isolates. RU-59863 seems to be a significant advance in cephalosporin chemistry and activity, especially against Gram-negative pathogens resistant to current beta-lactam therapeutic agents. Further studies of human pharmacokinetics and against clinical infections are encouraged.
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Affiliation(s)
- M E Erwin
- Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA
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Garau J, Wilson W, Wood M, Carlet J. Fourth-generation cephalosporins: a review of in vitro activity, pharmacokinetics, pharmacodynamics and clinical utility. Clin Microbiol Infect 1997. [DOI: 10.1111/j.1469-0691.1997.tb00649.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bryskier A. New concepts in the field of cephalosporins: C-3' quaternary ammonium cephems (Group IV). Clin Microbiol Infect 1997. [DOI: 10.1111/j.1469-0691.1997.tb00642.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Glauser M, Boogaerts M, Cordonnier C, Palmblad J, Martino P. Empiric therapy of bacterial infections in severe neutropenia. Clin Microbiol Infect 1997. [DOI: 10.1111/j.1469-0691.1997.tb00648.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jones RN, Baquero F, Privitera G, Inoue M, Wiedemann B. Inducible β-lactamase-mediated resistance to third-generation cephalosporins. Clin Microbiol Infect 1997. [DOI: 10.1111/j.1469-0691.1997.tb00643.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bryskier A. Novelties in the field of parenteral cephem antibacterials since 1993. Expert Opin Investig Drugs 1997; 6:305-20. [PMID: 15989630 DOI: 10.1517/13543784.6.3.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is still considerable interest in cephem antibacterial agents. In fact, there are a significant number of patents submitted for this antibacterial class. All the new cephem derivatives, independent of which group they belong to (III to V), possess a 2-amino-5-thiazolyl or a 5-amino-2-thiadiazolyl ring with an oxime group (at position 7 of the cephem nucleus). At position 3, they have a C-3' quaternary ammonium moiety. Research has focused on the following structural modifications: the nature of the oxime residues and the charged azolium heterocycle, and the addition of the vinylogous chain. The aim of researchers is to increase the overall activity of these compounds against Gram-negative bacilli, including against isolates producing type 1 beta-lactamases or extended spectrum beta-lactamases (Enterobacteriaceae). Non-fermentative Gram-negative bacilli are now included in the first screening process, in addition to Pseudomonas aeruginosa. Extensive research is ongoing with the aim of solving the MRSA problem. New promising entities have been reported.
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Affiliation(s)
- A Bryskier
- Hoechst Marion Roussel, Department of Clinical Pharmacology of Anti-Infectives, Romainville, France
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Bryskier A. C-3prime prime or minute Quaternary Ammonium Cephems, a New Wave of Cephalosporins. Clin Microbiol Infect 1995; 1:1-3. [PMID: 11866712 DOI: 10.1111/j.1469-0691.1995.tb00015.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- André Bryskier
- Roussel-Uclaf, Domaine anti-infectieux, Pharmacologie Clinique, 102, route de Noisy, F-92230 Romainville, France. Tel: 33 1 49 91 51 21 Fax: 33 1 49 91 50 20
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